FAQ 3. Engorgement

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Q. What is engorgement and how can I prevent it?

A. Most women have heard about engorgement. Many people think that engorgement is inevitable and part of the breastfeeding process. While it is common for moms to get engorged, it can and should be prevented if possible. Or fixed before it gets worse.

Engorgement happens when the breast is too full of milk and the tissues become stretched and inflamed. It happens when the milk is not being drained out of the breast adequately, either from a less-than-ideal latch that does not move the milk from breast to baby well enough, or from not breastfeeding or expressing milk often enough. Or both.

It can also happen if you use a cheap commercial pump that does not extract milk well or one that damages the breast tissue, causing inflammation.

Engorgement can be quite painful for mom. The breast can feel hot and tender to the touch. If the breast is really badly overfull, it can even feel like it’s on fire. If milk gets clogged inside the ducts, that can cause an aching pain deep within the breast.

Engorgement can make it hard for a baby to latch. S/he can easily slide off a breast that is too full. And a breast that is too full can gush and overwhelm the baby, who might choke and sputter and learn to resist the breast.

So this means it is important to really try to get a good, deep latch with baby actively, firmly compressing the breast tissue right from the beginning and to breastfeed every hour and a half or two hours — or more often if baby hasn’t gotten enough milk or if your breasts are feeling really full.

The feeling of fullness can tend to happen if the latch isn’t as good and deep as it should be to effectively remove milk, or if your breast makes milk quickly. Moms who are more full faster might need to breastfeed more often than mothers whose breasts fill up slower.

For those whose breasts gush, it might be helpful to express some milk ahead of breastfeeding, and to lie back or lie down to “stem the tide” so to speak. Some mothers need to offer the same breast after a little rest or burp, before switching sides. It depends on the individual mother-baby pair, and learning to read the baby’s cues for when to switch.

It can be helpful to use a warm washcloth to help get the milk flowing before you actually start breastfeeding. Or take a soothing warm shower and let the water flow over your breasts. Some moms find that this gets the milk flowing ahead of breastfeeding. This is good, and can help relieve the breast fullness and help baby get a better, deeper latch.

You can even bring baby into the bath with you — it helps to have an assistant for this. Get in the tub and then someone can carefully hand baby to you. The warmth can help increase milk flow, reduce pressure within the breast, and help the flow slow down. Then hand baby back to your helper before getting out of the tub.

Besides warmth, cold cabbage leaves really can help reduce swelling for some moms. It sounds crazy, but research actually shows it can help.

Remember, if you do become engorged, the best thing you can do is KEEP BREASTFEEDING, with a great latch, and breastfeed often. Your milk will still be the same quality, because the inflammation, if any, is in the breast tissue itself, and not in the milk.

Continuing frequent breastfeeding is helpful for reducing the inflammation, in fact. If the breast continues to stay inflamed, this can result in mastitis, which needs medical attention. You can keep this from happening by making sure that your milk is removed often, ideally by a well-latched and content baby.

Even if you are experiencing pain or discomfort from engorgement, baby breastfeeding will actually help relieve the pain, if s/he is latched well — since the nipple will be well back in the baby’s mouth beyond the hard palate where the nipple can rub and get sore. But if the nipple is deep then it will be near the soft palate at the back of the baby’s mouth. And that should not hurt.

But if you try all these things and you are having difficulties with latching and/or removing your milk, then it’s a good idea to get help and to do this sooner rather than later.

If your breasts are swollen and unbearably painful it might be an idea to ask your doctor or nurse if it would be okay to take a painkiller temporarily as you resolve your breastfeeding challenges, and to take the medicine only as directed. Usually acetaminophen is strong enough, but make sure to check with your doctor before self-medicating.

As for the breastfeeding challenge itself, a lactation consultant can help you resolve engorgement issues — or help you prevent them from happening in the first place.