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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.
Breast engorgement is defined as full, hard breasts. Some degree of engorgement occurs in approximately ⅔ of new mothers.
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.
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.
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.
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.
For discomfort or if your breasts do not soften after feedings, here are some suggestions for additional ways to treat 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.
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.
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