Breast Engorgement

Evidence 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094412/ 

Cochrane Pregnancy and Childbirth Group, Irena Zakarija-Grkovic and Fiona Stewart 

Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. 

Education 

Around 16 weeks of pregnancy your hormones trigger the lactation process. Once your baby and placenta are delivered, a sudden drop in estrogen and progesterone causes the hormone prolactin to take over. Prolactin is the hormone that produces milk. 

Colostrum is the first milk you will make; it is yellow, thick and small in volume. If your baby has been admitted into the Neonatal unit your baby maybe having some but not all feeds at the breast.  

It is recommended that you start expressing your breastmilk as soon as possible after birth. The guidelines are to express every 2 to 3 hours for a total of 8 to 12 times per 24 hours.  

Around 2 to 6 days after giving birth your milk supply will increase, it is quite normal for breasts to become larger and feel heavy, warmer and uncomfortable. 

Going too long without emptying your milk can lead to engorgement. Breast engorgement is when breast tissue overfills with milk, blood and other fluids. A painful condition on its own, engorgement can also lead to complications such as blocked milk ducts or mastitis in which the milk ducts become inflamed or infected.  

Symptoms of Breast Engorgement 

• The breasts may feel hard and swollen. 

• The engorged breasts can be very tender to the touch. 

• The skin of the breasts may feel warm or hot. 

• Engorgement can cause the nipples to flatten, making it more difficult for the baby to latch. 

Management and Relief 

Here are some things you can try:  

• Express milk frequently, ideally every 2-3 hours, to mimic the baby's feeding pattern and keep milk flowing regularly. This helps prevent engorgement by ensuring milk is removed consistently. 

• Double Pumping - Use a high-quality, hospital-grade electric breast pump to express both breasts simultaneously. This can be more efficient and effective at draining the breasts compared to single pumping. 

• In addition to pumping, hand express milk to ensure thorough emptying, especially if you feel areas of the breast that are still full after pumping. 

• Apply warm compresses or take a warm shower before expressing to help stimulate milk flow and make expressing easier. 

• Use cold compresses on the breasts after expressing to reduce swelling and discomfort. 

• Ensure that the breast pump flanges fit properly. Flanges that are too small or too large can cause ineffective milk removal and additional discomfort. 

• Gently massage your breasts before and during pumping to help milk flow and relieve any plugged ducts that could contribute to engorgement. 

• Stay well-hydrated and maintain a balanced diet to support your milk supply and overall health. 

• Try to get as much rest as possible and manage stress through relaxation techniques, as stress can impact milk production and letdown. 

When to Seek Help 

If engorgement is severe, persists despite these measures, or is accompanied by other symptoms like fever, it’s important to seek help from a lactation consultant or healthcare provider. These symptoms could indicate an infection like mastitis, which requires medical treatment. 

Ensuring you have the right support and information can make managing breast engorgement more manageable. 

Empowerment 

Balancing the demands of expressing milk while having a baby in the NICU can be overwhelming. Creating a routine for when you express milk will ensure your breasts don’t become too full and lead to Engorgement.  

Before your premature or sick baby can feed directly from your breast, kangaroo care can be a great way to help them get comfortable with skin-to-skin contact. 

Useful Links 

Australian Breastfeeding Association  

https://www.breastfeeding.asn.au 

King Edward Memorial Hospital (KEMH)  

https://www.kemh.health.wa.gov.au/Pregnancy-and-Birth/After-your-pregnancy/Breastfeeding 

NSW Health 

https://www.hnehealth.nsw.gov.au/__data/assets/pdf_file/0005/401387/breast20engorgement20when20breastfeeding_expressing.pdf 

Need support? NurtureConnect allows you to connect with our NurtureProgram support team, or call our 24 hour NurtureLine 1300 622 243 or join our Facebook community.

NurtureConnect