June 30, 2020

By Andrea Tran RN, BSN, MA, IBCLC

A common breastfeeding problem new moms are often faced with is breast engorgement. Knowing what to expect from engorgement and how to deal with it will help ensure that it is a temporary bump in your breastfeeding experience.

What is engorgement?

Breast engorgement is defined as full, hard breasts. Some degree of engorgement occurs in approximately ⅔ of new mothers.

What causes breast engorgement?

There are two types of engorgement. The first type is called primary engorgement. It occurs when a mother’s milk first comes in. This type of engorgement is caused by swelling of the breast tissue around the milk-producing glands as well as the milk that is starting to be produced. When the engorgement first occurs it is primarily the swelling that causes the hard breasts. There is still not a large amount of milk being made. As the swelling goes down the amount of milk being made increases.

The other type of engorgement is caused by breasts that are very full with milk. It is referred to as secondary engorgement.

When should a mom expect to experience engorgement?

A mother’s milk is said to “come in.” This makes it seem like it suddenly is there. However, it is more of a process that occurs over 24-48 hours. The breasts start to make milk 48-72 hours after the birth. Breast fullness is usually the first sign that the milk is starting to come in. If a mother is going to get engorged it will usually happen within 12-24 hours of the first signs of fullness.

How long does engorgement usually last?

Primary engorgement typically lasts 24-48 hours. There will be some women who experience engorgement for as long as a couple of weeks. This is not common though.

What are the symptoms of engorgement?

• Breasts get larger. Many moms have expressed surprise at how large their breasts got.
• Hardness.
• Breast tenderness.
• Lumpy breasts.
• The breasts often feel warm.
• They may have a shiny appearance.
• Some women describe their breasts as feeling tight.
• Some women get a low-grade fever. You should call your health care provider for any fever in the postpartum period.

Can engorgement be prevented?

Milk coming in is a significant biological change, so a noticeable change to her breasts is expected. For that reason, a certain amount of engorgement can be reassuring.

However, you may want to treat engorgement to reduce pain, tenderness, and the possibility that prolonged hardness can damage milk-producing cells. Frequent feeding (every 2-3 hours) is often enough to help minimize engorgement.

What can I do to treat engorgement?

For discomfort or if your breasts do not soften after feedings, here are some suggestions for additional ways to treat engorgement.

• Frequent feeding. Feeding every 2-3 hours is best.
• Use good positioning during feedings.
• Make sure your baby is latched properly. This will help ensure good emptying of the breast.
• Apply ice packs for 20 minutes every 2-3 hours to help decrease the swelling.
• Applying chilled green cabbage leaves has been shown to help decrease breast discomfort and swelling.
• Reverse Pressure Softening is a technique to move the fluid from the swelling away from the nipple. By gently pressing down at the base of the nipple and moving your fingers out you can help soften the areola to make it easier for the baby to latch on.
• Pumping may help. Because much of primary engorgement is tissue swelling I advise a mom to pump only if she is able to remove milk. To avoid creating an oversupply, pump just until you are more comfortable and your breasts feel softer.
• Avoid heat on the breasts. This will encourage more blood flow to the breasts and therefore more swelling.

Are there any possible complications from engorgement?

If a woman’s breasts get very hard and she goes for a long stretch without breastfeeding or pumping it can result in the milk-producing cells being destroyed. This is how a woman dries up her milk if she does not plan to breastfeed.

It is important to keep the milk moving. I recommend that a mother either breastfeed, use a breast pump, or do hand expression a minimum of every three to four hours.

If a mother is experiencing severe engorgement she should contact a lactation consultant.

Sources
Academy of Breastfeeding Medicine Clinical Protocol #20 - Engorgement (Revised 2016) Retrieved from https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/20-engorgement-protocol-english.pdf

Cabbage compression early breast care on breast engorgement in primiparous women after cesarean birth: a controlled clinical trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723919/

Application of Cabbage Leaves Compared to Gel Packs for Mothers With Breast Engorgement: Randomised Controlled Trial. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28941842/

Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15117523/

Andrea Tran RN, BSN, MA, IBCLC is a freelance writer who has been helping moms and babies breastfeed for over twenty-five years. She is married and the mother of three adult children.