Updated: Aug 8, 2020
Engorgement totally stinks. When I had my first kid 7 years ago I suffered from pathologic engorgement with a plugged duct every week for the first five months and then one every 2 weeks for the next few months.
At that point in my life I was not an IBCLC, so I can only look back and try to put the pieces together. Let me also be transparent in that at the time I did not reach out for help. Yes, I know not the wisest decision. While I was in school to become an IBCLC myself I learned that I did it ALL wrong!!! So I am here with this article to say that there is help and there is good information to support the process of physiological engorgement and mitigate pathological engorgement.
Physiological engorgement is common to experience, usually starting around the second or third day after your baby is born and can continue through the first 2 weeks or so postpartum. This kind of engorgement is the common engorgement that we expect to see when milk production picks up or “comes in”.
A couple of things are going on here in physiologic engorgement. The breast tissue is swelling up from an increased “congestion” of the vascular and lymphatic systems that carry blood and fluids through the breast. In addition, your alveoli, the milk making factories, are increasing in size due to milk production. All of this combined can cause your breast to swell and become very painful and tender.
Engorgement can look different for each mom and different at different times with the same mom. For example, it could be that just the body of the breast swells, it can be that just the areola swells, or it can be that both swell. Any combination of these can cause the breast tissue to become hard and taut, which makes latching difficult, especially if your nipple flattens out from the swelling.
It is important to get this worked out so that you can maintain breast health, effective milk removal, which not only creates a good milk supply but supports weight gain for your baby.
The other kind of engorgement is called pathological engorgement. This can happen anytime you have a lactating breast and milk is not being removed enough or effectively. In both situations engorged breasts might become red, veiny, hard and taut, warm, or shiny. In this condition latching can become difficult and painful. The treatment is the same.
* Deep latch
I know it can be difficult to get a deep latch while your breasts are engorged! However, this truly is the key to breast health. When your baby latches deeply and transfers effectively each lobe (cluster of milk making factories) drains more evenly. This goes a long way to protecting your breasts from pathologic engorgement and plugged ducts.
If you find that you are becoming engorged on one side or have a plugged duct, work on deeply latching baby with their chin towards the affect area. The reason for this is that the bottom jaw (and tongue of course) does all the work in transferring milk. This is the first line of defense in your toolbox to support "emptying" the affected areas.
* Rest while skin to skin and go bra free
Many moms find that engorgement happens when they have been busier than normal. Sometimes feedings get missed or pushed too far apart and sometimes mom forgets to take care of herself, leaving her worn down. Your body needs to REST and heal. Take this time to get skin to skin with your little one. This will allow your baby the time and space to be at the ready for breastfeeding and you the ability to easily respond to hunger cues.
And go BRA FREE. Wearing a bra at this time can cause added pressure to already sensitive milk ducts and skin.
* Finish the first side
While breasts are never really empty, allowing baby to finish the first side before switching keeps your milk flowing and breasts “emptying”. This protects the supply and demand flow of breastfeeding, thus avoids milk becoming stagnant and breasts engorged.
* Let gravity assist you (Reverse Pressure Softening)
Lie down on your back and use two fingers from each hand to GENTLY press into your chest wall at the base of your nipple. Hold this position for about 30 seconds to a minute in each spot moving in a circular motion. Then bring your baby to the breast to offer a deep latch.
* Hand express or pump
Note that engorged breast tissue is very fragile and bruises easily, so be gentle. You can do either of these options for 30 seconds or until your breasts become pliable. Then when you bring your baby to the breast they can get a nice deep latch that allows them to pull enough breast tissue into their mouth for a good nursing session.
* Take the swaddle off
When babies are swaddled hunger signs can often be missed, in part simply because they cannot use their body as well to signal hunger cues. Not only do these babies miss feedings, it can increase engorgement, and in turn lower your milk supply.
So remove the swaddle, and if they need that close coziness for comfort snuggle down with them or put them in a baby carrier. Near you they can be free to signal for hunger and at the breast protecting their weight gain, your milk supply, and your breast health.
* Breast compression
Compressing the breast during nursing encourages milk flow. This is an option when your baby has switched from active drinking to just sucking, as it stimulates a let down. To do this, place your thumb on one side of the breast and the other fingers on the other side close to the chest wall (make sure that your hand shape mirrors your baby’s lips). Then, gently squeeze your breast and hold. It is best NOT to do this if baby is resting or sleeping, a sudden release of milk could choke them. Follow your baby’s cues and suck/swallow actions to know when to release the pressure and repeat.
* Use cold therapy
Here is where I went absolutely wrong. When my breasts were quite engorged I would sit in my bed with a heating pad, always heating, and I would get in the shower and I would put the showerhead right on my breasts. But here's what we know in other areas of health. Heat increases vascular congestion. So the opposite is what we want to do, which is cold therapy. Cold therapy helps in reducing swelling by reducing blood flow, supporting lymphatic drainage, and decreasing edema.
The best way to use heat, if you would like to use heat, is going to either be in the shower with nice warm relaxing water flowing on your back for a few minutes, not directly on the breast itself. The other way to use heat is to put a moist warm cloth on your breast for few minutes immediately before feeding to help you relax to get a let down. Outside of that I would refer you to a cold therapy treatment. You can use a cold pack or gel pack for about 20 minutes at a time between feedings as needed.
* The use of heat used to be one of the top remedies told to moms. However, research has showed that cold therapy is the more effective. Slowly this updated information is spreading.
* Cabbage Leaves
Some people really like using room temperature or chilled green cabbage leaves. My caution here is that there is some research showing that cabbage leaves can reduce milk supply. The modest recommendation here is that you would use a cabbage leaf for only 20 minutes at a time and only until you have achieved your desired results for breast relief.
Note: If you are trying to wean it is often recommended that you can use the cabbage leaf for up to two hours or until wilted.
* Dangle feeding
As I mentioned earlier, the bottom jaw does all the work while breastfeeding. So, If you have an area that feels engorged or plugged and is not located in the area your baby's chin usually points during a nursing session, like on the outer side or towards the top, try dangle feeding. This is when you lean over your little one. Not only does this support a downward flow of your milk (helpful in this situation) it lets you place baby in any position you need.
* Enlist your partner
Sometimes it seems that no matter what we do our breast keeps filling up with milk and engorgement simply will not relieve. In these situations getting a baby to deeply latch to the breast can become even more challenging. Some couples find that their partner is their best solution. If you are both willing give it a try. They just might be able to latch well and release the milk.
Remember that physiological engorgement is common. However, it does need to be taken care of with effective treatments to prevent it from coming becoming pathological engorgement, which could possibly turn into mastitis or a reduced milk supply. If after using these remedies for 24 to 48 hours and your symptoms have not been relieved, reach out for professional help. Know that a fever of 100.6 accompanied with chills, flu symptoms, and body aches could indicate that engorgement has led to mastitis and professional help should be obtained.
To a Confident, Sexy, Love filled life! Kimberly Lindsay, BA, CPCC, ORSCC, IBCLC
Mental Fitness Coach for Spiritual & Creative Moms:
Who are ready to ditch their saboteurs so they can show up
as the partner, parent, and person they want to be - getting back to self and back to roots.
The content of this document is for educational purposes only. It does not take the place of a proper lactation consultation or replace medical care. The information provided is based on my research and information in the lactation field. However, it is up to each breastfeeding family to make the decisions that best meets their needs, including further research, and personal consultation. Please seek medical care for further support and/or evaluation as needed.