What is postpartum breast engorgement?

Usually 2 to 5 days after your baby is born, you will notice changes in your breasts. They will get larger, somewhat firm, and slightly tender as they start to make milk. This is called postpartum breast engorgement.

Engorgement is normal. However, the swelling of your breasts may make it hard for your baby to get milk. Your baby may not be able to latch on correctly and your nipples may get sore. If your baby is having trouble nursing, the pressure in your breast from the milk can cause you to make less milk or to even stop making milk. Knowing how to manage engorgement will help you avoid these problems.

What is the cause?

After your baby is born, hormones in your body change and your breasts start making milk. The milk and extra blood flowing to your breasts makes them engorged. It takes a few days until your body gets used to making and releasing milk. Getting milk to flow is more of a problem than making too much milk.

Once your baby is nursing well and your milk is flowing easily, you will have less swelling and firmness. Within a few days, your breasts will likely make the same amount of milk as your baby takes from your breasts. By the end of the first week after your baby’s birth, your breasts will have adjusted and will be much less engorged. However, if you go too long between feedings, your breasts may get firm and tender again.

What are the symptoms?

Your breasts are swollen and firm. They may feel tender or painful.

How can I take care of myself?

If you are breast-feeding your baby, here are some things you can do to help your breasts be less engorged and more comfortable.

• Nurse often.

  Nursing often can help your breasts be less engorged. Plan to nurse your baby at least every 2 to 3 hours during the day, and up to 4 to 5 hours between feedings at night. Try to feed your baby 8 to 12 times every 24 hours. Your newborn should nurse vigorously at least 10 minutes on the first breast before moving to the second breast.

• Use heat and cold to reduce fullness and discomfort.

  Warm your breast just before nursing. Heat improves blood flow and helps your milk flow. Try taking a warm shower just before feeding. Or cover your breasts with a warm washcloth. You can put a plastic diaper over the washcloth to keep the heat in.

  After breast-feeding, put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on your breasts for 15 to 20 minutes to decrease the swelling.

  Some breast-feeding experts recommend using cool cabbage leaves to treat painful breast engorgement. Many women who have tried cabbage leaves claim the treatment brings relief from discomfort.

• Use gentle pressure and express some milk.

  You can use gentle pressure to soften an area of your breast near the areola (the dark area around the nipple). This helps move some of the swelling around the areola so that the baby can latch more deeply onto your breast.

  Start by lying flat to let gravity move the swelling toward the chest. Put the fingertips of both of your hands at the base of your nipple and gently press in towards your chest. Press for 1 to 15 minutes. The pressure should be firm but not painful.

  Once the areola is soft, you can more easily let out (express) milk. Before each feeding, use your hands to let out a small amount of milk from both breasts. Express enough to soften the nipple and areola so that your baby can better grasp the area around the nipple. Gently massage your breasts before and during the feeding to help empty and soften your breasts.

  Put cool washcloths on your breasts between feedings to help relieve discomfort and reduce swelling.

  Ask your healthcare provider about medicine or supplements that might help with discomfort. Talk to your provider before you start taking any medicine or supplement.

• Express or pump milk as needed.

  It’s important to be able to empty your breasts because the engorgement puts pressure on the milk-producing glands and can quickly decrease your milk supply. If your breasts are so full that your baby cannot latch on or if your baby is not nursing well after your milk has come in, you may need to use a breast pump or get help with breast-feeding.

  If your baby is not nursing well, hand expressing or pumping your breasts will let you relieve discomfort and keep making milk. Express your milk at regular feeding times. Your healthcare provider or lactation consultant can help you learn breast-feeding techniques.

  If your breasts are still full after feeding your baby, pump or express milk for a few minutes until your breasts are softer and you have less discomfort. Soon your baby will empty your breasts well at each feeding and you will no longer need to pump. Ask your child’s healthcare provider if you need to feed your baby the expressed milk. If your baby doesn’t need it right away, you can freeze the milk for future use.

  Pumping or hand expressing does not cause you to make too much milk. Engorgement is caused by poor milk flow, not by making too much milk.

If you are not going to breast-feed, engorgement will usually get better several days after the baby is born. Here are some ways to help relieve discomfort while your breasts stop making milk:

• Wear a well-fitting, supportive bra. Sleep in the bra.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on your breasts for 15 to 20 minutes every 1 to 2 hours while you are awake.
• Use a towel or stretch bandage to bind your breasts. The hospital staff or a lactation consultant can help you learn the correct way to do this.
• Do not pump your breast milk, massage your breasts, or rub your nipples. If your breasts are stimulated or emptied, they will keep making milk and your breasts will stay painful.

Nonprescription pain medicine may help. Talk to your healthcare provider before you use any medicine to be sure that the medicine is OK for you to use.

Contact your healthcare provider if pain in your breasts is severe.