Breast Engorgement

Category: Birth & Beyond

Breast engorgement, unfortunately, is a common problem. MH speaks to the experts on how to deal with it.


Breast engorgement is when your beautiful, life-giving, new-mummy breasts swell and become hard, lumpy, throb or feel painful. In more severe forms, the pain may spread to your armpits and you may run a mild fever.
According to Kang Phaik Gaik, senior nurse manager and senior lactation consultant at Alvernia Parentcraft Centre, Mount Alvernia Hospital, “It is a common minor problem for breastfeeding mothers which occurs around three to five days after delivery.”

What Causes it?
As soon as you deliver, you stop creating pregnancy hormones – elevated levels of estrogen and progesterone drop – and instead, your body starts producing prolactin, which kick-starts milk production.
For the first few days, your breasts are likely to feel normal while you are producing colostrum, also known as “the first milk”. Colostrum is rich in antibodies and very important for baby’s protection. After a few days, when your milk comes in, it is totally normal for your breasts to become larger, warm, swollen and more tender and this is called engorgement.
Pain and the hardening of the breasts are caused by a few things: Kang says that “increased blood and milk supply, delayed initiation of breastfeeding, infrequent feeding, improper latching and omitting night feeding”, all can cause engorgement. It can also happen if you have a normal breastfeeding routine but there is a sudden drop in the amount of milk you pump or if baby suddenly starts drinking less.

Severe engorgement can be problematic as it may make it difficult for your baby to latch on and milk flow may lessen.

The easiest way to help your breasts not become overly full is to begin breastfeeding as soon as possible after the baby is born. Begin in the delivery suite with the help of your nurses. Kang says, “On your admission for delivery, inform delivery suite staff of your choice of feeding. Try to have skin-to-skin contact with baby immediately after birth. Initiate breastfeeding when the baby shows readiness to feed in the delivery suite.”
Unless medically advised, try to avoid using bottles and pacifiers too early, especially while your baby is learning to breastfeed. Once your milk has come in, breastfeed at least eight times in 24 hours to prevent over fullness – but always be aware of     baby’s demand for the milk.
If you need further advice, consult your hospital lactation consultant especially if you need help with baby latching on. Kang advises that you “Read, attend talks or an antenatal course, and chat with other breastfeeding mothers to gain more breastfeeding knowledge before delivery.”

If you are away from your baby and miss a feeding, don’t forget to hand express or use a breast pump to remove the milk and keep the flow regular. When it is time to wean your child off breastmilk, always do it gradually and never stop cold-turkey.

If you are experiencing some pain, there are a few things you can do at home to help yourself feel better. According to Kang, “If the breasts are hard and painful and milk is not leaking, you can minimise swelling and pain by applying chilled cabbage leaves one to two times for an hour each time or apply cold packs to soothe the pain and to reduce swelling to encourage better milk flow.”
Helen Espina Cruz, senior lactation consultant at Raffles Hospital adds, “Avoid applying cabbage on the nipple and areola area. Once you feel better and the breasts are not engorged, don’t apply cold cabbage or cold packs anymore as this will decrease the milk supply.” The important thing to remember is to feed the baby as frequently as possible on demand.

Kang also suggests that you try massaging your breasts in the following manner: use a “circular motion from the outer part of the breast to the inner part of the breast, then press in towards the chest and stroke down from the top of the breast towards the nipple. Cup your thumb and fingers behind the areola and press inwards towards the chest, then compress the edge of the areola”. This softens it so that baby can latch better.
Finally, make sure you are wearing the right bra. Cruz says, “The nursing bra should be well fitted and should not be a tight, wired bra. Good support is important for comfort as the breastmilk is increasing in volume.”
In general, home treatment only gets you so far. “You need to see a doctor if you experience mastitis with fever, flu-like symptoms, chills, colds, body aches or redness on the breasts,” says Kang.

To Breastfeed or not to Breastfeed?
Most experts would advise mothers to breastfeed if they can because it brings a whole host of benefits – from helping to create the bond between you and your baby to breastmilk being the healthiest option for baby.
Also, Kang says that “latching your baby has a faster relief of breast engorgement than expressing milk with a pump. Latching baby helps to drain the breasts better with better milk flow and reduces swelling. If you choose not to latch your baby, you need to massage breasts before expressing and between expressing to encourage better milk flow. Hand expression allows faster relief than a breast pump”.
Cruz adds that if you choose to stop breastmilk production completely, then you need to “decrease the frequency of feeding to gradually decrease the milk supply. Applying chilled cabbage or a cold pack will gradually suppress the milk production”.
“Chilled cabbage leaves can be used four times a day for four days to suppress lactation,” agrees Kang.

Is Leaking Normal?
“Your breasts will leak in response to the need of your baby to feed. When a mother hears the sound of her baby’s cry or when she thinks of her baby, this will trigger a milk ejection reflex and the breast will start to leak. This is a normal response,” explains Cruz.
She adds that breast pads or a breast shell will help prevent milk staining your clothing. “The more frequently the baby breastfeeds, the more milk the body will produce. Expression of milk, especially when you are back at work will maintain the milk supply. Have a photo or video of your baby while you are expressing your milk to help get a larger yield of milk,” she says.
Finally, Cruz’s last words of advice are that you stay relaxed and happy through the time you breastfeed. “Plan your schedule ahead of time and let your colleagues or boss know that you are breastfeeding or expressing so that you can feel more relaxed about it.” An atmosphere of understanding can never be underestimated!
“Enjoy parenting! Babies grow very fast!” finishes Cruz, and boy, she’s right!

Thanks for sharing!