Breast Engorgement

Breast engorgement is an issue for many women, generally in the early days and weeks of breastfeeding their baby. Some women experience breast engorgement when they are still pregnant, though not to the same degree as after their baby is born.

Breast engorgement is usually only a temporary issue. Over the first few weeks of baby's life a mother's milk supply equals her baby's needs.

What is breast engorgement?

Breast engorgement is when the tissues of the breast fill with milk, creating pressure and pain. Blood and body fluids can also fill the breast tissue, creating a feeling of fullness and discomfort.

Signs and symptoms

The breasts can appear stretched and full, often with more visible veins. The nipples can also look stretched as the breast tissue around them extends the skin. With breast engorgement, the breasts can feel warm or even hot to touch.

What causes breast engorgement during pregnancy?

Hormones signal to the breast to prepare for breastfeeding. Breast and nipple changes can be the first sign of pregnancy. Colostrum is an early form of milk produced by the breasts from around the third trimester of pregnancy. Colostrum is rich in fats and antibodies and is the only nutrition newborn babies need.

After birth

Newborn babies are hard wired to seek their mother's breast and start sucking. When a baby is premature or there have been birth complications, it can take a while to learn how to attach and suck effectively.

Early breastfeeding is important. Although the volume of colostrum is generally small, it is nutritionally perfect for newborn babies.

It can take 3-4 days for a mother's breasts to fill with milk. Regular, effective sucking by the baby helps a mother's breasts to produce milk.

When breastfeeding

Some mothers produce more breast milk than others and seem to be more prone to breast engorgement. Frequent, uninterrupted breastfeeds can help to avoid engorgement from occurring. Women who have had breast implants may be more prone to breast engorgement.

What does breast engorgement feel like?

The feeling can range from mild discomfort to significant pain. We all have different pain thresholds and our own individual interpretation of what pain means. Breast and nipple tissue is always sensitive and any build up of pressure is uncomfortable.

How to prevent

Breast engorgement is uncommon immediately after birth. For most women, it takes 3-4 days after their baby is born for their breasts to produce milk. In women who have breastfed before, it can take less time for them to lactate than women having their first baby.

Breast engorgement is relieved when a baby feeds, though for some women, offering a breastfeed only provides temporary relief.

What's important is to breastfeed as often as the baby demands. Look for your baby's cues or signals that they want to feed. Avoid following the clock or timing your baby's feeding. Healthy, well babies are able to give their own signals that they want and need to breastfeed.

How to relieve breast engorgement

The best way to manage breast engorgement is to breastfeed as frequently as your baby demands. In newborns, this can be very couple of hours or even more often. Newborn babies can demand to breastfeed 8-12 times in a 24 hour period. This is nature's way of ensuring they have enough milk to grow and thrive and for their mother to produce enough milk.

It can take 6-8 weeks for a mothers breast milk supply to settle to meet her baby's needs. Over the early weeks, a mother's hormones are stabilising and her baby is adjusting feeding and digesting milk. There are a lot of complex adjustments being made.

Tips to relieve breast engorgement

• Breastfeed your baby frequently. If they are sleepy, it's alright to wake them to offer a breastfeed.
• If your baby is struggling to attach, try expressing a little breast milk first. This may help them to attach effectively to the nipple.
• Express your breasts for comfort. You could try hand expressing or using a pump.
• Use a warm washer or cloth on your breast when you're feeding. This may help milk to flow and for your milk to let-down .
• Gently massage your breasts in a downward motion towards your nipple when your baby is feeding.
• Shower and allow the warm water to flow over your breasts. Gently massage and express your breasts.
• Wear a firm, supportive bra. Take your bra off when you are breastfeeding so there's no interruption to the flow of milk.
• In-between breastfeeds use a cold pack or cool washer inside your bra to help relieve breast discomfort.
• Some women find relief by fully expressing their breasts if the pressure is too uncomfortable.

There is no one right way to manage breast engorgement. Experiment with different ways to relieve the pressure and do what works for you.

Avoid

• Using excessive heat or cold on your breasts or nipples.
• Offering your baby any formula or water to drink.
• Long periods of time between your baby's breastfeeds.
• Stopping your baby from sucking when they're still eager to feed.
• Being separated from your baby. It's important they are physically close to you so you can see and hear them if they need to feed.
• Stopping breastfeeding when you have breast engorgement. This can lead to mastitis or a breast abscess forming.

For more advise on breast engorgement

Speak with your child health nurse or a lactation consultant.

Check Australian Breastfeeding Association for specific breastfeeding information.

If your breasts are painful and not relieved by breastfeeding, see your doctor. Mastitis (breast infection) can happen when breast engorgement does not resolve.

Written and reviewed by Jane Barry, midwife and child health nurse on 16/04/20.

Written and reviewed by Jane Barry, midwife and child health nurse on 12/01/20