Engorgement: Prevention, Treatment, and Management

Veronica Tingzon, IBCLC By Veronica Tingzon, IBCLC, RLC

Engorgement was the most painful thing I remember about my own breastfeeding experience with my first son. I felt like I’d just undergone breast augmentation surgery when my milk came in. With my second son, I was elated that I didn’t have one moment of engorgement. What was the difference?

There are a few differences as to why I did not become engorged the second time around. My own struggles will help you understand why you are becoming engorged and how to prevent it or treat it if you already have it.

When my first baby was born, I labored for over 37 hours, 24 of which was under the influence of epidural and IV fluids. Then, I ended up having an emergency cesarean when my son couldn’t make it out on his own. Both of us were tired. I was in pain and feeling miserably nauseous from the medications from the c-section. I didn’t attempt to nurse my son until he was 6 hours old. By that point he was too sleepy to go to breast. He didn’t make an attempt to feed again until he was about 12 hours old. The next 12 hours he would feed for 5-10 minutes on each breast, every 4 hours. My nipples were already becoming sore and cracked.

This is an example of a very common first day of life. I was totally mismanaged. In retrospect, I wish I could wave a wand and go back to that moment knowing what I now know.

So, let’s analyze this scenario as it applies to engorgement. Breastfeeding did not begin immediately at birth when my son was most receptive to learning to breastfeed. I did not feel well enough to initiate my first attempt until he was 6 hours old- the point at which my baby was his sleepiest after a very long birthing process. Once he did begin to feed, the feedings themselves were very poorly latched feeds that weren’t enough time at breast to satisfy him. And, the feeds were also spaced too far in between.

The next day, my husband and I learned that my son was jaundiced and we had to supplement. So I attempted to nurse him for 10 minutes each side, then I supplemented him with a ½ an ounce to an ounce of formula after each feed- via bottle of course. I didn’t pump in between, and because my baby was born on Memorial Day weekend, the lactation staff was on skeleton a crew. I never got to be seen by a lactation specialist.

On my fourth day I went home, I fed exactly as I had been doing in the hospital. My milk “came in” the next morning. I was in so much pain; I had to hold my arms out to the side, as if I had a bad sunburn. Clothing rubbing against my breasts was a miserable feeling, but not wearing a bra was also uncomfortable because of the weight of my new found breast size. Bottom line: I wasn’t feeding my son well! Most of his calories were from the formula. He was not emptying my breasts and was too tired from the jaundice to even try. As the breasts got more full, the milk “traffic jam” wouldn’t allow my breasts to empty, so he didn’t even bother really trying to feed at all. After all, that bottle-thing would be coming if he just waited long enough. Also, the extra fluid from the IV also had me very swollen with trapped fluid (known as edema) which made the congestion in my breasts even worse.

So, how did I get through it? Thank goodness for the lactation educator at the hospital breastfeeding support group! She got me through the engorgement (as well as the bad latch), saved my breastfeeding, and unknowingly, was the inspiration for me to later become a lactation consultant.

Let’s talk about treatment of the engorgement…..

Hot/warm compresses (click here to see Booby Tubes) to the breasts or a warm shower are a great way to release the milk BEFORE the feeding. Couple the warm compresses with a circular massage to the breast, and now you’ve softened the breasts enough for baby to be able to latch on. 

If this does not help, you can also use a pump to help express a little bit of milk out before the baby latches. This technique will also help to draw out your nipple, which may have flattened out in whole or in part because of the engorgement.

Another wonderful technique to use is something called Reverse Pressure Softening (RPS). This technique is a little uncomfortable at first, but works well on the edema caused by too many IV fluids and the engorgement, as well. The technique, created by J. Kermaline Cotterman, IBCLC, works by pushing in the breast all the way to the chest wall at the base of the nipple where the areola begins. Press back with the tips of your fingers, release, then press back again and release again for about one minute of alternations on each breast. This should push the milk “traffic jam” out of the way so that your milk is able to “let-down.” (Please see instructional video.)

Now, this is the step that most people miss yet it’s probably the most important one! Ice!

Yes, ice. The extra fluid in your breasts: milk, edema, blood, need to be brought down to a comfortable norm. Ice is what helps to reduce inflammation- as with a swollen ankle or knee joint. When you’ve warmed your breasts with the hot compress or shower, you’re leaving yourself open to worse engorgement post feed because the heat expands your vessels and ducts. Icing AFTER the feed for about 20 minutes will help to reduce and compress the ducts and vessels, and also reduce the inflammation caused by the edema.  Booby Tubes can also be put in the freezer to help reduce the swelling and tenderness of engorgement.

Ibuprofen can also help reduce the inflammation along with taking the edge off of the pain caused by the engorgement. But, don’t allow the ibuprofen to take the place of the ice packs. 

After 2 or 3 days, the engorgement should have subsided. If it has not, please contact a board certified lactation consultant in your area to help you with this issue.

As I mentioned earlier, I had no engorgement with my second baby. He was on the breast within a half an hour of birth. I nursed him non-stop for the first 24 hours of life. He had an awesome latch and suckle from the get go. What a 180-degree difference in experiences!