Engorgement – too much of a good thing?

What is it?
A moderate to severe “over-fullness” of the breasts, especially during the first week after birth.

During the first day or two after delivering your baby, your breast tissue will probably feel firm but soft and pliant – fairly “normal”. Then, typically on day 2, 3 or 4 after a vaginal birth, or, day 3, 4 or 5 after a cesarean section, you may notice that your breasts are becoming warmer, tender and swollen. Some people describe this as “milk coming in”, as the colostrum becomes more plentiful and transitions into a thinner, yellowish milk. The breast tissue may feel very firm or even hard and extend into the armpit area. The fullness of the breast is only partly milk, it is also extra blood flow and body fluid (edema) creating the swelling. If this fullness transitions into a painful, hot, hard swollen breast, that is typically called “engorgement” as the breast is engorged, or “overfull”. Again, it’s not all milk that makes the breast so full and hard. But, frequent nursing (or expression) will provide some relief and encourage resolution of the symptoms.

Ice or Cold Packs: keep six small bags of frozen peas or corn in the freezer. These make the perfect ice packs to place around your breasts in between nursing sessions – the cold packs will help reduce swelling and provide needed comfort. Just keep refreezing and reusing, as long as needed.

Add ibuprofen. Ibuprofen is the generic name for Advil or Motrin. This NSAID (non-steroidal anti-inflammatory drug) can help in several ways: by offering relief from discomfort, reducing a low-grade fever (if present) and by helping to reduce the inflammation or swelling of the breasts. Use the ibuprofen (400 – 600 mg) every six hours regularly for best anti-inflammatory action. This medication is approved by the American Academy of Pediatrics for use in breastfeeding women and is considered safe for most. It’s recommended to take ibuprofen with meals or a snack. As always, check with your provider for specifics about your own care.

Engorgement care plan:

  1. Use ice after and between feeding sessions. Keep 6 small bags of frozen vegs (peas, corn) in freezer to re-use/re-freeze. These adjust/form perfectly over your breasts & under armpits just where you need and want them.
  2. Use warmth just before nursing or pumping. Hot washcloth or shower may help soften breast and get milk flowing.
  3. Ibuprofen 600 mg every 6 hours with meal or snack x 48 hours. Keep it up as an anti-inflammatory; it will help to reduce swelling and discomfort.
  4. Pumping to relieve engorgement: it’s okay! As long as you don’t pump frequently, then softening or even emptying your breasts once or twice a day will NOT lead to over-supply or make engorgement worse. Rock hard breasts are NOT healthy, and don’t make it easier to breastfeed.
  5. Not all the fullness in the breast is milk. It’s also edema, interstitial fluid. So pumping may soften breasts but may not relieve all fullness.
  6. Babies will latch easier when the areola is softer. Otherwise, it’s like trying to latch onto a firm beach ball with an M&M glued to it, covered in olive oil. Good luck, and she’ll just grasp the nipple and hang on for dear life. Ouch.
  7. You can use manual (hand) expression, or a manual-pump, or your electric breastpump to soften the breast just prior to nursing. Express to relieve fullness or allow the milk to let down and spray before bringing the baby to the breast.
  8. Positioning: Baby under breast will be overwhelming if the milk is flowing fast. Have baby’s head either level to, or above, the breast especially at the beginning of a feeding session when the flow is heaviest if he tends to cough, choke or splutter with fast flow.

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