It is completely normal for your breasts to become full, heavy and even painful when your milk comes in, when you have missed a feed, or when you have a sudden increase in your supply. Generally, this will last no longer then 24 hours (with the exception of milk coming in), the areola should remain soft and your baby should be able to latch on without any hassle.

True engorgement occurs when the duct system is not cleared adequately, causing an accumulation of fluid. Increased pressure in the milk ducts and glands produce breasts that feel firm, hard, tender and warm or even hot to touch. The skin may become translucent and the nipples may flatten and even get lost in the breast. Milk flow slows down and relief is not found easily.

A mother can experience engorgement at any time during her breastfeeding journey whenever milk is not removed adequately. However, it is most common in the weeks immediately following birth. This is because feeding patterns are so irregular and your body has not yet adjusted to suite your baby’s needs.

Consequences of Engorgement

Engorgement can compromise your milk supply – remember that milk removal promotes milk production. Breast tissue allows milk storage for as long as 48 hours before the rate of milk production and secretion begins to decrease rapidly.

Engorgement affects the letdown reflex – the flattened nipple of an engorged breast makes it difficult for your baby to get a good latch. This insufficient latch makes it almost impossible to stimulate the nipple adequately in order to promote letdown. Without the letdown reflex, your baby will not be able to remove milk from your breasts and the pressure in the milk ducts will increase even more.

Cracked nipples – when a baby is trying but struggling to latch correctly, you are increasing your chances of getting sore, cracked nipples.

Increased risk of infection – when things remain stagnant in the breast, bacteria has a chance to grow resulting in breast infections such as mastitis

Permanent tissue damage – increased pressure in the breast for lengthy periods of time can cause cells in the breast to shrink and to eventually die off

Relieving Engorgement

Engorgement is very painful and it can be a little scary, but it certainly is no reason for one to stop breastfeeding. It is important to remember that it is a temporary situation and with proper treatment, it is usually resolved within 48 hours.

Feed – every two hours or even sooner if baby desires. Place no time limits on feeding times. Continue to feed at least 8 times in 24 hours even after engorgement has resolved.

Massage – gentle breast compression during feedings will help drain the breast more adequately

Express – using a good quality electric breast pump express a little milk before each feed. This will help to soften the breast making it easier for baby to latch. Expressing between feeds may also be necessary depending on the stage of engorgement. Massaging and compressing the breast during pumping may increase the flow significantly. DO NOT express between feeds for longer than a period of 48 hours as this can lead to an increase in milk supply making it impossible to relieve engorgement.

Ice – cold compress applied between feedings will help ease discomfort

Rest – lying flat on your back with your feet elevated will gel to reduce swelling in the breasts

Cabbage – Researchers suggest that phytoestrogens present in cabbage contribute to reducing swelling in tissues. Scour the inside of a chilled cabbage leaf with a fork and place inside your bra. Change your leaves with every feed. As soon as your baby or pumping provide relief, discontinue the use of cabbage as it can suppress milk production or even dry up your milk completely.

Preventing Engorgement

Ultimately, prevention is the best cure. here are a few key tips:

• Initiate breastfeeding within the first hour of life
• Ensure a correct latch and positioning to optimise milk extraction
• Become familiar with your baby’s feeding cues and feed on demand
• Do not limit time spent at the breast – allow your baby to drain one breast fully before moving over to the other side
• Listen for swallowing when your baby is nursing – this is a good indicator of milk removal
• Avoid the use of artificial nipples for at least 6 weeks post birth as this may cause nipple confusion
• Minimise interference with breast feeding
• If baby is not feeding well, be sure to express milk to maintain your supply until feeding is corrected
• Try not to miss feeds.
• Wean slowly. If the time has come for you to wean your baby off the breast, do it slowly and carefully