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Engorgement: What is it and how to prevent it

Help with engorgement is probably the number one early breastfeeding call lactation consultants receive. The first few day after birth your baby is getting colostrum, a nutrient dense pre-milk. But as your milk starts to “come in” between day 3-5 after delivery, it changes from the sticky small quantities of colostrum, to transitional milk and finally mature milk. The change from colostrum to mature milk is usually smooth but sometimes it can be bumpy. Engorgement may start in the hospital or surprise you first thing in the morning after you are home. Your new lactating breasts are now supersized and really firm. When you try to latch your little one on the breast, your baby may push off crying or fall asleep after a few tries at latching. Even when your baby is hungry, your engorged breasts will not cooperate. If engorgement is severe enough it may feel like you are trying to shove a large ball through a mail slot.

Your breasts may become engorged because your body is making more milk than your baby’s needs or it may be from excess swelling called edema in your breast. Either way, breast feeding may feel impossible. Some mothers try pumping and bottle feeding for a few days until the swelling goes down. This may seem like a good idea but the early introduction of bottles can cause nipple confusion and flow preference so when you try to put your little one back to the breast after a few days they will latch shallow or refuse to latch.

How to Prevent Engorgement

  • Feed your baby often, listen and watch for active sucking and swallowing. You may hear gulping or a KAW sound with each swallow of milk. That’s great!

  • Nurse your baby often. It is not unusual for healthy newborns to nurse 8-12 times a day.

  • Help your baby open wide for a good, deep latch by tapping the lips with your nipple.

  • Do not skip feedings or offer formula instead.

Handling Moderate Engorgement

  • Gently massage your breast in circular motions and apply a warm compress before latching your baby.

  • If a warm compresses and massage is not helping, try a warm shower and gently massage your breast in the shower.

  • Use your thumb and forefinger to pull the nipple out before attempting to latch the baby. Special Note: Babies are hardwired to close their mouth when they feel the nipple hit their palate. Give them some to hold onto.

  • After you latch your baby, try deep breast compressions to keep baby drinking.

  • Apply cold compresses or bags of frozen vegetables to your breasts after feedings to help with swelling.

Severe Engorgement

If your breasts are very swollen and the nipples completely flat, try a technique called” Reverse Pressure Softening”. Use your thumbs or fingers to gently press firmly into the areola to “push” the milk back out of areola. Press gently inward until you feel the areola soften under your fingers, work around the entire areola. After the areola is soft, use Nipple Shaping to pull the nipple out before latching.

Use a combination of deep breast compressions and massage to keep your breast soft during the feedings and make your milk flow faster. It’s important to listen for good active drinking when your breasts are severely engorged. If you baby seems to be sleeping a lot at the breast try hand expression to remove a small amount of milk to soften your breast. Save any milk you hand express and feed it to your baby using an eyedropper, syringe or teaspoon. Sit your baby up right for spoon feeding. Gently touch the spoon to your baby’s lip and allow baby to lap it out of the spoon. After a little calories, your baby will be more alert and ready to nurse.

Hand expression video:

In between feedings apply cold compresses to your breast for 15 to 20 minutes. Use gel compresses or frozen bags of peas. Try not to use anything extremely firm that will bruise already distended breast tissue. You can also apply cold cabbage leaves with the veins crushed for 10 to 15 minutes 3 times a day only. Warning: over using cabbage leaves can reduce your milk supply. Place the cabbage leaves inside your bra to hold them in place. If you develop a rash discontinue using the cabbage leaves. At night sleep on your back to help the swelling drain out of your breasts. Don’t limit your fluid intake, it can make you’re your engorgement worse. Try to eating fruits like watermelon that are natural diuretics. If none of these suggestions work, it’s time to call for professional help.

Other helpful videos

Reverse Pressure Softening:

Cup feeding a newborn:

  • Nurse your baby often. It is not unusual for healthy newborns to nurse 8-12 times a day.

  • Help your baby open wide for a good deep latch by tapping the lips with your nipple.

  • Do not skip feedings or offer formula instead.

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