In another article, we explained the coming in of mature milk after you have colostrum: a natural process that happens between 24 to 48 hours after birth. But this process can come with complications and become a painful problem. Today, we will talk about breast engorgement and how to resolve it.

But let’s start from the beginning: What is breast engorgement?

Engorgement is an accumulation of fluids, liquid blood, and plasma in the breasts in the first days after giving birth. The blocked liquid forms a swelling and hinders breast milk coming out through the nipple. This causes pain and inflammation and makes it impossible for babies to breastfeed.

Why does engorgement happen?

Engorgement is more frequent in mothers who have had long births and have received lots of intravenous fluids. Also, mothers who have had a complicated beginning of breastfeeding or have been separated from their babies for many hours after the birth may suffer from this annoying complication.

Breast engorgement is a serious medical problem and is very different from a feeling of fullness that mothers experience during the normal coming in of (mature) milk at the beginning of breastfeeding a newborn baby. This feeling of fullness is absolutely normal when breastfeeding begins, but it should never be painful or even prevent the baby from breastfeeding.

My baby can’t latch onto my breast or seems to refuse it. Why?

When breasts are seriously engorged, they become so hard and solid that it’s impossible for babies to position their tongue correctly and achieve a proper milk transfer. For a baby, this will be almost like trying to feed from a wall! Sometimes, babies manage to latch on but don’t feed with the correct suction motion because they cannot make the right tongue movement to get the milk out. They might spend a while attached to the breast, and when they let go, the breast feels just as hard as before.

Other babies get angry and cry when they can’t breastfeed, and you might think that your baby is refusing to breastfeed.

What NOT to do in case of engorgement

Sometimes, you might do things that make engorgement worse, and without knowing it, you make it even harder to resolve the issue. The most important are:

• Do not apply heat: as said before, engorgement is an inflammation, and it is not advisable to apply heat because you can make it worse.
• Do not separate mother and baby: because separation is one of the possible causes of the problem, whenever possible, make sure that mother and baby can be physically close, ideally in skin-to-skin contact.
• Do not postpone feeds: maybe you feel the fullness of your breasts, but maybe your hospital room (or your house) is full of people, and you feel uncomfortable breastfeeding. However, it is not advisable to space out feeds; it would be best if you can offer your baby the breast very often, even after less than an hour has passed between the feeds.
• Giving a pacifier or bottle teats/nipples: this is related to the previous point; studies have shown that the use of pacifiers or teats can interfere with a good latch of the baby to your breast. So, in the first days (or weeks) after birth, it is best not to offer them to the baby so breastfeeding can be established.

How can I get rid of breast engorgement?

Removing the engorgement allows you to get relief from the pain and helps your baby to feed. But first of all, you need to unblock the milk flow. In order to do this, avoid applying heat to your breasts, you have to apply cold with things like cabbage leaves, clay, cold ice packs, or simply frozen vegetables wrapped in a towel.

Then, to drain the breast milk, perform the so-called Reverse pressure softening (RPS) massage that allows the areola and nipple to soften so your baby can latch on properly.

Here is a video of this technique:

Once your baby has finished feeding, apply cold again. If your doctor has prescribed anti-inflammatory medication, you can continue to take it until your breasts feel better. Anti-inflammatory medication given after birth should be safe when breastfeeding a baby, but you can always check if you can take it at www.e-lactancia.org.

How long can engorgement last?

Following all the above recommendations, the engorgement should be cleared within 24 to 48 hours. Your breast will improve if you follow all the above measures, and the engorgement will eventually disappear completely.

Do you have any more questions?

Our free app, LactApp, for iPhone or Android, provides more information about breastfeeding. In the contact section, you can access an in-app consultation channel where our IBCLC lactation consultants will answer your questions.