Breast Engorgement: Why it Happens and How to Prevent and Relieve the Pain

Engorgement happens when your breasts become uncomfortably full, or “engorged” with milk. If you have ever experienced breast engorgement, you know all too well the pain of hard, full breasts feeling like they’re ready to burst. Unfortunately, it is very common. Read on for a better understanding of why engorgement happens, and how to relieve and prevent symptoms if engorgement happens to you! 

Why does breast engorgement happen?

There are a few reasons why women experience engorgement.

When milk is first coming in—beginning between two and five days after birth—your body starts producing milk, and your breast tissue can swell as blood, lymphatic fluid, and milk collect in the ducts. It’s normal—though painful—for your breasts to become larger, heavier, and sore.

Engorgement that occurs in the early stages of breastfeeding typically lasts about one week. Continuing to nurse allows your body to adapt to the amount of milk your baby needs for each feeding.

Engorgement often results from missed feedings, clogged ducts, a change in how often your baby nurses, or a change in how often you pump. Remember the first night your baby slept all the way through the night and you were so excited to sleep, but then woke up feeling like you were going to explode? We do, too. Or the time you were out running around getting things done and all of the sudden—OUCH!

Many women also experience engorgement when they start the weaning process. While you ideally want to wean over the course of a few weeks to minimize engorgement as much as possible, some babies stop nursing abruptly, leaving their mamas in a lot of pain!

It’s important to remember that although unpleasant, breast engorgement is common, and there are ways to manage it and even prevent it.

And always remember—if the swelling or pain seems extreme, or if you run a fever, call your doctor or IBCLC in case of infection.

How long does breast engorgement last?

Luckily, if managed well, engorgement can pass quickly. If your engorgement is related to your milk first coming in, it may last up to one week. If engorgement is due to a missed or late feeding or pumping session, you should feel relief when you pump or nurse, and be sure to empty both breasts. Unrelieved engorgement can be a precursor to mastitis and clogged ducts. So it’s very important not to allow engorgement to persist or long intervals to elapse between feedings or pumping. Once engorgement does pass, your breasts will be softer, and will feel much less sore. There will still be plenty of milk—but less pain!

It still sounds awful though! How can I prevent this from happening? 

To help prevent or alleviate engorgement after birth, make sure your labor and delivery team knows you want to breastfeed, and get that baby to your breast as soon as possible! Offer your breast frequently, look for your baby’s hunger cues—such as putting his hands to his mouth or crying—and keep your baby snuggled against your skin to encourage breastfeeding. Breastfeeding “on demand” will help establish your milk supply. Newborns need to nurse at least 8–12 times per day and should never go more than four hours without feeding. After the first month or two, breastfed babies should nurse between 7–9 times per day—though if it’s more than that, that’s okay!

Breastfeeding can be painful when your breasts are engorged, but your body needs to grow attuned to the amount of milk your baby actually needs. If you’re trying to build up an extra store of milk, you can keep pumping to build your supply. Let your baby finish nursing on one breast before switching to the other. If your baby doesn’t nurse on the other side, start on that breast the next time.

Avoid introducing a bottle or pacifier unless your doctor or IBCLC recommends it. The muscles used to suck on a bottle or pacifier are different than those used to breastfeed, and your baby may have a hard time nursing afterwards (this is called “nipple confusion” or “nipple preference”).

If engorgement is happening because of weaning, you may need to slow down the weaning process if you can. Experts recommend starting by skipping one feeding at a time, until your body gets used to the reduced need for milk. But sometimes slow weaning isn’t possible (for example, certain medical conditions, or baby abruptly stops breastfeeding), and engorgement will happen—your best option here will be to relieve the discomfort and try to minimize engorgement as much as possible.

When they are engorged, how can I relieve the pain?

First: keep nursing! Make sure you are feeding or expressing milk every two to three hours and that your baby is latching on.

Keep in mind that if engorgement is serious, it can actually be harder for your baby to latch on deeply due to a hard areola, and that can lead to painful nipples, clogged ducts, or a low milk supply. Before you breastfeed, use our moist heat compresses -  Rachel’s Remedy Breast Relief Packs to trigger letdown and release some of the extra milk your body is making, relieving the pain and making it easier for your baby to latch. Put the Relief Packs in the freezer while feeding, and then after feeding, if your breasts are still engorged, use them to help relieve the swelling.

While your baby is nursing, gently massage that breast. This encourages the milk to flow and will help relieve some of the tightness and pain. Also feed your baby in varying positions: alternating sitting up, lying down, and using the football hold, in order to help drain the breast as much as possible.

Like with clogged ducts, try to wear a comfortable bra to make pain less likely as well as to prevent complications from engorgement, such as clogged ducts and mastitis. 

Both moist heat packs and cold packs are the most effective way to help breast engorgement. Use Rachel’s Remedy Breastfeeding Relief Packs for up to 20 minutes before nursing or pumping to relieve the pain, and then freeze them to use afterward to bring down swelling. Studies have shown that moist heat application to engorged breasts, especially before feeding, helps increase blood flow, and supplies oxygen and nutrients to help relax and reduce pain. Moist heat also triggers the hormone oxytocin, which assists with milk letdown.

In effect, moist heat helps engorgement by providing soothing relief to the affected area, as well as by promoting milk flow to help prevent and relieve engorgement.

You can purchase Rachel’s Remedy Breastfeeding Relief Packs here. When you want to relieve the pain of engorgement (as well as increase milk supply and prevent and relieve many other common breastfeeding discomforts), you’ll be glad you have them! 

And remember—as with any breastfeeding problem, or if you get flu-like symptoms or a fever, you might have a breast infection—be sure to check in with your doctor or IBCLC. 

Sources:

• Resmy V, Nalini S.J., Sumathi, G. Effect of Lukewarm Water Compress On Prevention of Nipple Pain and Breast Engorgement Among Primiparous At A Selected Hospital In Chennai. Journal of Science. 2014. 4(10). 620-624.
• http://www.parents.com/baby/breastfeeding/problems/all-about-engorgement/
• http://www.babycenter.com/0_engorged-breasts_231.bc
• https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Engorgement.aspx
• New Mother's Guide to Breastfeeding, 2nd Edition (Copyright © 2011 American Academy of Pediatrics)
• http://www.lalecheleague.org/faq/weanhowto.html
• https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4483

Image: Anton Nossik [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons