Engorgement is a term that describes breast swelling that commonly occurs in the first week after childbirth. It is a transitional stage in breastmilk production where colostrum gradually changes to mature milk. There are individual circumstances that may delay this transition beyond the first week, in which case we recommend working with a lactation consultant.
Swelling related to engorgement is not necessarily the breasts “filling with milk” but rather a complex increase in blood and lymphatic fluid in response to breast changes. Therefore, the goal of managing engorgement is not to “empty the breasts” but alternatively, manage symptoms as the breast milk supply self regulates.
Common symptoms of engorgement include:
- Breast swelling
- Breasts feeling very firm (can be as firm to touch as the forehead)
- Breast tenderness and discomfort Postpartum is also a hormonally unique time, where the body re-adjusts after delivery. This can include fluctuations in body temperature. If you are concerned about the way you are feeling, develop a fever >100.4F, or experience flu like symptoms, it is important to follow up with your healthcare provider.
Management:
- Breastfeed frequently in response to baby’s hunger cues. When the breasts are especially full and taut, it may be hard for your baby to latch. Reverse pressure softening or alternatively hand expressing for 1-2 minutes prior to latching can soften the areola.
- Please note that pumping to “empty the breasts” can worsen engorgement. If your baby is latching well and frequently, we do not recommend pumping. Your circumstances may be unique. If pumping is a part of your feeding plan, please follow up with a lactation consultant to ensure proper breast pump usage.
- Take 600mg of Motrin every 6 hours with food to decrease inflammation and discomfort. You can also concurrently take mg of Tylenol every 6 hours with Motrin. Please follow up with your provider if you have any allergies to these medications to discuss alternative options.
- Apply cold compresses for 15-20 minutes between breastfeeding. Do not apply ice directly on the skin, we recommend a barrier such as a thin cloth.
- Wear a supportive bra without underwire
- We do not recommend applying heat or aggressively massaging the breasts, as this can worsen inflammation and cause tissue damage.
When to follow up:
- If your symptoms do not improve in 2-3 days of management, or you develop a fever or flu like symptoms, please contact our nurse triage line at (415) 666-1250
- If engorgement is impacting your baby’s ability to latch, or causing a decrease in your milk supply, we recommend working with a lactation consultant. If you delivered your baby at CPMC, we recommend following up with the lactation consultants at Newborn Connections. Newborn Connections phone number: (415) 600-2229
