What is breast engorgement?

Some new mums experience breast engorgement when their milk starts ‘coming in’ a few days after the birth. It’s usually temporary and easily treated – read on to find out how

What is breast engorgement?
Medela expert Sioned Hilton
Sioned Hilton, health visitor, neonatal nurse and lactation consultant:
Mum-of-three Sioned has been supporting families with babies and young children for more than 30 years. As well working with breastfeeding and expressing mothers, both in hospitals and the community, she contributes to parenting magazines and conferences, and delivers workshops for healthcare professionals.

When you first start breastfeeding your baby, your breasts produce colostrum in small amounts that gradually increase over the first few days. But after around two to four days they start making much larger quantities of milk – a change known as your breast milk ‘coming in’.1

One of the signs milk is coming in is your breasts become fuller and firmer. This swelling is not just caused by the greater quantity of milk, but also by increased blood flow and extra lymph fluids in your breast tissue.2

For most new mums, if their baby is feeding well and frequently, these feelings of heaviness pass without problems. But some produce almost more milk than their breasts can hold, which makes them feel rock hard and uncomfortably full – a condition called engorgement. While this is usually only temporary, the 24 to 48 hours it typically lasts for can be painful.

What do engorged breasts feel like?

Engorgement can happen in one or both breasts. It may cause throbbing and swelling, sometimes extending as far as your armpit, and could make your breasts feel fairly hot or lumpy – this is because of all the activity going on inside. You may notice other breast engorgement symptoms, including the skin of your breasts looking shiny and feeling stretched, and your nipples becoming hard and flat. Engorgement may even cause your body temperature to rise to around 37.5 to 38.3 °C (99 to 101 °F).3

As well as being painful, breast engorgement can cause breastfeeding difficulties – which can, in turn, worsen the problem. Your baby might struggle to latch if your nipples are flatter and your breast tissue is harder, which can cause sore nipples. In addition, if your baby’s latch is poor she’s less likely to drain the breast well. This means that, if left untreated, engorgement can lead to blocked ducts, mastitis and reduced milk production.

What causes breast engorgement?

Engorgement usually occurs because a baby is not feeding frequently enough (at least eight times every 24 hours). It can happen to any new mum, but is more common in women who’ve had previous breast augmentation or other breast surgery.2 Pressure from a badly fitting bra or tight clothing can make the discomfort worse, and may lead to blocked ducts and possibly mastitis.

Breast engorgement can happen to women who don’t or can’t breastfeed, as well as those who do. The hormonal changes that follow delivery of the baby and placenta, which cause an increase in milk production, occur whether you breastfeed or not. Engorgement can also happen if you suddenly cut breastfeeds, perhaps because your baby is sick, sleeping longer, starting solids, or going into childcare.

How can I treat engorged breasts?2

The most effective breast engorgement treatment is a hungry baby! You should try to empty your breasts as much and as often as possible to help keep milk flowing – so feed on demand, between eight and 12 times every 24 hours.

Keep your baby in skin-to-skin contact with your chest for as long as possible throughout the day, and when you’re awake at night. This way she can smell the tempting aroma of your milk, has easy access to your breasts, and you’re more likely to spot her early hunger cues so you can ensure she feeds frequently. Let her take as much milk as she wants from one breast before offering the other.

It’s also well worth getting your baby’s latch and positioning checked by a lactation consultant or breastfeeding specialist, to make sure she’s feeding effectively and draining your breasts properly. The tips below may also help relieve symptoms.

Tips for engorgement relief2

  • Ensure you’re breastfeeding a minimum of eight times every 24 hours.
  • Check that your baby has a good breastfeeding latch.
  • Try breastfeeding in different positions.
  • Massage your breasts gently while feeding to help the milk drain effectively.
  • Express a little milk, either by hand or with a breast pump before breastfeeding to help soften your nipple so it’s easier to latch on to.
  • If your breasts are still very firm and full after a feed, express again until you feel comfortable.
  • If your baby is unable to breastfeed, replace the feeds with expressions. Pump your breasts until they feel much softer – a minimum of eight times every 24 hours.
  • Try ‘reverse pressure softening’, a technique that can move excess fluid from the breast. A lactation consultant or breastfeeding specialist can show you how to do this.
  • If your breasts are leaking milk, try a warm shower or applying a warm, wet flannel just before breastfeeding or expressing to soothe them and help milk flow. Don’t do this for more than a couple of minutes, as too much heat may worsen swelling.
  • If your breasts aren’t leaking, apply a cold compress, chilled gel pad, or even frozen peas wrapped in a cloth, to your breasts for ten minutes after a feed to reduce swelling and relieve pain. 
  • Tuck clean cabbage leaves inside your bra. Yes, really! Many mums find they help reduce swelling and discomfort, and there’s scientific evidence to back this up.4
  • Take anti-inflammatory painkillers. Paracetamol and ibuprofen can be used while breastfeeding, although ibuprofen has contraindications for asthmatic mums. Always consult a healthcare professional and follow the manufacturer’s and pharmacist’s guidance. It’s generally best to avoid aspirin – for more on which medicines you can take while breastfeeding, read Breastfeeding while sick.
  • Wear a properly fitted nursing bra and avoid underwires, or you may prefer not to wear a bra.
  • Don’t skip feeds or stop breastfeeding suddenly as you could make the engorgement worse.

Seek medical advice if you develop a fever5 of around 38 °C (110 °F) or above, or if your baby is unable to breastfeed because of the engorgement.

Finally, try to be patient. Your body is still getting used to making milk and feeding your baby. The engorgement should soon subside as you both get used to breastfeeding.

References

1 Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12(4):211-221.

2 Berens P, Brodribb W. ABM Clinical Protocol# 20: Engorgement, Revised 2016. Breastfeed Med. 2016;11(4):159-163.

3 Affronti M et al. Low-grade fever: how to distinguish organic from non-organic forms. Int J Clin Pract. 2010;64(3):316-321.

4 Boi B et al. The effectiveness of cabbage leaf application (treatment) on pain and hardness in breast engorgement and its effect on the duration of breastfeeding. JBI Libr Syst Rev. 2012;10(20):1185-1213.

5 NHS Choices. How do I take someone’s temperature? [Internet]. UK: NHS Choices; updated 2016 June 29. Available from: www.nhs.uk/chq/pages/1065.aspx?categoryid=72