Breast engorgement occurs when milk replaces colostrum and milk supply increases more quickly than the newborn's appetite. Engorged breasts may feel overfull, warm, hard, tender, or painful. Engorgement may tighten the areola, flatten the nipple, and make latch-on difficult for the baby.
New breastfeeding mothers have several options for relieving normal postpartum breast engorgement, including frequent nursing, breast massage, application of warmth, cool compresses, and hand expression or use of a breast pump. To avoid plugged milk ducts and mastitis, lactating mothers should wear loose fitting bras and clothing.
Comfort Measures for Postpartum Breast Engorgement
Frequent Nursing: Breastfeed on demand. Nurse every two to four hours, day and night, or more often according to the cues of the baby. If tightness around the areola and nipple prevents the baby from latching on easily, compress the areola to soften the nipple area. Finish one breast before offering the other. Nurse on one breast for as long a stretch as the baby desires, switching to the other breast only when the baby pulls off or falls asleep.
Breast Massage: Before nursing, gently massage the breast toward the nipple and allow some milk to flow out to soften the nipple for easier latch. During nursing, gently compress and massage the breast to stimulate the letdown of milk.
Application of Warmth: For only a few minutes at a time, apply warmth to the breasts by standing in a warm shower, applying warm washcloths, or by dipping the breasts in a bowl of warm water and allow some milk to flow out. Shower water should not spray directly on the engorged breasts. Application of warmth should not be done for longer than a few minutes because it may worsen swelling and inflammation caused by the engorgement.
Cool Compress or Cabbage Leaf: Before nursing, apply a cool compress or cabbage leaf to the breast for up to twenty minutes to relieve swelling and inflammation. Limit the use of cabbage leaf compresses which can cause a decrease in milk supply. See Cabbage Leaves for Treatment and Prevention of Breast Engorgement.
Hand Expression or Use of a Breast Pump: Between feedings, hand express or pump out just enough milk to provide relief. To manually express breast milk, use the thumbs to gently stroke downward, working around the breast toward the nipple. Avoid pumping out too much milk which will encourage an increase in milk supply.
Breast engorgement typically subsides within a few days as the mother and baby find a balance between supply and demand. During that short time before the baby's appetite catches up to the mother's milk supply, women can choose among several treatments for relieving the discomfort of normal postpartum breast engorgement and for preventing clogged milk ducts, mastitis, and latch-on difficulty for the newborn.
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