Engorgement

Cause:
Milk production begins 1-5 days after delivery, depending upon which baby this is for the mother. The fluids necessary for milk production are carried to the breast through the blood and lymph system. This increased supply of fluid collects in the breast tissue causing the breast to swell. Early, frequently feedings will relieve the swelling and soften the breasts. When feedings are infrequent, delayed or missed, engorgement occurs. The breasts may be swollen, hard and painful.

Recommended Treatment:

• Put ice packs on the breasts between feedings. Bags of frozen peas wrapped in a wet washcloth work well.*
• Hand express or pump a small amount of milk or colostrum to soften the breast and position the baby correctly. A warm shower or tub bath or soaking the breasts in a pan of warm water may make milk expression easier.
• Breastfeed every 1 1/2-3 hours during the day and every 2-3 hours at night. To increase the flow of milk, gently massage the breast in a circular pattern while the baby is nursing, using the flat part of your hand. If your breasts are still full, hand express or pump to relieve fullness.
• Wear a bra for comfort and support. Avoid bras that are too tight or bind, making it difficult to relieve fullness and soften the breasts. Avoid bras with underwires.
• Do not use a nipple shield. It decreases nipple stimulation, milk production and milk release.

To Prevent Engorgement:

• Breastfeed as soon as possible after birth.
• Breastfeed every 1 1/2-3 hours during the day and every 2-3 hours at night.
• Breastfeed as long as the baby wishes on the first breast before offering the second breast.
• Offer both breasts at every feeding.
• Begin each feeding on the breast offered last.
• If you delay or miss a feeding or the baby nurses poorly, hand express or pump to relieve fullness.

* Some women choose to use cold, raw, cabbage leaves on the breasts after each feeding to relieve engorgement. Why cabbage leaves relieve engorgement is unclear. There may be a substance in the leaves which decreases swelling or it may be the temperature of the leaves. Rinse the leaves well in cold water before use. Place the leaves on the breasts with the nipples exposed until the leaves wilt (15-20 minutes).