Engorgement

Definition

Temporary breast swelling which occurs 3-5 days after delivery when colostrum (yellow) changes to mature milk (white). Caused by the increased milk volume and tissue swelling (edema) making it difficult to release the milk. The breasts become full and heavy, pink, achy, warm, hard and shiny with lumpy areas. The fullness may make the nipples less prominent or flat causing the baby to have difficulties latching on frustrating both mother and baby.

Causes

May be due to infrequent short feedings, poor positioning, shallow latch, incorrect or weak sucking, sore nipples, a sleepy or jaundiced infant causing missed feedings or by the use of supplements making baby less hungry for the breast.

Prevention

Wake sleepy baby every 2½ to 3 hours (8–12 feedings per day) by removing from blanket, changing diaper, or using a cool cloth to infant's face
Nurse on each breast for 15–20 minutes at every feeding
Correct positioning to provide a deep latch-on to empty milk sinuses
Gentle circular massage from outer edge of breast towards nipple before and during feeds
Avoid pacifiers
Rest, well balanced diet, ample fluids for mother

Treatment

Apply warm, moist heat compresses (warm water in clean diaper), warm shower or leaning forward and immersing breasts in a warm basin of water to dilate ducts
Hand massage of breasts prior to feeding to make nipples and areola softer for better, deeper latch
Use relaxation, shoulder massage and visualization before and during feeding to enhance flowing of milk
Continued frequent breastfeedings to empty breasts
Following nursings, recline on back - cover breast with a thin towel and apply frozen bag of vegetable or ice for 20 minutes to reduce swelling
Chilled cabbage leaves may be placed inside bra for ½ hour twice a day (should be avoided by anyone with a sulfa allergy)
Use of a roomy, but supportive bra with dry cotton nursing pads may provide comfort
Empty breasts using a medical grade electric breast pump in severe cases to prevent atrophy of milk ducts. Inexpensive single store bought pumps should BE AVOIDED to prevent further trauma to already inflamed breasts
Call a professional for help if no improvement within 24 hours