Breastmilk engorgement

What is breastmilk engorgement?

Breastmilk engorgement is a common breastfeeding problem. In the time leading up to birth, a pregnant woman's breasts prepare to produce breastmilk. Lactation can begin during the pregnancy itself or shortly after birth, in time to feed the newborn. Engorgement occurs when the mother's breasts produce milk faster than the baby consumes it.

Engorgement can be painful and distressing to the mother and interfere with the baby's ability to attach correctly to the breast and feed.

Types

Primary engorgement

This can occur in the first few days after birth, as your body and your baby are still sorting out the breastfeeding process. This is normal and usually resolves on its own after a few days. ^[1]

Secondary engorgement

This can occur at any time during the breastfeeding period, for a number of reasons, including:

• Poor attachment of baby to the breast;
• Weaning child;
• The mother is unable or unwilling to breastfeed the child, and her breasts fill until breastfeeding is successfully suppressed;
• Hyperlactation - the mother naturally produces too much milk;
• Baby is feeding less than usual, or;
• The mother has undergone breast augmentation surgery.

Signs and symptoms

A normal full breast is warm and tender to the touch. The skin may look marbled (blood vessels showing), and milk flows from it easily.

An engorged breast is hot, hard and painful to the touch, the skin can look shiny and reddish, and milk does not flow easily from it. ^{[1] [2]}

Methods for treating engorgement

Feeding techniques

Some feeding methods that can help you to relieve engorgement include: ^{[3] [4]}

• Breastfeeding your baby as often and as much as it wants or expressing milk regularly;
• Massaging the breast while feeding;
• Encouraging your baby to feed when your breasts are full, even at night-time, and;
• Wearing a good, comfortable and supportive bra. Remove it completely before feeding.

Expressing milk

When an engorged breast becomes painful and difficult for the baby to latch on to, expressing some milk from it ('milking' the breast) can provide relief. It is better to express only until the breast stops becoming hard and painful, since an 'empty' breast is a signal for the body to make more breastmilk. Expressing a little milk from an engorged breast just before a feed can also help your baby attach better.

Warm compresses

During or just before feeding, warm compresses applied to the breast can aid the let-down reflex and encourage a better flow of milk.

Avoiding nipple stimulation

Milk production is stimulated when the nipples are touched and rubbed, in the way a feeding baby does. Avoiding clothes rubbing against your nipples between feeds will help prevent milk leaking and the breasts producing more milk.

Fluid restriction

Drinking less fluids will not affect your milk production.

Pain relief

Supporting bra

A firm supporting bra will put pressure on your breasts and prevent the pain and discomfort of engorged breasts moving.

Cold compresses and cabbage leaves

Icepacks and compresses placed on or around your breasts between feedings can help relieve pain. Cold green cabbage leaves used in the same way are equally effective - and for some women, more comfortable ^{[5] [6]} . There is no firm evidence that cabbage leaves reduce engorgement more quickly than any other substance. ^[7]

Pain-relief and anti-inflammatory medication

In some cases, your doctor may prescribe you pain-relief and anti-inflammatory medications to help with engorgement

Potential complications

If breastmilk engorgement is not treated, complications can include:

• Damage to milk-producing cells due to the pressure of continued engorgement, which can make milk production suffer; ^{[1] [2]}
• Mastitis, and; ^{[1] [2]}
• Mothers stopping breastfeeding due to engorgement. ^[2]

Prevention

Feeding technique

The feeding methods mentioned above for treating engorgement will help prevent your breasts becoming engorged in the first place.

Attachment

Correct attachment of the baby to the breast is a crucial part of successful breastfeeding. A well-attached baby will suckle easily, ensuring a good milk flow. For the mother, good attachment can often prevent engorgement as well as other problems such as sore or cracked nipples, mastitis and blocked milk ducts.

Recognizing and enabling good attachment

• Attachment is easiest when your baby is calm, especially during the first days;
• There is no one 'right' way to hold your baby when breastfeeding - every mother and child settle into the position that suits them;
• Your baby should not have to strain, stretch, or turn its head to suckle;
• Skin-to-skin contact calms your baby and encourages milk release and feeding;
• Baby's head will be tilted slightly backwards when feeding, with the chin digging into the breast. When the nipple brushes against the baby's upper lip, the baby will open its mouth wide and close it around the nipple and some of the breast around it. When feeding, the nipple is near the back of baby's mouth;
• A baby who is well attached to the breast will look calm and content. You will hear swallowing sounds, not sucking sounds;
• Your nipples should not be painful after feeding;
• If you need to stop your baby feeding, break the suction by inserting your little finger gently between the corner of your baby's mouth and the breast, and;
• Nipple shields, when used correctly, can help a baby attach the right way in some cases where attachment is a problem.

References

1. Mangesi, L. and Dowswell, T. (2010) Treatments for breast engorgement during lactation. In The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd. Accessed from link here
2. Pollard, M. (2011) Evidence-based care for breastfeeding mothers. A resource for midwives and allied health professionals. London: Routledge.
3. Mangesi, L. and Dowswell, T. (2010) Treatments for breast engorgement during lactation. In The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd. Accessed from link here
4. Murtagh, J., MD. (2011) John Murtagh’s General Practice (5th Revised edition edition.). North Ryde, N.S.W.: McGraw-Hill Medical Publishing.
5. Engorgement. Australian Breastfeeding Association. Accessed 19 November 2014, from link here
6. Roberts, K.L. (1995) A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. Journal of Human Lactation: Official Journal of International Lactation Consultant Association 11:17–20.
7. Nikodem, V.C., Danziger, D., Gebka, N., et al. (1993) Do cabbage leaves prevent breast engorgement? A randomized, controlled study. Birth 20:61–64.

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