A few days after birth, your milk will come in and it’s at this stage that some breastfeeding people experience tender, engorged breasts that feel swollen, hot, and hard. Let’s look at how to manage it.

WHAT IS ENGORGEMENT?

Engorgement occurs when there is an increased milk supply and blood flow to the breasts, causing them to feel hard, heavy, hot, and incredibly tender – it can even be painful for some people, almost like their breasts are going to burst! Your breasts may look shiny, feel warm to the touch, and you may experience a slight throbbing sensation, while the areolas and nipples tend to feel hard and tight.

Engorgement typically occurs in the first days after birth when the milk ‘comes in’. As much as engorgement is due to the breasts being filled with more milk, it is also due to swelling from the extra blood flow which arises to support milk production. Engorgement in this stage of breastfeeding is usually temporary and will settle down as your milk supply regulates.

Engorgement can also occur in other circumstances, such as when a breastfeeding or pumping session is missed or delayed for several hours, or if a baby is weaned from the breast too quickly.

HOW TO PREVENT AND MINIMISE ENGORGEMENT

• Feed your baby on demand, as often as they want to during the day and at night. 8-12 times in 24 hours is a good guide to follow but your baby may want to feed more than this. Following a routine or feeding schedule can result in more instances of engorgement and mastitis if your breasts aren’t drained often enough.
• Allow your pēpi to finish feeding on one breast before offering the other side.
• Don’t limit your baby’s time at the breast. Let your baby feed until they are showing signs of being full.
• Make sure your baby is latched and positioned correctly to ensure they are emptying the breasts efficiently.
• If your baby is unable or unwilling to nurse well, you’ll need to express regularly and frequently to minimise engorgement and keep up your milk supply.

TREATMENT TIPS

• The best treatment for engorgement is breastfeeding your baby sufficiently, effectively and frequently.
• Apply a cool compress before breastfeeding and between breastfeeds to reduce swelling. Some people find applying cold cabbage leaves to also be soothing.
• Gently massage the breasts towards the nipple before and during nursing to help with milk flow.
• Hand express just before feeding if your baby is struggling to latch due to the engorgement.
• Practise reverse pressure softening to soften the areola at the base of the nipple prior to feeding – this helps resolve engorgement and aids with latching.
• If you are feeling uncomfortably full between feeds, hand express a little, just to comfort. Keep in mind that breastfeeding is based on supply and demand so pumping too much can encourage oversupply.
• Keep in mind that while using warmth can help with milk flow, it can also increase inflammation and swelling. If you choose to use moist warmth treatment (like the shower or a warm compress) it’s recommended to only do so for a few minutes at most.

WHEN TO SEEK ADDITIONAL HELP

If engorgement continues beyond a few days or you’re finding it difficult to latch your baby as a result, it’s best to seek advice from your LMC or a lactation consultant so you can manage it and continue breastfeeding successfully.

Untreated engorgement can also lead to blocked ducts and mastitis. If your breast/s appear to have a wedge-shaped area of inflammation that is pink, red or swollen (there may be red streaks and the skin can be shiny), or you have a fever, aches and pains, chills, fatigue, or flu-like symptoms, contact your LMC or GP as soon as possible.