It’s normal for your breasts to feel fuller, lumpier and possibly sore when your milk comes in around Day 3 or so.

This normal breast fullness typically reduces within the first few weeks, if your baby is feeding well and often.

Normal breast fullness can sometimes develop into engorgement, particularly if milk is not removed from your breasts often enough or well enough.

Engorgement means your breasts are overfilled with milk and tissue fluid.

Engorgement most commonly occurs during the first week after birth, but can also occur at a later stage (e.g. when a feed is missed or when weaning occurs too quickly).

Engorgement Symptoms

If you have engorged breasts, they might:

Be painfully full
Feel warm
Feel hard
Be swollen
Have diffuse red areas

Tips To Help Prevent Engorgement

#1: Breastfeed Often

Breastfeeding your baby often (whenever she shows feeding cues) prevents your breasts becoming overly full, which reduces the risk of engorgement.

After a baby’s first breastfeed (which ideally occurs within the first hour after being born), she will typically have a long stretch of sleep. After that, she might want to feed often, even cluster feed, especially if no drugs were used during birth.

In the early days, a baby’s stomach is only about the size of a marble. It makes sense that she would want to feed to get small volumes of colostrum; so feed often.

Ideally, you and your baby will be in the same room at all times, and you’ll spend as much time as possible in skin-to-skin contact with her. This will help you pick up on your baby’s feeding cues to ensure no feeds are missed.

#2: Good Positioning And Attachment

If your baby is well positioned and attached to your breasts, she will be more likely to breastfeed effectively, which helps prevent engorgement.

A baby is positioned and attached well if:

She is close to you with her chest touching yours
She has a good amount of your breast in her mouth
Her lips are turned out (not sucked in)
Her chin is touching your breast
Her nose is free (or just touching your breast)
She is covering more of your areola with the chin side of her jaw

Treatment For Engorgement

If your breasts become engorged, it is a good idea to seek advice from a lactation consultant. She can thoroughly assess the reasons your breasts are engorged. One important aspect of the assessment will be watching your baby breastfeed. Based on the assessment she will help you work out the best course of action. This is particularly important because if breast engorgement is not resolved promptly, your supply might be affected.

Apart from the above preventative measures (which are also important aspects of treating engorgement), here are some other treatment ideas:

When your breasts are engorged, the milk does not flow easily. This can make it harder for your baby to get milk. A few minutes of gentle massage to your breasts, just prior to your baby’s feed, will help your milk flow better
Alternate the breast you use to begin feeds
Avoid skipping breastfeeds or replacing them with other fluids (unless medically indicated)
Gently massage your breast towards your nipple while feeding
Use cold packs or cabbage leaves (cooked, and then chilled) after or in-between feeds, to relieve discomfort. After feeds, you can apply the cabbage leaves for up to twenty minutes, where engorgement feels the worst. When the pain is relieved, discontinue their use
If necessary, express just enough for comfort, after feeds
Occasionally, for severe engorgement, a full drainage of your breasts, by expressing, might be necessary. A lactation consultant will be able to guide you in this.
Speak with your medical adviser about pain relief medication, if needed

Some mothers suffer painfully engorged breasts, no matter how well their babies are positioned and attached, or how often their babies feed. It is more likely to happen to you if your baby is unable to breastfeed with normal skill and frequency straight away (e.g. if she has been exposed to drugs during the birthing process). A lactation consultant can guide you in getting breastfeeding working well for you and your baby as soon as possible.

What If My Baby Is Having Trouble Attaching?

The swelling associated with engorgement can make your nipples become flat. This makes it harder for your baby to attach. In such a situation, hand expressing a little milk before attaching your baby might help.

Reverse-pressure softening can also help. To do this, apply pressure with your fingertips at the sides of and close to your nipple. Then push inwards for a few minutes, or until the breast tissue softens underneath. This technique softens the area around the nipple and areola, which will make it easier for your baby to attach. You might find the method most effective while lying on your back.

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The good news is that engorgement passes. Seeking help from a lactation consultant (ideally an IBCLC) can help it pass sooner, and get breastfeeding working well for you and your baby.