Engorgement: when your milk comes in and you feel like a porn star with a bad boob job.

Around day three to day five, if your breasts become really hard, warm, red, and shiny, then you are probably engorged. Don’t freak out!  This is temporary and you will get through it!

Normally:

  • You can expect your milk to come in three to four days after giving birth.
  • You will know your milk is coming in because your breasts will feel fuller, warmer, heavier, and perhaps a little swollen and uncomfortable.
  • We don’t judge milk coming in by the quantity or color of your milk, although it does tend to increase in volume and change from a yellow to a white color.
  • You can expect a low grade fever of 99.0-100.3 that goes away in about 24 hours.

It is not normal:

  • If your breasts are really firm and really tender.
  • Your breasts are so full and the areola is so taught that you can’t latch the baby well anymore or latching has become newly painful.
  • If you spike a fever of 100.4 or higher (call your midwife or OB).
  • If there are lumpy sections of your breast that aren’t softening at all after breastfeeding (see your Lactation Consultant).
  • If your breasts still feel really full, firm, and uncomfortable five or more days after baby is born (see your Lactation Consultant).

What’s going on?

Most people think engorgement is due to too much milk, but really it is your body freaking out about lactating—it isn’t used to being filled with milk! Most of the problem with engorgement is swollen tissue, not too much milk.

What to do if you are engorged: cool before, warmth and massage during, cool after.

To decrease swelling:

  • Apply ice to your breasts for twenty minutes on and twenty minutes off between breastfeeding sessions.  Frozen peas, ice diapers, or cold rice socks work well. Don’t put the ice right on your skin; keep a layer of fabric between you and the ice.
  • Take 600 mg Ibuprofen (Motrin or Advil) every six hours.  This works better for decreasing inflammation than Tylenol.
  • Once a day, apply a cold, clean cabbage leaf to each breast and let it wilt. (This actually works to decrease milk supply slightly, so don’t do it more than once a day).

To move milk:

  • About five minutes before breastfeeding, apply warmth to the breast you are going to use.  Try a warm rice sock, a heating pad, or a warm washcloth.  This will help move milk, but it can also make swelling worse, so avoid a lot of heat.
  • Massage your breast before and during breastfeeding from the chest wall down to the nipple.
  • Continue to nurse frequently and on demand.  Aim for ten or more feedings in 24 hours and try not to let baby go more than three hours without nursing until engorgement resolves, as your breasts may get uncomfortably full at the three-hour mark, which makes latching harder.
  • Pay close attention to baby’s latch.  It is trickier to get a good latch when your breasts are engorged.  After the baby has nursed for a few minutes, if the latch still feels pinchy or uncomfortable, try unlatching and relatching.  Your breast may be a little softer and you may be able to get a deeper latch.

Keep your breasts from getting too full:

  • If the breast you are about to nurse on is really firm, hand express or pump just to take the edge off and soften the areola a little bit, then latch baby.
  • You don’t want to pump your breasts to fully soften them or your body will get the message to make more and more milk! Do pump or hand express just enough to keep them from feeling like they are going to explode.
  • Encourage baby to nurse from both breasts. If baby will not accept the second breast and it is very, very full, hand express or pump to take the edge off, then apply ice.
  • If baby is not nursing well, or is not waking to feed, pump both breasts for about 15 minutes on a comfortable setting.  You will need to feed this milk to the baby via bottle, spoon, or syringe.

Seek help by making an appointment with an International Board Certified Lactation Consultant if:

  • You can’t get a comfortable latch.
  • You have open cracks or wounds on your nipples.
  • There are lumps in your breasts that aren’t softening even after multiple nursing sessions.
  • Engorgement lasts for five or more days after the birth of your baby.

Call your Midwife or OB ASAP if:

  • You spike a fever of 100.4 or higher (this is probably mastitis).
  • You feel flu-like symptoms, chills, body aches (this is probably mastitis, too).
  • You have a very painful, red, warm lump in one or both of your breasts (this is probably a plugged duct).

Still pregnant?

If you are local to the Wilmington, DE area, I would love to meet you at an upcoming Breastfeeding Basics class.

Too far to travel? No time for live classes? Check out comprehensive online program: The Pregnant Mama’s Guide to Breastfeeding Success

Currently Nursing?

Come see me or one of my fabulous colleagues at The Birth Center in Wilmington, DE. Let us take the time to teach you about your own unique baby and breastfeeding relationship during a one on one consultation.

One Comment