Clinical Reference Systems: Pediatric Advisor 10.0

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 breast engorgement.

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 problems.

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 much milk.

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 less engorged.

How can I take care of myself?

1. Prevention

   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.

2. 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 these areas.

   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 engorgement:

   • 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.

3. 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 areola.

   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.

4. 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 breast-feeding technique.

   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.