How to Treat Engorged Breasts

mother holding small baby in her lap

Ladies (and gents), engorgement is the real deal. I thought my breasts had gotten big while I was pregnant. They grew as my stomach did. I never realized that it was possible that they could get bigger.

Like a lot bigger.

In the first few days after delivering your newborn, your breasts produce a small amount of colostrum. Your baby nurses frequently, swallowing small amounts of this golden colored fluid each a session. There’s no “milk” in those first few days.

Then your milk arrives.

They were so big and heavy that I felt like I had to hold them up in the shower. My luscious cleavage exploded out of the top of all of my bras, tank tops, and nursing shirts. It was extraordinary.

It was also really uncomfortable.

What is breast engorgement?

When your milk “comes in” your breasts produce much, much more than your baby can initially consume. You might hear this time called “first week engorgement.”

The result is that your breasts become “engorged.” Engorgement is caused by the increased blood flow to the breast tissue and the start of milk production. First week engorgement is not caused by letting your infant nurse too much or too little. This is just part of the process. It is actually a great sign that you are doing a great job nursing your new infant. It can be really hard to tell whether your infant is getting anything during her time at the breast. Arrival of your milk like this is a sign that she has been nursing well. Pat yourself on the back.

Some women experience engorgement as the massive swelling of the breasts. Others may experience tenderness only, without swelling. Some women’s breasts become lumpy. The swelling may extend across the chest and under the armpit.

How do I make breast engorgement stop?

The key to working through first week engorgement is letting your baby nurse regularly. If you express milk regularly, your body eventually adjusts to produce just enough milk for your infant, and not too much more.

If you stop nursing during this time, milk production declines and may stop altogether. Remember, this is the time where the body takes cues from the nursing baby. If you nurse your baby through engorgement, the body will produce what she needs. When you don’t nurse, your breasts produce what your breasts thinks she needs (which is nothing).

If you nurse your baby and THEN pump any remaining milk out, you signal to your breasts that you need MORE milk than your baby is consuming. In this case, you may struggle with “over-supply” as long as you continue to pump.

Engorgement makes it hard for my baby to nurse

If your breasts are really swollen, the nipple make change shape. It may actually expand dramatically, or flatten. Your breast might actually seem larger than the entire child trying to nurse on it.

Seriously.

This is a key time to stick to your nursing schedule. If baby struggles to latch, be wary of supplementing with formula at this time. Supplementing with formula is a signal to your breasts that milk is not needed.

If your nipple is completely flat because of the swelling of your breast (and baby can’t get a hold of it), try gently pinching the skin of the nipple between your thumb and forefinger so that it protrudes enough for baby to suck it into her mouth. Another option would be to stimulate the nipple until milk starts to flow and then offer the nipple area to baby. This will help her get on there.

How long does engorgement last?

In most cases, if mothers nurse through engorgement, it should pass within 24-72 hours.

How do I relieve the pain in my breasts while waiting for engorgement to pass?

Here’s some suggestions for how to treat engorged breasts:

  • Wear supportive clothing that is comfortable but not restrictive
  • Nurse frequently, every one to three hours, even at night, even if you have to wake the baby up
  • Encourage the baby to nurse for at least 10 minutes a side
  • Switch from breast to breast if baby is only hungry enough to take one breast at a time
  • Massage the breast while baby nurses to encourage milk to flow
  • While nursing, touch your breast and seek out any “hard” spots in the tissue, and lightly massage those areas while baby nurses
  • Nursing experts disagree about heat packs versus cold packs–some say too much cold will reduce breastmilk production, and some say too much heat to help with the hardness of the tissue will make the swelling worse, I found that a little bit of each was beneficial
  • Take a mild pain reliever if necessary
  • Pumping is not recommended as noted above, but if your breasts are still full and rock hard, and baby is full and satisfied, use the pump to relieve some of the pressure (do not drain the breasts completely with a pump multiple times a day, or you’ll have too much milk)

Again, remember that while engorgement is obnoxious, it is a good sign! Engorged breasts means that your baby has been latching, and consuming colostrum. Engorgement is a sign that she has, in fact, been getting some.

Engorgement from skipping feedings

While first week engorgement is something to be proud of, engorgement at other times is not a good sign. To keep your milk supply steady and consistent, you need to remove a consistent amount of milk from the breast from day to day, week to week. If you miss a feeding, the milk that normally gets removed stays in the breast. Since the breast doesn’t have a brain, it keeps making milk on the same schedule.

After a while (not long, honestly), there is a back up in the amount of milk in the breast. The breast takes this as a sign that milk is not needed, and commits to making less milk.

Engorgement is the sign to the body that the milk is not needed. If you let your breasts become engorged on a regular basis, your milk supply will decrease. If you are working towards weaning, this can be a good thing. But if you are not planning on weaning and actually need to keep up your milk production, you risk harming your milk supply.

To avoid engorgement as your baby gets old, make sure you continue to nurse (or pump) on a regular schedule. If you are away from your baby (and it is okay to be away from your baby you know), remember to pump your breasts thoroughly, even if you aren’t in a situation where you can get that milk to your baby. You just need to keep communicating to your breasts that milk is needed, and they should keep making it.

Can breast engorgement cause chills?

Generally, chills aren’t a symptom of engorgement. However, when engorgement occurs, it can cause the breasts to swell, throb, and even feel warmer than normal. This may cause the rest of the body to feel colder than normal in comparison.

Engorgement can also encourage the development of other breast troubles, such as plugged ducts or even mastitis. If you are suffering from engorgement and you find you are also experiencing chills, take your temperature. If you have a fever (or other flu-like symptoms) you may have a breast infection, and you may want to consider contacting your doctor or the nurse about it. Untreated mastitis can become a fatal infection to a nursing mother.

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