Breastfeeding problems: Engorgement

When you're nursing, there may be times when your breasts become uncomfortably full with milk. This condition is called engorgement.


Causes/associated factors
After the baby is born, your breasts will gradually begin to produce larger amounts of milk. When milk production increases, the blood circulation to your breasts increases as well. These increases will cause your breasts to enlarge.
Two to six days after delivery, your breasts may feel full, heavy and a little tender. If your baby nurses often and effectively, this fullness will decrease over the next two to three weeks.

For some women, however, the breasts become painfully engorged during the first week after delivery. Engorged breasts may swell to as much as twice their normal size. With proper treatment, the pain can be eased significantly within 12 to 48 hours.

You're at higher risk for engorgement if anything interferes with frequent, effective breastfeeding, including:

missed or delayed feedings
supplemental feedings of water or formula
a sleepy baby who doesn't empty the breast well
improper positioning of the baby at the breast
incorrect or poor quality sucking
limited feeding times in the hopes of preventing sore breasts (Cutting feedings short may actually lead to increased soreness.)
using a nipple shield

Signs/symptoms
Symptoms of engorgement may include:
breast swelling and firmness that may extent to the armpits
breast tenderness or pain
hard, shiny skin covering the breast
sensation of warmth in the breast
Sometimes, the areola (the round, pigmented area of the breast surrounding the nipple) becomes swollen and the nipple flattens. If this is the case, the baby may not be able to latch on to the breast correctly. The baby may become fussy or fall asleep frustrated after trying to nurse for a short time.


Treatment
To treat engorged breasts, consider the following suggestions:
Breastfeed every one and a half to two hours until both breasts soften. Allow your baby to finish on the first breast rather than switch to the second breast after a set period of time.

Before nursing, apply warm compresses to your breasts for 10 to 15 minutes, take a warm shower or lie on your side in a warm tub.

Massage your breasts before and during feedings.

If your areola is swollen and the baby can't latch on properly, gently express enough milk by hand to soften the areola. This may be easiest after applying warm water to your breasts or while standing in the shower, as described above.

Apply cool compresses or ice packs just after and between feedings.

Take a mild pain medication such as acetaminophen to relieve discomfort. Remember to consult your doctor before using any medications while breastfeeding.

Wear a well-fitting nursing bra 24 hours a day. Avoid tight bras and underwire bras.

Use a breast pump once or twice over the next few days to fully drain your breasts.
You may also want to consider a home remedy that's been effective in some studies -- under your bra, place cool cabbage leaves on your breasts. Strip the large vein and leave a hole in each leaf for your nipple. Replace wilted leaves with fresh ones (usually within two to four hours).

If your baby isn't nursing effectively for an extended period of time, be sure to consult his or her doctor. You may also need to express your milk with a breast pump for bottle feedings.

To determine the best solution for your situation, you may want to consider your options with a breastfeeding specialist. To find a breastfeeding specialist, ask a nurse in the postpartum unit at your hospital, your doctor or your baby's doctor -- many hospitals have breastfeeding specialists on staff.

As another option, the nonprofit organization La Leche League provides education, information, support and encouragement for breastfeeding mothers through support groups with specially trained leaders. To learn more about La Leche League, call (847) 519-7730.


Complications
Left untreated or ineffectively treated, engorgement may lead to a decreased milk supply or breast infection. Repeated attempts to latch on may cause sore nipples. A baby who doesn't get enough milk may gain weight slowly.

Prevention
Frequent breastfeeding and correct technique and positioning at the breast can help prevent painful engorgement. At first, you may need to breastfeed eight to 12 times a day (about every two to three hours). Unless medically necessary, avoid supplemental feedings of water, sugar water or formula during at least the first few weeks after delivery. You may want to avoid pacifiers, too.
If your baby can't nurse effectively or you must miss a feeding, use a breast pump to empty your breasts.

When you're ready to stop breastfeeding, wean your baby gradually to help prevent engorgement.