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Engorgement: How to Manage the Discomfort and Protect Your Supply

Woman scrolling phone in nursing chair while holding a sleeping newborn

If you have ever experienced engorgement, you certainly know what I am referring to, and you probably don’t want to go through it again. In the beginning, you worry about your milk coming in, and wham – engorged. You survive on such little sleep and finally, the baby sleeps through the night, wham – engorged. You need to head back to work, so you start pumping like crazy to build your stash, wham – engorged. But what is engorgement and why is management so important?

What is engorgement?

Engorgement is an uncomfortable overfilling or distention in the lactating breast. The alveoli of the ductal system (think milk storage pods) are stretched full of milk causing swelling and pain in the breast tissue. It is most common in lactogenesis 1 or the onset of copious milk production – when your milk comes in, before it regulates. However, it can occur at any point during the breastfeeding journey. Some women experience it when they do not feed or pump on schedule, the first few times the baby sleeps a longer stretch at night, or while they are trying to wean and decrease breastmilk production. Whichever way it occurs, it can be uncomfortable, and if not well-managed, can lead to damage to the breast tissue or impact future milk supply. 

Here are six tips on what to do if you find yourself engorged. 

  1. Empty the breast If there is too much milk, remove some. Offer the breast often. Look for feeding cues, and at the beginning, try not to stick too much to the clock or a schedule. It is important to do this strategically, though. If your baby needs 3 ounces every 3 hours and you remove 7 ounces every hour, your body will think that it is what you need. Try just to remove the milk you need to feed or just enough to feel comfortable. Give your body time to regulate, especially in the beginning or when sleep is starting to come in longer stretches. It is okay to feed, pump, or hand express just what you need to feel better. You do not have to completely “empty” the breast bilaterally (on both sides) with every feed or pump session.

  2. Ice breast tissue after feeds  This will help to improve the inflammation and discomfort without stimulating increased production. An easy way to do this is to tuck a small bag of peas from the freezer into your bra. Cabbage leaves are also often used, but in my opinion cabbage stinks!

  3. Take ibuprofen If you can, take ibuprofen to reduce inflammation. Tylenol is also helpful for pain relief but is not as great with inflammation. Discuss with your healthcare provider alternative options if you cannot take ibuprofen or have questions about dosing. Ibuprofen is considered safe for the nursing mother. 

  4. Wear a supportive bra Find a supportive but not tight bra or tank top, and wear it 24/7. Give those Cooper's ligaments a break (ligaments that support breast tissue)! It is also recommended to avoid underwire. Constrictive bras can increase your risk for clogged ducts or mastitis with engorgement. Supporting the breasts will promote comfort and allow for improved emptying. 

  5. Hand expression Learning proper hand expression is my number one piece of breastfeeding advice. With mastitis, it is great for relieving a little pressure in a controlled manner. You can take off just enough milk to feel comfortable or for the baby to latch well, without overdoing it and causing oversupply. It is also less stimulating than using the double electric breast pump and can be done on one side if the baby feeds on the other. 

  6. Reverse pressure softening The aim of this is to displace edema or fluid buildup around the areola or nipple. This will allow the baby to latch onto a breast that would otherwise be too firm or hard and remove some milk. Videos on YouTube can help to teach this technique, as can an experienced IBCLC. Also here is a detailed description of the technique.

It is important to actively manage engorgement symptoms. Engorgement is common in the early days, and when not managed, it is a common reason for early weaning. The good news is that it does recede as milk regulates, but it can take up to two weeks. If the breast tissue remains engorged, it can lead to inflammatory mastitis, clogged ducts, or infection in the breast (bacterial mastitis or abscess). In these cases, you will not see improvement with the interventions listed above. If you do not see improvement over the course of 48 hours or begin to develop systemic symptoms (i.e. fevers, chills, body aches), you should contact your OB-GYN or PCP. 

Not removing milk from the breast can also impair breastmilk production or cause downregulation. If the milk sits in the breast, a peptide called FIL, or feedback inhibitor of lactation, tells the body to produce less, decreasing your supply. The more you take the milk out, the more you will make. Prolonged engorgement and inflammation can both damage the milk-producing tissue and tell the body you do not need as much. Finally, overfull alveoli make it hard for the prolactin receptor to work – the key to milk production can no longer fit in the lock. Keeping the breast tissue healthy and functioning well is always important along the breastfeeding journey.

Engorgement is uncomfortable and can be frustrating for both mom and baby. The good news though, is that engorgement should be transient. Within the first few weeks of nursing, your supply should regulate. If you are constantly engorged much longer than 2 weeks after starting your breastfeeding journey, talk to your provider about your supply and struggle. You may need to be evaluated for oversupply. No one should have to manage overfull, swollen, painful breasts for the entirety of breastfeeding, and hopefully, now you will feel confident managing an occasional wham of engorgement!

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