E is for Engorgement

Engorgement can happen once your mature milk comes in and can last for a few days or more.  When your mature milk comes in you begin producing much larger quantities of milk than you were when producing colostrum.  In addition to the extra milk your breasts also fill with extra blood and fluids to help in the milk production process.  Usually this occurs two to five days after your baby is born.  This engorgement will last while your body regulates your milk production, adjusting your supply to fit the demands of your baby – this could take a few days or weeks.  If you are not breast feeding this period can be particularly uncomfortable.

Once your mature milk arrives your breasts will likely increase in size, become heavier, firmer, and warmer.  They will likely also be uncomfortable.  But not everyone experiences full blown engorgement; they may simply notice the increase in size and weight.  Engorgement can cause your breasts to be lumpy, hard, and swollen possibly all the way to your armpits.  It can increase the size and firmness of your breasts to the point that your nipples flatten, this can make it very difficult for your baby to latch.  To help your baby latch in this situation use your fingertips to apply gentle pressure completely around the base of your nipple, and hold for one minute.  This will create dimples on the areola and slightly raise the nipple making it easier for your baby to get a good latch.  Engorgement is made worse if your baby has a bad latch or isn’t sucking well.  Thankfully engorgement is only temporary.  Although it can recur when your baby starts sleeping through the night or weans – any abrupt change in your baby’s nursing habits can cause engorgement. 

To prevent severe engorgement the best thing you can do is get a good latch with your baby and ensure he/she is emptying your breast properly before your milk comes in.  Nurse frequently, at least every three hours, and never skip a feeding.  The first few weeks there is no such thing as nursing too often, when your baby unlatches on one side, always offer the other side.  Whatever you do, don’t stop nursing!  This will only make engorgement worse, if you are unable to nurse your baby – make sure you pump during that missed feeding.

Severe engorgement for an extended period of time can lead to mastitis, so make sure to look for signs of infection and contact your doctor if you have a high fever and flu like symptoms in addition to engorgement. 

Finding Relief

When breastfeeding, the best source of relief is your baby.  If your breasts begin to become uncomfortable, offer them to your baby and see if he/she will nurse.  If your baby isn’t interested in nursing at that time, or your breasts are too firm for him/her to latch, there are other ways to find some relief.  Try taking a warm shower, using a warm compress, or massaging your breasts until they begin to leak – limit the use of warmth to 5 minutes though to keep from swelling.  If you still need relief, after each nursing session you can use a cold compress for a few minutes to help reduce swelling.

If those options don’t work, you can use your breast pump to express milk just to the point of comfort.  You do not want to pump for too long or completely empty your breasts as this tells your body to increase your milk supply, perpetuating the problem.  On the other hand you do not want to let the engorgement go on too long as full breasts send your body a signal to decrease milk production.  After trying all these relief techniques, if you are still experiencing engorgement, some women find one pumping session completely emptying both breasts can finally solve the problem and any future discomfort can be solved simply with nursing or applying warmth.

While nursing, you can massage or compress your breast to ensure your baby completely empties the breast.  When nursing your baby while engorged, once your breasts have softened slightly un-latch your baby and re-latch to ensure your baby has a good deep latch that will empty your breast fully.

If you are not breastfeeding or pumping and are looking to decrease or stop your milk production there are other sources of relief for you.  If you plan on pumping or breastfeeding, do not use these methods for relief as they can drastically decrease your supply.  Green cabbage leaves can be chilled in the freezer and inserted into your bra, changing them for fresh chilled leaves once they warm up.  This process may smell a little, but has been found to work rather quickly for some moms and the cold helps with comfort and swelling.  Sage tea has been said to help dry up your milk, you can steep dried sage in hot water and drink a glass 3 times a day – you may need to steep it with a tasty tea or add honey to help cut the bitterness.  Peppermint tea has also been said to help, and it a bit tastier.  An estrogen based birth control can also help with the drying up process.  Decongestants are used to dry up mucus when sick and can also dry up other fluids in your body, including breastmilk.  These are not intended to dry up milk though, so you may want to ask your doctor before using these for that purpose – he may be able to prescribe a medication, cabergoline, intended for this purpose instead.

Weaning

If you wean gradually you are unlikely to experience engorgement again.  However, if your baby or you decide to just stop nursing one day, you will likely experience some engorgement.  At this point you can try any of these methods if you wish to dry up your supply. 

When your baby would be nursing, pump instead.  Each week remove one pumping session (the same one each day) to gradually wean and avoid possible engorgement.

Chilled green cabbage leaves used as described above, sage tea, peppermint tea, and an estrogen birth control can all help with the drying up process.  As a last resort, talk to your doctor about using a decongestant or prescription medication to aid in the process.

How long did your engorgement last?  What gave you the most relief?

Next week I will be blogging on the letter F… F is for Fundal Massage.