Clinical Reference Systems: Pediatric Advisor 10.0
Postpartum Breast Engorgement
What is postpartum breast engorgement?
Usually on the second to fifth day after you have your baby,
you will notice changes in your breasts. They will become
larger, somewhat firm, and slightly tender as they begin to
produce large amounts of milk. This is called postpartum
Engorgement is a normal process. However, breast swelling
with engorgement may make it difficult for your baby to
get milk because:
- Your baby may not be able to latch on correctly and
your nipple may become sore.
- Not releasing the pressure in your breast can cause you
to make less milk or to even stop producing milk.
Knowing how to manage engorgement will help you avoid these
What is the cause?
Postpartum breast engorgement is caused by the hormone
changes in your body after delivery. The changes in
hormones cause your breasts to start making a lot of milk.
Extra blood flowing to the breasts add to the engorgement.
How long will it last?
Engorgement usually lasts just a few days until your body
gets used to making and releasing milk. The swelling of your
breasts makes it seem like you are making more milk than
your baby needs. However, getting milk to flow is really
the problem with engorgement, rather than making too
Once your baby is nursing well and your milk is flowing
easily, there will be less swelling and firmness. Within a
few days, your breasts adjust to your baby's appetite. Then
you will then most likely produce as much milk as your baby
takes from your breasts. By the end of the first week after
delivery, your breasts will have adjusted and will be much
How can I take care of myself?
Nursing frequently day and night helps reduce breast
engorgement. Plan to nurse your baby at least every 2
to 3 hours. Feeding less often is OK at night, but
don't allow more than one period of 5 hours to pass
between feedings each night. Aim to feed your baby 8 to
12 times every 24 hours. Your newborn should nurse
vigorously at least 10 minutes at each breast.
- Managing fullness and discomfort
Support your breast with your hand and, if necessary,
gently squeeze your thumb and index finger together to
help make your nipple and areola (the colored area
around the nipple) easier to grasp. Lightly tickle your
baby's lips with your nipple and wait until your baby's
mouth opens wide. Then quickly pull her to your breast
so she grasps both your nipple and as much areola as
possible (at least 1 inch).
Warm your breast just before nursing. Heat improves
blood flow and helps your milk let-down. Thus, a warm
shower or warm washcloth on the breasts just before
feeding may help relieve engorgement.
Gently massage and press on the firmer areas of your
breast while your baby nurses to help empty and soften
Put cool washcloths on your breasts between feedings to
help relieve discomfort and reduce swelling.
Some breast-feeding experts recommend using cool
cabbage leaves to treat uncomfortable breast
engorgement. Many women who have tried cabbage leaves
claim the treatment brings relief from discomfort and
improves milk flow. (Cabbage has been used for
centuries as a folk remedy for a wide variety of
ailments.) Whether improvement results from the cool
wraps or from a specific property in cabbage is not
known. Here is how you can use cabbage leaves for
- Put thoroughly washed and dried, crisp, cold, green
cabbage leaves over your engorged breasts. You can
wear the leaves inside your bra or use them as
compresses covered by a cool towel. You can cut
holes in the leaves, if necessary, to allow the
nipples to stay dry.
- Leave the cabbage leaves in place for about 20 to 30
minutes or until they have wilted. Usually only one
or two applications of the leaves are needed to
soften the breasts and establish good milk flow.
Longer periods of time have been used by women who
are trying to dry up their milk.
- Milk expression during engorgement
Many women are afraid to pump or express milk while they
are engorged because they think it will cause them to
make even more milk. However, engorgement is really a
problem of poor milk flow, rather too much milk.
If your breasts are so full that it's hard for your baby
to latch on correctly, you may want to pump or hand-
express some milk before the feeding. Express enough
to soften the nipple and areola so your baby can better
grasp your nipple and about 1 inch of the surrounding
If your breasts are still uncomfortably full after
feeding your baby, pump for a few minutes until your
breasts are softer and your milk is flowing better.
Reduce the firmness enough to relieve discomfort and
produce obvious softening. Encourage your baby to nurse
frequently to relieve breast fullness. Soon your baby
will probably empty your breasts well at each feeding
and you will no longer need to pump excess milk.
Your baby's doctor can tell you if you need to feed your
baby any expressed milk. If it is not necessary, the
milk you express can be frozen for future use.
- Unrelieved engorgement
Unrelieved engorgement is considered to be a breast-
feeding emergency because residual milk and sustained
pressure on the milk-producing glands can rapidly
decrease your milk supply. Thus, if your breasts are so
full that your baby cannot latch on or if your baby is
not nursing well after your milk has come in abundantly,
you will need to get help with breast-feeding and
perhaps rent an electric breast pump. Use the pump to
express your milk at regular feeding times. Pumping
your breasts will allow you to relieve uncomfortable
fullness and to keep producing abundant milk. The
pumped milk can be fed to your baby until he or she
learns to breast-feed well. Your baby's doctor can
refer you to a lactation consultant to assist with
To find where you can rent a pump, call Ameda/Egnell at
1-800-323-4060; Medela, Inc., at 1-800-TELL-YOU
(1-800-835-5968); or White River at 1-800-342-3906.