Guest Author - Jessica Gunsch

Engorgement is a painful, yet common problem in the first days postpartum when your body is establishing a milk supply. It usually lasts about 24 -48 hours but it can occur anytime in the first few months, especially if it is your first child. (It can also happen anytime during the breastfeeding years when you are away from your baby at a time which you would normally nurse and when you begin to wean.)

Your body works hard to ensure that you will have plenty of milk for your baby before the two of you establish a supply and demand routine. As a result, there is usually an over abundant supply of milk, an increased blood supply to the breasts and sometimes extra fluid or edema of the breasts; which all result in engorgement. When your breasts are engorged they become rock hard, painful to the touch and probably leaky. For me, engorgement felt like I was carrying around a couple of overfilled water balloons that were about to pop at any second! Remember that this will soon pass. In the meantime here are some tips that can help to relieve your discomfort.

An ounce of prevention is worth a pound of cure.Doing everything you can to prevent engorgement is crucial. Do not give your baby any pacifiers, bottles or supplements for the first week or so. Nurse your baby as soon as possible after delivery; at least within the first hour and continue to nurse often thereafter.

In the first days of breastfeeding, you do not want to encourage your body to produce more milk if you become engorged, so it is important not to express breast milk to relieve the pressure if possible. However, extremely engorged breasts can cause your nipples to flatten and your baby might have trouble latching on. If this happens you should try to express some milk either manually, with a breast pump, warm compresses or a warm shower. Express only enough milk to allow your nipples to return to their normal shape so that the baby can latch on.

You should nurse your infant every one or two hours and at the first sign of engorgement. Sometimes newborns are too cozy and sleepy to take the initiative to nurse so you may have to wake her. Co-sleeping with your baby might allow your baby to nurse without completely waking; a win-win situation! Be sure to nurse on both sides so that both breasts are softened.

If your baby isn’t hungry, try putting ice packs on your breasts to relieve the pain. Warm compresses and showers also work but they tend to encourage milk let down. This will initially provide relief but can aggravate and prolong engorgement later on.

If your pain is severe, you can take a mild painkiller such as acetaminophen (Tylenol) but be sure to get the okay from your doctor first. When using painkillers, you should take them just before nursing to prevent unnecessary medication from entering your milk.

Note: In some cases engorgement can lead to plugged milk ducts and mastitis so it is important to treat engorgement. Plugged ducts are characterized by hard painful lumps in the breast. Plugged ducts can lead to mastitis which is a bacterial infection in the breast. Symptoms of mastitis resemble flu symptoms along with breast pain. If you suspect mastitis call your physician. Both are most effectively treated by frequent nursing and/or pumping. Mastitis may require antibiotics. Neither of these will cause harm to your baby so you should not discontinue to breastfeed for this reason.

If you become engorged because you are temporarily away from your baby, you will get immediate relief by pumping or manually expressing milk. This will not affect your milk supply or cause further engorgement. If you become engorged because you have returned to work, take the opportunity to express milk for your baby’s caregiver to give to your baby later.

If you have had to wean suddenly, try not to express milk to relieve the engorgement (but keep in mind the potential for plugged ducts and mastitis). Expressing milk will only prolong the process. Instead take painkillers and use cold packs to provide relief. Cold compresses of cabbage leaves are said to relieve engorgement and help dry up your milk.