What Is Breast Engorgement and How To Treat It
For most women, lactogenesis II - the fancy word for the onset of mature milk production - comes naturally due to a hormonal chain reaction of sorts, about 3-8 days after delivery. Colostrum, the first milk, makes way for the fattier, higher calorie milk that will support your baby’s rapid growth and development. This transition from one type of milk to another is abrupt, and requires a good milk removal system - whether via a pump or a nursing baby - to sustain and signal the body to produce an adequate amount. Even with a baby who latches well, or an efficient pumping routine, most breastfeeding women will experience some level of breast engorgement in the early days. Engorgement in itself isn’t pathological - it’s not a result of disease - but if not adequately treated, it can lead to inflammation and sometimes infection of the breast tissue. Engorgement can greatly impact supply if left untreated, so understanding engorgement, knowing how to treat at home, and knowing when to get help is of utmost importance to any and every breastfeeding mom.
What does normal breast engorgement look like?
There are two types of breast engorgement: physiological and pathological. In other words, normal and abnormal. Normal engorgement is what most, if not all women experience as they’re beginning their breastfeeding journey. Normal engorgement includes:
Enlarged breasts that feel heavy, full, and tight.
Mild edema (swelling due to fluid buildup)
Mild to moderate discomfort.
Milk still flows freely.
Normal engorgement can be caused by things like a sleepy baby, a poor latch, early supplementation with formula or donor milk, or fluid retention from the labor process (especially if you had IV fluids and/or pitocin).
How to treat normal breast engorgement at home
There are several ways you can self-treat normal breast engorgement at home. Remedies include:
Frequent feeding (or feeding on-demand)
Ensuring correct positioning of baby and correct latch
Gentle massage during feeding
Applying an cooling pack after feeding
NSAIDs may help (i.e., ibuprofen)
If you’re having trouble with positioning and latch, I highly recommend seeking out an experienced lactation professional or IBCLC in your area who can come to your home and help. When milk is not removed from the breast frequently and efficiently, it can lead to more severe engorgement and inflammation.
In the past, breastfeeding guidelines recommended heat packs for engorgement, however the new recommendations say that cold is actually better than heat because it reduces inflammation instead of increasing blood flow to the area.
What does abnormal engorgement look like?
This type of engorgement is an emergent situation that needs effective treatment as soon as possible. You may be suffering this type of engorgement if you have any of these symptoms:
Enlarged breasts that are hard and lumpy. Many women who have experienced severe engorgement have said their breasts felt like “rocks” or “bowling balls”
Very tight, red, shiny skin
Unable to express milk due to tightness of skin and swelling of the breast around nipple and areola
This type of engorgement is caused by ineffective milk removal. The breasts contain small sacs called alveoli, which produce milk in response to the hormone prolactin. If the alveoli fill with milk, and the milk is not then removed from the breast by the infant or a pump, the sacs can become overfilled and put pressure on other sacs nearby, which can cause blockages within the ducts. All of this swelling and overfilling can build up and cause pain, redness and uncomfortable engorgement that makes it hard to latch the baby or remove milk at all. As you can imagine, not being able to latch results in greater swelling and even more engorgement - an unfortunate and vicious cycle.
Does severe engorgement need medical attention?
If you are experiencing severe engorgement, you should seek medical attention if you have a fever of 101 degrees or greater, have intense pain, have a red area on one breast that is hot to the touch, or express milk that contains blood or pus. These things could all be indicators of mastitis, which is caused by ineffective milk removal and engorgement that has gone untreated. Mastitis sometimes involves an infection as well, and sometimes doctors will prescribe antibiotics if there is an infection that needs to be cleared. You do NOT need to stop breastfeeding if you have mastitis! But it is important to get help as soon as possible so you can preserve your milk supply.
How can I treat severe engorgement at home?
If you are experiencing symptoms of severe engorgement but do not have a fever or other symptoms of mastitis, you may want to try some at-home remedies to relieve the engorgement:
Relieve edema around the nipple with gentle massage, counter-pressure and reverse-pressure-softening.
If you still cannot latch the baby after massage, hand express or pump
Enlist the help of a lactation professional or IBCLC to help you get the deepest latch possible and the best positioning so that you can ensure a good latch and effective milk removal
Utilize ice packs for cold therapy
Lymphatic drainage massage
No matter what - keep removing milk!
The “Finger Test” to check for engorgement
If you’re unsure if what you’re experiencing is normal, abnormal or if it is even considered engorgement at all, you can do what is called the “finger test”. To do it, place your index finger to your cheek. If your breasts feel like this, you are likely experiencing very little to no engorgement. Now, touch your finger to the tip of your nose. If your breasts feel like this, you’re likely experiencing moderate engorgement. It may be helpful to utilize the first set of tips in this blog post (under “normal engorgement”). Now, touch your forehead. If your breasts feel like this, you are experiencing severe engorgement. Try the remedies listed here, and if you’re still experiencing discomfort, or any of the symptoms of mastitis, it’s recommended that you call your provider as soon as possible.
Breast engorgement can be a stressful, uncomfortable and worrying aspect of the breastfeeding journey, even if it is considered “normal”, but with the right tools and knowledge, you can approach this obstacle with confidence! If you’d like to learn more, and feel prepared and excited for your breastfeeding journey, consider taking a 1-on-1 class in the comfort of your own home. Learn more here.