Facts on Breast Fullness and Engorgement

Breast fullness is a normal part of lactation which nearly all women experience when their milk comes in, 2 - 5 days after birth. With this normal fullness, the breast tissue is compressible, and you generally feel well (you rarely have pain or a high fever).

This normal breast fullness can develop into engorgement if the baby isn't nursing often enough or vigorously enough, or if you are separated from your baby and don't remove the milk frequently and effectively. Your breasts may become extremely tender and painful. Because the breast is so full and swollen, the nipple and areola may flatten out, making the tissue difficult for the baby to grasp.

Suggestions for Preventing/Handling Engorgement:

-Nurse frequently. Try to nurse at least 10-12 times in 24 hours - every 1 ½ - 2 hours during the day, with no more than a 3 hour stretch at night.

-Try to nurse for at least 15 minutes on the first side before offering the second. Don't set time limits on time spent at the breast.

-Nurse baby with only a diaper on (skin- to -skin contact will stimulate sucking).

-Vary nursing positions to help promote drainage of the breast.

-Wear breast shells (with holes for air circulation) for 20 minutes between feedings.

-Wear a supportive bra (avoid under-wire), but don't bind your breasts - this can lead to plugged ducts.

-Lie flat on your back between feedings so that your breasts are elevated.

-Apply cold compresses to your breasts and under your arms between feedings. Cold can help reduce swelling. Use a layer of fabric between the compress and the skin. Apply cold compresses for 15-20 minutes off and on for 1-2 hours.

-The use of heat immediately before nursing can help the milk let-down. Taking a warm shower, leaning over a basin of warm water, soaking in a warm bath, or applying warm compresses or a heating pad may help. Moist heat is best. Gentle breast massage can also help the milk flow more readily.

-If the nipple and areola are swollen, don't try to nurse without softening them up first. Hand express or pump a little milk from your breast to soften the nipple and areola before trying to nurse.

-If your breasts remain full, knotty, and tender after nursing, you may want to pump for 5-10 minutes to remove all the milk that comes out quickly and easily. Removing the milk will relieve the pressure and reduce the swelling, softening the areola and making it easier for the baby to latch on. Whether you manually express or use a pump, be very gentle, since engorged breasts bruise easily due to increased blood volume.

You may want to use cabbage leaf compresses if the above suggestions don't bring you enough relief. This sounds really strange, but this is a remedy that has been used for over a hundred years with much success. No one is exactly sure why it works, but since it is inexpensive, safe, and effective, you may want to give it a try. Here's what to do:

1. Buy plain green cabbage.

2. Rinse and dry leaves. Put them in the refrigerator.

3. Remove base of hard core vein and gently pound leaves.

4. Wrap around breast and areola, leaving nipple exposed. The leaves fit nicely around the breast, and the cold feels good.

5. Cover entire breast, and if needed, the area under your arms.

6. Change every 30 minutes or sooner if they become wilted.

7. Check your breasts often and as soon as you feel the milk beginning to drip, or if your breasts feel different', remove leaves and try to nurse or pump.

8. Re-apply as needed (up to 3 times between feedings). Check OFTEN as over use can cause a decrease in your milk supply.

If pain and swelling persist, ask your doctor about use of an anti-inflammatory drug compatible with breastfeeding. Often Advil (two tablets taken 3 or 4 times a day, every 6-8 hours with food) will be helpful.

Sage tea (available at health food stores) is a powerful herb that contains a natural form of estrogen and may decrease your milk supply. Drinking a cup at bedtime for a night or two may help in cases of severe engorgement. As with cabbage leaves, monitor breast changes often as over use can decrease your supply.

Call your doctor if your temperature rises over 101°, or if you develop localized pain or flu-like symptoms. Even if you develop a breast infection, breastfeeding can and should continue.

Remember that engorgement usually subsides within 24 - 48 hours, so hang in there. During this uncomfortable period, take comfort in the fact that most mothers who experience engorgement usually have more than adequate milk supplies once the initial period of discomfort is over.