Understanding Engorgement in the Postpartum period

Breast engorgement is a common concern among new nursing mothers when their milk comes in, causing breast pain and sometimes difficulties in nursing or pumping, and is a common reason to call a lactation consultant. In this blog post, we will break down the causes of breast engorgement during the postpartum period and provide practical advice on how to alleviate it.

WHAT IS BREAST ENGORGEMENT?

Breast engorgement typically occurs a few days after childbirth during a phase called "lactogenesis II” or “the onset of copious milk production” (commonly referred to as the “milk coming in.”) This is when a woman's body transitions from producing colostrum to mature human breast milk and the milk starts to be produced in larger volumes. It can be a sudden and uncomfortable experience, often happening when you're at home and away from health care providers or lactation specialists.

Breast engorgement is characterized by the breasts becoming hard, swollen, and painful. It happens not only because milk production increases but also due to inflammation and fluid buildup in the breast tissues. Engorged breasts can make it difficult for babies to latch and for milk to flow easily through the milk ducts, causing frustration for both the mother and the baby and can put you at risk for a breast infection.

Managing Breast Engorgement

The good news is that breast engorgement typically resolves on its own within 24 to 48 hours. The key is to express milk from the breasts regularly, whether through nursing, hand expression, or pumping. If your baby is nursing well, then allowing your baby to nurse at the breast as often as they want or need to is the best way to help with the engorgement and also help your body learn how much milk it needs to produce for your baby.

Hand expression is often the next best technique for the removal of milk during engorgement, either alone or in combination with using a breast pump. If you need to pump, then you can initially pump based on time (10-15 minutes per pump session), but as your volume of milk increases, you want to make sure you are not removing significantly more milk than your baby is eating (unless you have a premature or sick baby who is not eating much or at all).

Here are some practical steps to manage breast engorgement and help ensure a healthy breastfeeding experience:

Reverse Pressure Softening

This technique involves gently pushing the fluid in the breast tissue back towards the chest wall and lymphatic system, reducing inflammation around the nipple and areola. You can use your fingers to press gently on the breast adjacent to the nipple (the areola), moving the fluid toward your back. Spend a few seconds in each area to soften the breast.

VIDEO DEMONSTRATING REVERSE PRESSURE SOFTENING

Ice Packs

Applying ice packs to the breasts (avoiding the nipple area) can help reduce inflammation and provide relief for painful breasts. Wrap the ice pack in a cloth or towel to prevent direct contact with the skin.

Ibuprofen

Over-the-counter ibuprofen is an effective anti-inflammatory medication that can help alleviate breast engorgement. Follow the recommended dosage instructions or the dosing recommended by your doctor (you may already be taking ibuprofen for vaginal or abdominal pain after delivery, and it will also help with your breast symptoms).

Lymphatic Massage

This involves a gentle, more generalized massage to relieve inflammation. Lift the breast slightly off the chest wall, tap it gently, and then gently pet the breast towards the armpit, where inflammation naturally drains. Be sure to maintain a gentle touch.  You can do this multiple times per day, as often as you need to.

It is incredibly important to remember that gentleness is key during these massages. Avoid excessive pressure, kneading, or using tools such as vibrators, as those methods can lead to more inflammation and potential complications like plugged ducts, mastitis or other medical conditions.

VIDEO DESCRIBING LYMPHATIC MASSAGE.

Summing it Up

Breast engorgement is most common during the first few days after birth, but it can occur later for various reasons. By using these gentle techniques, breastfeeding mothers can often relieve the discomfort and avoid more severe issues. Keep in mind that if you have persistent or worsening symptoms, it's essential to consult with a lactation consultant, breastfeeding medicine specialist, or other health care professional for further guidance and get answers to your breastfeeding questions.