Engorgement

Breast engorgement is a common challenge that many breastfeeding mums face, particularly in the early days when milk supply is being established. It happens when the breasts become overly full, firm, and often painful. While engorgement can be uncomfortable, it is usually temporary and manageable with the right strategies. Here’s everything you need to know about what causes engorgement, how to prevent it, and how to relieve discomfort.

What is breast engorgement?

Breast engorgement occurs when your breasts become too full of milk, leading to swelling and discomfort. This can make the breasts feel hard, warm, or even painful. Engorgement is especially common when your milk first comes in (around 2-5 days after birth), but it can happen at any point during your breastfeeding journey if milk builds up faster than it’s removed.

Engorgement can also make it harder for your baby to latch, as the breast may become too firm, and the nipple may stretch and flatten, making feeding uncomfortable for both of you. If left untreated, engorgement can lead to complications like blocked ducts or mastitis, so it’s important to address it early.

Causes of engorgement

Several factors can contribute to breast engorgement:

Milk “coming in”

When your milk first comes in a few days after birth, your body may produce more milk than your baby can consume. This initial oversupply can lead to engorgement as your body adjusts to your baby’s feeding needs.

Infrequent breastfeeding

If your baby isn’t feeding frequently enough or if you miss a feeding session, milk can accumulate in the breasts, causing them to become engorged. This can also happen if your baby suddenly starts sleeping longer or skipping feeds.

Sudden weaning or reduced feeding

Weaning or reducing feeding sessions too quickly can lead to engorgement. If your body is still producing milk at a high rate, the milk may build up, causing swelling and discomfort.

Oversupply

Some mums naturally produce more milk than their baby needs. While an abundant milk supply can be helpful, it can also increase the risk of engorgement if milk isn’t removed regularly.

Symptoms of engorgement

The signs of breast engorgement are usually quite noticeable:

Swollen, firm, or hard breasts.
Pain or tenderness in the breasts.
Warmth or redness of the skin.
A feeling of fullness or heaviness in the breasts.
Difficulty with baby latching due to the firmness of the breast and areola.

If these symptoms are not addressed, engorgement can worsen and lead to more serious issues, such as blocked ducts or mastitis.

How to relieve engorgement

If you’re experiencing engorgement, there are several ways to relieve discomfort and prevent further complications.

Feed your baby frequently

One of the best ways to manage engorgement is to breastfeed your baby frequently—at least 8-12 times in 24 hours. This ensures that milk is being removed regularly and helps your body adjust to your baby’s needs. Don’t wait for your baby to cry before offering the breast—look for early hunger cues, such as rooting or sucking on hands.

Ensure a proper latch

A good latch is essential for effective milk removal. If your baby is struggling to latch due to the fullness of your breasts, you can try expressing a small amount of milk before feeding to soften the breast and make it easier for your baby to latch on.

Use gentle massage and reverse pressure softening

Gently massaging your breasts while breastfeeding or expressing milk can help relieve fullness. Start from the outer part of the breast and move toward the nipple in a circular motion to help stimulate milk flow. You could also try reverse pressure softening to alleviate discomfort. Reverse pressure softening aims to push fluid in the tissue under the nipple and areola back further into the breast to relieve the pressure and to help your baby latch more effectively.

Express milk

If your baby isn’t feeding often enough to relieve engorgement, you can express milk by hand or with a breast pump. However, avoid expressing too much, as this can signal your body to produce even more milk. Express just enough to feel comfortable and prevent engorgement.

Warm and cold compresses

A warm compress applied to the breasts before feeding can help soften the breast tissue and stimulate milk flow. You can also take a warm shower and allow the warm water to help soften the breasts. After feeding, apply a cold compress or chilled cabbage leaves to reduce swelling and relieve discomfort.

Wear a supportive bra

A well-fitting, supportive bra can help provide comfort and support while dealing with engorgement. Avoid tight bras or bras with underwires, as they can put pressure on your breasts and lead to blocked ducts.

Medications

Common anti-inflammatory or pain relief medications can be quite effective. It's a good idea to discuss your options with your midwife or doctor to find the best approach for your situation.

Preventing engorgement

While engorgement can happen naturally, especially when your milk first comes in, there are steps you can take to prevent it from becoming severe or recurring frequently.

Feed on demand

Breastfeeding on demand—whenever your baby shows signs of hunger—helps prevent milk from building up in the breasts. This regular milk removal reduces the risk of engorgement.

Avoid skipping feeds

Try to avoid missing or delaying feeds, especially in the early weeks when your milk supply is being established. If you’re unable to breastfeed, consider expressing milk to prevent engorgement.

Wean gradually

If you’re planning to wean your baby or reduce breastfeeding sessions, do so gradually. Slowly dropping one feeding session at a time allows your body to adjust to the decreased demand and reduces the likelihood of engorgement.

You’ve got this

Breast engorgement can be uncomfortable, but with the right care and attention, it can be managed effectively. Frequent breastfeeding, gentle massage, and proper care will help relieve the discomfort and keep your breastfeeding journey on track. Remember, every mum’s experience is different, and finding what works for you is key.

If you’re ever in doubt or need additional support, don’t hesitate to reach out to a lactation consultant or healthcare provider for personalised advice. You’re doing an amazing job!