Engorgement: a guide for breastfeeding mums
Posted by Katie James, Lactation Consultant and midwife on Apr 24, 2015
All you need know about engorgement for breastfeeding mums. Join me as I interview Katie James, IBCLC and midwife about engorgement when you’re a new nursing mum. If you prefer, you can also read the article below. If you have a topic you would like us to cover please let me know!
What is engorgement?
There are two types of engorgement. The most common is when there is an ‘over-fullness’ of breastmilk. Often after birth as the pregnancy hormones drop and the breastfeeding hormones rise, we see the colostrum milk being produced, often clear or yellow and sticky. Then around 60 up to 80 hours after birth the mature milk comes in. There is a rapid increase in the amount of milk that comes into the breast, and baby starts drinking more and getting fuller.
For some women your body produces more milk than your baby can take. This can either be because your body perhaps thinks you have twins or triplets, or alternatively, for some reason your baby isn’t feeding frequently enough. Your breasts will become full with milk, then fuller and fuller, until the breast becomes rock solid and hard. Instead of lumpy, full and soft in areas, it is hard all over. You breasts may feel tight and heavy as well.
The second type of engorgement is actually swelling or oedema. It is more likely to happen to those women who have had quite a lot of fluid given to them during labour. Some women get swollen hands or feet post-natally, and sometimes in the breast. In this case it isn’t milk making your breast full, its fluid in the tissue.
What happens when your breasts get really full
There are some myths around engorgement. What we know is that there is actually a protein present in the milk that regulates your bodies supply and demand. It tells our brain whether our breasts are too full, and to slow production, or if the breast is empty, and to produce more to refill. When women become engorged they keep producing milk until the breast is extremely full and uncomfortable. The protein in the milk at this stage will be telling the brain that there is too much milk, and the brain will switch off production and will start to re-absorb the milk and not produce any more.
For women who choose not to breastfeed, and formula feed from the beginning, this is what happens. The breasts become engorged with milk, and then the mechanism says to the brain ‘stop production’, and everything settles back down and the milk disappears.
If you are planning to breastfeed though, we really don’t want this to happen to you. You need to frequently drain the breast of milk and keep the production going. This will settle the engorgement down and will create a good milk supply. In the past, midwives incorrectly thought that if the breasts were overstimulated by expressing and feeding in the early days, this would cause issues with excessive milk supply. However, we now know that in the first week after birth it is a different system, and we need to get the milk flowing. Basically, if you have engorged breasts, we want you to be feeding your baby a minimum of eight times every 24 hours, roughly around three hourly, or more frequently if baby is happy to nurse more often.
Tips for nursing with engorged breasts
You may find that you need to pump or hand express a little bit of your breast milk off to allow your areola to soften first, so baby can get a nice deep attachment. Sometimes if the breast is overfull, baby can’t attach deeply, and therefore can’t drain the milk well, which causes issues. So, you may need to soften the areola first, by expressing a little bit of milk, and then attach your baby to drain the milk. Remember your baby is much better than any pump or any hand expressing at getting the milk out efficiently. After you baby has fed, some women will still feel quite engorged and may notice that the back of the breast tissue is still quite firm and hard. At this point you might need to put the pump on to help drain the breast for comfort. You don’t have to drain the whole breast, just until it feels comfortable.
Some women feel that heat on a hot washer or flannel on the breast and circular, gentle massage can help the milk flow better, and help to soften your breasts. You may need to do this regularly until your breasts are feeling more comfortable and soft. It may take anywhere from 24 to 72 hours for your uncomfortable engorgement to completely clear up.
Fluid Retention in Breasts
It is difficult to reduce fluid retention in some circumstances. There are a number of things that can happen during your labour and birth that may require you to receive fluids. Some of these include:
What’s important to know if you have swelling in the breast that is due to fluid retention, is that it requires very different treatment to normal milk engorgement. What we often notice is if mum is wearing a bra, when she takes her bra off, there are indentations left in the breast, or if you press and hold your finger lightly there for 10 or 20 seconds, and then the indentation stays after you have removed your finger. That means its fluid retention and swelling rather than milk engorgement.
Treatment for Fluid Retention in the Breasts
In this case, we don’t want any kind of heat on the breast, because that will just push more fluid into the tissue and make the problem worse. What your midwife will help you to do is something called “Reverse Pressure Softening”. You will use your fingertips to push back and up on the outside of the areola, and hold it for perhaps 30 – 40 seconds to try to push the fluid away. And then move your fingers around the areola and repeat. After this the breast should be softer, and you can put get baby to feed, or put the pump on to help get the milk out. This may last 24 to 72 hours depending on how engorged the breast is. This is a bit more complicated, but it is good to notice the difference between the two types of engorgement.
Should I use cabbage leaves or newborn nappies in the freezer to help with engorgement?
Although there is not much scientific evidence to support using cabbage leaves, anecdotally, it can be very useful. The cabbage leaf is used because of the ideal shape, and because they hold their coolness well. You would take a cabbage leaf and put it in the fridge or freezer and then put it in your bra, around the breast and leave it for 10 minutes to help cool the breast down. After 10 minutes, make sure you remove the cabbage leaf, or you may start to smell of cabbage! Similarly, the newborn nappies make a good curved shape to put around your breast, and putting them in the freezer helps them to feel cold. A word of warning though! The nappies can get really hard and very cold, so be cautious that you don’t get frozen burns on your breast when you’re using frozen nappies.
What both nappies and cabbage leaves do is help cool your breasts. When you have so much activity and blood flow your breasts can feel really hot. These can help cool everything down after a feed or expression, and can feel soothing for some women. You can also buy gel packs that can cool or heat your breasts that have the same effect. If it feels soothing it’s a great idea to do, if it doesn’t feel soothing for you, don’t do it.
Interestingly, a lactating breast is generating as much activity in terms of heat as our brain. When you’re lactating, you’ll notice that often the veins will pop up on your breast when your milk comes in, because there is so much work going on. So that’s why the coolness can be soothing. But if it doesn’t feel nice for you, then don’t do it.
What about after the first week? Will I still experience engorgement after this?
This depends on everyone’s individual supply. If you are someone with very large supply, you may need to do more soothing manageability methods with your lactation consultant or midwife. For most women, after that initial first week, the breasts do settle down somewhat. And then between 3 and 9 weeks once your body has worked out the right supply for your baby it settles down even more. At this point, some women may be afraid that their milk has gone! But this is just your body getting more efficient at producing exactly the right amount of milk at the right time for your baby.
In terms of whether you will always be using cabbage leaves and heat packs? No. For most women the discomfort is mostly when the milk comes in, in the first 3-5 days, and then the milk supply will settle a bit and so your breasts will often feel very full and heavy just prior to a feed, and then will feel quite comfortable after a feed. For those women who are always leaking, and always feeling really full and heavy, then perhaps they are on the scale of having oversupply, which needs to be dealt with slightly differently.
We are all different and all produce milk differently!
Have you experienced engorgement? What has your experience been?
