Congratulations! You have a beautiful new baby and are basking in the amazing wonder of this precious little bundle! It’s day 5 postpartum and your milk has come in, but now your breasts are feeling very full, heavy and tender. It is normal to experience that fullness when your milk first comes in. Your breasts may also swell a bit with extra blood flow as they prepare to become baby’s full-time milk machines! If you received IV fluids while in the hospital, the swelling may be a bit more than normal, but it will dissipate in a few days.
What is Engorgement?
Engorgement occurs when the swelling and fullness of your breasts is extreme. They will feel painful, hard with shiny stretched skin, be warm to touch and you may even have tender lymph nodes in your armpits. The swelling may be so excessive that your nipples have flattened out and now baby is having a hard time latching. You are likely very uncomfortable and may even have a low grade fever. So what can you do to find relief and get your baby latching well again?
How Can I Find Relief?
Applying heat to your breasts before feeding can help. Use moist, warm towels or compresses or take a shower right before feeding and let the warm water run over your breasts. You only need to shower for a couple of minutes, as too long in the heat may actually increase inflammation. Hand expression before feeding can help soften your breasts so it is easier for baby to latch. Do this by making a “C” with your hand. Push your pointer finger and thumb back towards your chest wall and hold for 5 to 10 seconds. Release then repeat. You can collect any milk you express in a clean container and then store it appropriately by refrigerating or freezing it to use later.
If your nipple has flattened from the engorgement and baby is having a hard time latching you may need to do reverse pressure softening. This means using gentle positive pressure to soften a 1 to 2 inch area of the aerola, temporarily moving some of the swelling backward and upward into the breast. You can also massage your breasts gently from your chest towards your nipple before feeding. Doing breast compression or massaging the breast while baby eats may also be helpful in emptying your breasts. To do breast compression, hold your hand at the base of your breast and squeeze for 5-10 seconds, repeating throughout the feed.
If, after feeding you are still feeling full and uncomfortable, express some breastmilk just until you feel a bit of relief. You don’t want your breasts overfull so pumping can help with that. Pump on a low setting for no more than 10 minutes as engorged breasts are more susceptible to damage. You don’t want to pump too much at this point as it can lead to overproduction and temporarily make the engorgement worse. Hand expression is likely more effective than pumping at emptying milk ducts so give it a try. You can also apply ice to your breasts for 20 minutes and then off for 20 minutes to help reduce discomfort and swelling. An ice pack over a layer of cloth or bag of frozen veggies works well for this. Ibuprofen may be helpful for the pain and is an anti-inflammatory so will help with swelling as well.
What does Cabbage Have to Do with Breastfeeding?
Have you heard of using cabbage to help with engorgement? As strange as it sounds, many women find relief when using the cabbage leaves and some say it is even more effective than using ice. However, if you have open skin from cracked, blistered or bleeding nipples, or if you have an allergy to cabbage or sulpha you shouldn’t use cabbage leaves on your breasts. Wash your cabbage leaves and use a rolling pin to crush the veins. Place the clean, chilled cabbage leaves on your breasts inside your bra until wilted, approximately 20 to 30 minutes. You can repeat as often as you like but be sure to only use the cabbage leaves until the engorgement subsides.
How Can I Prevent Engorgement?
Offer your baby the breast frequently (roughly every 2 hours) and try to fully empty the breasts with every feed. By taking milk out of your breasts often (either by feeding or hand expressing) you are allowing the milk and other fluids in there to move around more easily. Do lots of skin to skin with your baby, it can help reduce your pain and frequent breastfeeding is more likely while doing skin to skin. Most Mamas find relief in 12-48 hours with proper treatment. If you are struggling with breastfeeding and need help please reach out to a Mama Coach in your area. As Registered Nurses we offer lactation support and will come to your home to assess both you and baby and get you going on the right track. You got this Mama!