Breast Engorgement During Lactation

Breast engorgement is a painful hardening and swelling of the breast during lactation and has two main causes:

1. Excess fluid, usually from intravenous (IV) fluids, finds a path of least resistance and ends up in ankles and breasts, which allow for expansion and become swollen. This can happen even if you do not receive IV fluids, and usually happens in the first few days after the birth of your baby, but can last a week or more. This swelling (aka edema) is in the blood vessels and tissues in the breast, not in the lobules and milk ducts where the milk is. It is important to "chase" this fluid back out of your breasts so it does not put pressure on the milk ducts and restrict milk flow and to make it easier for your baby to latch onto a softer breast.

   1. To remove the excess fluid, perform what is known as reverse pressure softening, or softening of the breast by reversing the flow of this extra fluid. Use your fingers, slightly indenting your breast and sliding your fingertips over your breast from nipple to outer edges of the breast. It may help to go into your armpit. Repeat multiple times and work your fingers all around your breasts. This action should be started before your breasts become engorged, preferably within the first 24 hours after birth, and continued until your milk production greatly increases in the next three to five days. Continue performing reverse pressure softening longer than this if you have swollen ankles, which is a sign that you still have extra fluid circulating. Massaging your nipples before you start and with each stroke of your fingers will help increase milk production by increasing oxytocin and prolactin- two very potent hormones of lactation.

      
      

2. Excess milk. Which really is not excess milk but a lack of removal of milk frequently enough to keep your breasts soft. This type of edema has a significant negative effect on your milk production. When your breasts get full of milk, a protein in your body know as negative feedback inhibitor of lactation (aka FIL) causes your milk supply to decrease because it thinks you have excess milk. Every time your breasts get full, this protein continues to down-regulate your milk production, often leading to sub-optimal production of milk, no matter how hard you try to increase it later. This protein is what causes milk to dry up for those not wishing to provide breastmilk for their babies.

   1. To prevent milk edema, you must remove milk very frequently until you have achieved full milk production and your body knows how much milk you need. This means removal of milk at least 12 times/24 hours until your milk transitions to more mature milk, then often enough to keep your breasts soft, which could be as often as 18 times the day your milk transitions. Continued removal based of your breast fullness should be performed until you have reached full milk production and your baby has returned to birthweight and is thriving. The best form of removal is a well-latched full -term baby who feeds vigorously. If this is not the case, removal by hand expression and/or pumping is warranted.

      
      

   Cold compresses on your breasts may help with any discomfort after feeding or pumping, but should not be used immediately before feeding or pumping as cold restricts vessels in which the milk needs to flow out of.

   
   

   Warm compresses should not be used on any type of edema as heat brings more fluid to the area. Warm showers are often suggested for engorgement, but something warm like a hot pack or pad across your shoulders would be a much better suggestion, as that will help with relaxation and perhaps let-downs, which will further increase milk removal without adding to the edema.