It is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the 2nd to 6th day after birth. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing, and flattening of the nipple. Engorgement sometimes also causes a low-grade fever and can be confused with a breast infection.
Engorgement is the result of the milk building up, and usually happens during the third to fifth day after birth. This slows circulation, and when blood and lymph move through the breasts, fluid from the blood vessels can seep into the breast tissues.
All of the following can cause engorgement:
- poor latch-on or positioning
- trying to limit feeding times or infrequent feedings
- giving supplementary bottles of water, juice, formula, or breast milk
- overusing a pacifier
- changing the breastfeeding schedule to return to work or school
- baby changing the breastfeeding pattern by beginning to sleep through the night or breastfeed more often during one part of the day and less often at other times
- having a baby that has a weak suck who is not able to breastfeed effectively
- fatigue, stress, or anemia in the mother
- an overabundant milk supply
- nipple damage
- breast abnormalities
Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. If treated properly, engorgement should only usually last for one to two days
- Minimize engorgement by making sure the baby has a good latch and is feeding effectively. Breastfeed frequently after birth. Allow the baby to feed as long as he or she likes, as long as he or she is latched on well and sucking effectively. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the last feeding. Breastfeeding often on the affected side helps to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.
- Avoid supplementary bottles and overusing pacifiers.
- Try hand expressing or pumping a little milk to first soften the breast, areola, and nipple before breastfeeding, or massage the breast and apply heat (only use heat if the breasts are leaking freely, otherwise it may worsen the swelling).
- Cold compresses in between feedings can help ease pain. Some women use cabbage leaves to soothe engorgement. Although their effectiveness has not been proven, many women find them soothing. You can use either refrigerated or room temperature leaves. Make sure to cut a hole for your nipple, apply the leaves directly to your breasts, and wear them inside your bra. Remove them when they wilt and replace with fresh leaves.
- If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home.
- Get enough rest and proper nutrition and fluids.
- Wear a well-fitting, supportive bra that is not too tight.
Ask for help if the engorgement last for two days or more.