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. Your breasts may have become engorged because your body is making more milk than your baby’s needs or it may be from excess swelling called edema from your body's response to IV fluids. Either way, breast feeding may feel impossible.
What not to do first. A lot of mothers pumping and bottle feeding for a few days assuming that once the swelling goes down, baby will latch. Unfortunately, this can cause problems. One is flow preference, if you do not use a technique called Paced bottle feeding. The milk flow from the bottle may be so fast that your baby easily becomes frustrated with a slower flow from you. The second is nipple confusion. Artificial nipples are much firmer and longer than most natural nipples. Babies are hard wired to close their mouth with they feel something touch their palate. Artificial nipples can cause super stimulation of the palate. So when you try to the breastfeed after a few days, they will latch shallow or refuse to latch at all. Mother's will say my baby keeps shaking their head on the breast and pushes off crying.
This is nipple confusion, baby is not getting the right signals to close their mouth and suck because the natural nipple is not touching the palate as firmly as an artificial nipple would.
Prevention is BEST
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.
Tap baby's lips with your nipple to stimulate a big wide mouth when latching.
Gentle massage hard areas of your breasts in a circular or downward motion to increase flow when baby is nursing.
Do not skip feedings or offer formula instead.
Use cup feeding or a syringe if you need to supplement your baby.
Resolving Engorgement
Gently massage your breast in circular motions and apply a warm compress before latching your baby.
If a warm compresses and massage are 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. Deep breast compressions: https://www.youtube.com/watch?v=25qhrc4Y0tU
Apply cold compresses or bags of frozen vegetables to your breasts after feedings to help with swelling
If your nipples are flat from swelling, 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.
Congratulations! Baby has latched. Now what?
Use a combination of deep breast compressions and massage to keep your breast soft during the feeding so your milk will 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 expressed and feed it to your baby using an eyedropper, syringe, small medicine cup or teaspoon. Sit your baby up right for cup or spoon feeding. Gently touch the spoon or cup to your baby’s lip and allow baby to lap it with their tongue. After a little calories, your baby will be more alert and ready to nurse.
Look for signs of satiation. Baby's hold their hands close to their face when they are hungry because they are meant to self attach. They are trying to bring and hold the breast in their mouth. As the feeding progresses well, their hands will drop away from their face and their fists will open. You know your baby is satisfied when they are "milk drunk" with floppy arms and relaxed legs.
In between feedings apply cold compresses to your breast for 15 to 20 minutes. Use soft gel ice packs, cold wet towels or frozen bags of peas. Try not to use hard cold packs, they can potentially bruise distended breast tissue. You can also apply cold cabbage leaves with the veins crushed for 10 to 15 minutes 3 times a day only. Place the cabbage leaves inside your bra to hold them in place. At night sleep on your back to help the swelling drain out of your breasts. Don’t limit your fluid intake, it can make engorgement worse. Try eating fruits like watermelon that are natural diuretics. If none of these suggestions work, it’s time to call for professional help.
Helpful videos:
Hand expression: http://newborns.stanford.edu/Breastfeeding/HandExpression.html
Reverse Pressure Softening: https://www.youtube.com/watch?v=2_RD9HNrOJ8
Cup feeding a newborn: https://www.youtube.com/watch?v=o01U_i2CDFw&t=3s