Breast Engorgement

What Is Breast Engorgement?

Engorgement is the extreme filling and swelling of your breasts that causes them to become hard, warm to the touch, and uncomfortable. It is your body's way of telling you that the supply/demand relationship of breast milk is out of balance. You need to express (get rid of) some of the milk produced -- and fast!

Breast engorgement is common one to seven days after birth, although it can happen later in the postpartum period. It seems to be more common in first-time mothers, with the likelihood decreasing with each subsequent pregnancy.

What Causes Engorged Breasts?

Breast engorgement can actually be seen as a good thing in the beginning, as it is a sign that your milk has "come in" and production is strong. The condition happens for several reasons:

Shortly after giving birth, milk comes in rapidly and is not expressed quickly enough. There is also breast tissue swelling that occurs early, which can worsen this early engorgement.
When your normal breastfeeding routine is interrupted and you cannot nurse or pump like usual.
When weaning your baby off the breast, you stop suddenly and don't give your body the time to adjust slowly.
If your baby's demand for breast milk drops suddenly due to illness or the rapid increase of solid foods in their diet.

The Breast Engorgement Cycle

Typically, one to three days after giving birth (although it can be up to seven days), your breasts will begin producing large quantities of milk. It is normal for your breasts to become larger, get heavier, and feel sore. This fullness should decrease by the first or second week after giving birth if your baby is breastfeeding regularly and well. If not, this fullness could turn into engorgement and feel uncomfortable.

When this happens, the fullness can be painful. It can even make it difficult for your baby to latch on effectively because the nipple has flattened out due to the fullness of your breast. If the nipple flattens out, your baby may have difficulty getting the proper part of the nipple in her mouth to latch correctly.

This can create a painful and frustrating cycle that results in a decrease in milk production, sore nipples, and increased hunger in your baby. If this happens, you should work on treating the engorgement right away (see Breast Engorgement Treatment).

Symptoms of Breast Engorgement

Signs and symptoms of breast engorgement can vary. Some possible indications include breasts that are:

Firm
Warm to the touch
Throbbing
Uncomfortable or painful.

Some women also will have a low-grade fever (under 101ºF or 38.3ºC).

How to Prevent Engorgement

It may be possible to prevent breast engorgement by:

Breastfeeding your baby soon after birth.
Nursing often in the beginning. Have your baby stay with you in the room while in the hospital so you can nurse often. Ideally, you should nurse 8 to 12 times every 24 hours in the beginning.
Manually expressing milk (by hand) or pumping between feedings.
Ensuring correct positioning and latch-on. Your baby's mouth should take most of the nipple in for a good latch. If you feel pain or pinching during breastfeeding, stop and ask for help from your nurse or a lactation consultant.
Wake your baby at least every two to three hours during the day and every four to five hours at night in the beginning. Frequent nursing removes the colostrum and incoming milk so that normal postpartum fullness does not develop into painful engorgement.

If you do experience breast engorgement, don't think you have done anything wrong. It tends to happen with most new moms.

How Do You Manually Express?

There are a number of different techniques for manually expressing milk by hand. One way of doing this is as follows:

Create a c-shape with your hand, with the thumb on top. Your fingers should be 1 to 1.5 inches behind the nipple. Keep your fingers together to avoid cupping the breast and apply gentle pressure with your thumb on top of the breast, pressing straight back against the chest.
Roll your thumb and fingers towards the nipple while pushing against the chest. Work around the entire breast. It may be helpful for you to use both hands.
Continue pressing inward and rolling the fingers over the breast tissue. It may be necessary to apply pressure closer to or further away from your nipple to find the right area.

Possible Complications of Breast Engorgement

Women who have frequent breast engorgement are at an increased risk for mastitis (an infection of the breast) or plugged milk ducts due to increased pressure in the breast. Both of these conditions could result in a fever and plenty of pain.

Breast engorgement can also cause:

Feeding problems or slow weight gain if your baby is unable to latch on to your engorged breast(s)
Sore nipples due to your baby's inability to latch on completely to an overly filled breast
Damage to the milk-producing cells, which may, in turn, cause an overall decrease in milk supply.