Not all women will experience engorgement, at least not to an extreme level. In fact, if breastfeeding is being well managed, and you are feeding frequently and effectively, you may avoid it altogether (good for you!). But if you do find yourself with these unwelcome contenders for rack of the year – here’s what is happening and what to do.
Your hormones have done their thing, and lactogenesis II (milk coming in) has well and truly happened. Remember what I said about your breasts not knowing how many babies you have had? Bless them, they don’t know if they are supposed to be feeding twins, quads or more. So there is a tendency to go into oversupply mode. Now, if this milk isn’t removed (by your baby or a pump) then the milk backs up in the breast. Your body, in its wisdom, tries to prevent you from getting an infection. Let me use an analogy.
When you sprain your ankle, what happens? It swells up - right? Not because of the injury directly, but because your body, in an effort to prevent infection, sends in lymphatic fluid which is full of infection fighting white blood cells.
Your breast is exactly the same. When milk backs up in the breast, you are in danger of developing an infection (mastitis), so good old lymphatic fluid floods your breast in response to the inflammation caused by all that milk going nowhere. Unfortunately, what then happens is that the lymph presses on the milk ducts, so milk sometimes doesn’t flow. It can be maddening to have rock hard breasts but no milk coming out of them. Added to this is that your baby probably can’t attach to your breast because it is so hard they can’t get a decent mouthful. Sometimes the breast is so hard that your nipple can seem to disappear and flatten out due to the swelling.
All is not lost. As ever, keep calm, and try the following:
- Try manual lymphatic drainage: Stroke from the nipple towards the armpit. Yes, you read that right. The lymph is the problem here, not the milk. Lymph drains to the armpit, so stroke towards it to push the fluid away from the breast.
- Stay horizontal. The fluid needs to drain away from the breasts, so sitting up or standing will not work.
- Gently massage the breast – you may find milk begins to drip at this point.
- Once milk is dripping, you can begin to hand express to soften the areola.
- Try a soak in a warm bath or shower.
- Warm flannels placed on the breast can get milk flowing.
- Take an anti-inflammatory medication such as ibuprofen – this reduces the swelling.
- Use cold compresses after a feed or expressing.
- If you are in a lot of pain from the engorgement and they are absolutely rock hard, get a bag of frozen peas out of the freezer, lie down with a tea-towel over your breasts and place the bag of frozen peas on top of the tea towel. It will really help the inflammation. Then you can try the massage and expressing.
- The process of massage, expressing, and getting milk to flow can take quite a long time. I’ve known it take 45-60 minutes to get milk flowing nicely.
Once you have got over the initial engorgement, try to just feed your baby frequently to prevent it getting that bad again. You may still over-produce milk for a while, but I promise it will settle down. It’s fine to express very small amounts of milk to stay comfortable – pumping 10-15mls of milk to soften the breast will really not make a vast difference to your milk production, so don’t worry that you will over-stimulate your supply.
Serious engorgement is actually a breastfeeding emergency because when your breasts become hard (like your forehead) then your breast begins to down-regulate your milk production. The breast is a clever organ – it knows when it’s too full and will take steps to protect itself from mastitis. This is why you won’t explode! Your body will just slow down the rate of milk production. So you need to treat it to keep your body making milk.