Engorgement
Engorgement is a common lactation issue that affects most moms at some point during their breastfeeding journey. It can be very uncomfortable and can even lead to early weaning!
Especially for people that haven't prepared for breastfeeding while pregnant, engorgement can come as quite a surprise. Not to mention the fact that if you give birth in a hospital, the engorgement most likely will happen after you are discharged, leaving you at home to manage it on your own, (if you haven't scheduled an appointment with a lactation consultant).
What exactly is engorgement?
There are two different types of engorgement. One is expected, and it occurs during the first few days postpartum (usually around 3-5 days after giving birth). The other kind of engorgement happens when it has been too long between nursing or pumping sessions and your breasts become extremely full of milk. Today I am going to talk about how to manage that engorgement that happens during the first week postpartum.
Engorgement in the early postpartum period happens when your breast milk starts to increase in volume between 36 and 96 hours postpartum (Breastfeeding and Human Lactation, page 199). When the placenta detaches from your uterus, your hormones shift and your body gets the signal to start making more milk (remember, milk production started during the second trimester of pregnancy!). There is a lot of blood flow to the area, and in addition to the breast milk increasing, a lot of extra fluid builds up in the breast tissue itself. Your skin might feel tight and warm, and this breast fullness can feel really uncomfortable!
What is the best way to manage engorgement?
Ensure a proper latch
Feed frequently
Use a cold compresses for 20 minutes at a time
Take anti-inflammatory medications (if safe for you to take/approved by your healthcare provider)
Perform hand expression and reverse pressure softening to make it easier for baby to latch on to the breast
In addition to those tips, my other big piece of advice is to practice gentle breast massage.
How to do gentle breast massage:
The most important thing to remember when touching our breasts is that they are ORGANS not MUSCLES. We do not want to be aggressive or use firm pressure (this goes for any massaging you're doing for plugged ducts or mastitis, too!). Being too rough only increases the inflammation in the area, and does not help the swelling in the breast to decrease.
There are different massage techniques you can use and there might be a health care provider in your area like a physical therapist or an IBCLC who specializes in this type of massage who can show you some different approaches. With any technique, the goal is to gently move the swelling fluid out of the breast (remember, the swelling isn’t just milk) and into the lymph system.
We have a lot of lymph nodes in our armpits, so what you want to do is move the fluid up towards your armpit. I know it sounds strange, because we are usually trying to move milk down the milk ducts and out the nipple! Use a gentle, sweeping motion to massage your breasts from the nipple and up to your armpit. It helps if you use a lotion or an oil while you do this.
Some breastfeeding mothers think that if they pump, that will help the engorgement. But if baby is latching well, there is no need to use a breast pump. Remember, a lot of the firmness in the breast is caused by fluid in the tissue itself, which won't come out with a pump because it is not inside the milk making areas of the breast. So the massage, ice, and anti-inflammatories are your best bet when it comes to managing the engorgement.
If you’re engorged and having trouble managing it, reach out to a lactation consultant for help. It’s a great idea to get in touch with an IBCLC while you are still pregnant and many of us can set up appointments for that first week postpartum and then adjust the appointment date as needed when the baby arrives. If you see an IBCLC within the first few days, we can make sure you are on the right track with your engorgement!
Jess
Sources:
Auerbach, K. G., & Riordan, J. (1993). Breastfeeding and human lactation. Boston: Jones and Bartlett.
https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/20-engorgement-protocol-english.pdf
Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2020 Sep 18;9(9):CD006946. doi: 10.1002/14651858.CD006946.pub4. PMID: 32944940; PMCID: PMC8094412.