Engorged Breasts: Why It Happens And What You Can Do About It

Do your breasts feel heavy, hard, and sensitive like they are about to burst? Well, this is known as breast engorgement. Many mothers develop engorged breasts in the first weeks after giving birth. Not only is breast engorgement painful, but it can also lead to other breastfeeding issues if it isn’t properly treated. Being able to recognize engorgement will help you to prevent it, treat it, and avoid complications. Here’s what you need to know.

What causes breast engorgement?

2 to 4 days after your little one is born, your breasts start making milk. Your body directs extra blood and fluids to your breasts to increase milk production. As a result, your breasts feel heavy, warm, and swollen. This “fullness” is typical of the first week or two after birth. In fact, this degree of engorgement is the most intense you will experience. If you are breastfeeding, engorgement will start getting progressively better once your feeding habits settle and your milk production adapts to your baby’s needs.

And what if you are not breastfeeding? If you aren’t planning to breastfeed, you may experience breast engorgement as well. Because your body isn’t aware of your feeding plans, it will continue to produce milk. You can simply wait out breast milk production. In a few days, your body will get the message — it doesn’t have to produce milk so the supply can dry up. This will stop the engorgement. As tempting as it might be, do not express or pump milk. This will only signal your body that it needs to carry on producing milk, prolonging your pain and discomfort.

Other causes

• Overabundant milk supply

  Your body is pretty smart, did you know that? The amount of breast milk you produce is based on demand. This means that the more your body nurses, the more it produces milk at an optimal level to keep your little one full but not engorge your breasts.

  However, this process can be thrown out of balance. You may start producing too much milk, too quickly, which causes engorgement. Genetics, certain medications, hormone levels, baby strike (your baby’s refusal to breastfeed), or a growth spur may cause excessive lactation.

• Expressing milk

  “Expressing milk” means squeezing milk out of your breasts so you can store it and feed it to your baby later. Some books and articles recommend expressing milk to be one step ahead of your baby’s needs. But please bear in mind that making more milk than your little one needs can increase the risk of engorgement and mastitis (inflammation in the breast caused when a blocked duct isn’t relieved).

• Changes in feeding schedule

  Schedule changes can have an impact on your milk production. When milk that is normally expressed at certain times isn’t, it sits in your breasts and fills them, leading to breast engorgement. Changes in feeding schedule happen when you are traveling, hosting visitors, or in the midst of a festivity. Sometimes, these changes are out of your control. Your baby may start taking naps at different times or fall asleep during feeding time. They may also fall ill and may have trouble nursing if they are dealing with a stuffy nose. Or, perhaps you’ve enrolled your baby in daycare, and now both of you follow a different routine.

• Dietary adjustments

  Breast engorgement also happens when you supplement your baby’s diet with formula, switch completely to formula, or start adding solid foods. Supplementing with formula between nursing sessions may cause your baby to feed less which wouldn’t be sufficient to drain your breasts.

  “Weaning”(the process of slowly eliminating breastfeeding sessions over until your child is no longer nursing) can also result in an oversupply if you do it too quickly.

What are the common symptoms?

Symptoms of engorged breasts include:

• Swollen, firm, and painful breasts. If your breasts are seriously engorged, they may be very swollen, hard, warm, shiny, and a bit lumpy to the touch.
• Swollen armpits. You may develop slightly swollen and tender lymph nodes (small, round or bean-shaped clusters of cells) in the armpit area.
• Flattened nipples. The areola (dark area around the nipple), may become very firm. This makes it hard for your baby to latch on.
• “Milk fever”, a slight fever of around 100.4°F (38°C).

Complications of breast engorgement

In addition to pain and discomfort, breast engorgement can lead to serious issues such as sore nipples, plugged milk ducts, blebs (blisters covering a nipple opening), and, as mentioned before, mastitis. Complications such as mastitis need medical treatment. So make sure to see your doctor, pediatrician, or lactation consultant as soon as possible.

Naturally, these complications affect your baby too. For instance, if the engorgement flattens your nipples, this can cause a poor latch (when your baby struggles to properly connect to the nipple). Some babies may go on a “nursing strike” due to frustration from trying to latch on. In some cases, the pressure from the backup of milk inside your breast can lead to a “let-down” reflex. This is a quick flow of milk that can cause your baby to gag or choke.

How can you prevent breast engorgement?

Preventing engorgement may be possible if you keep the milk moving out of your breasts and try not to let your breasts become overfilled. Here are some tips for breastfeeding parents:

• Breastfeed whenever your baby is hungry.
• Empty your breasts during each feeding. Start by emptying one breast completely before switching to the other. How can you know when it’s time to switch? Pay attention to your baby. If they stop sucking or start slowing down, or if you no longer hear them swallowing, it’s time to switch sides.
• Make sure the baby is latching on and feeding well.

How can you treat it?

If you aren’t breastfeeding

• Take pain-relief medication approved by your doctor.
• Wear a supportive bra that prevents your breast from moving significantly.
• Apply a cold compress or ice pack to ease swelling and inflammation. Place a thin cloth between your skin and the ice pack to prevent skin damage.
• Resist the urge to pump or remove a lot of milk from your breasts. If your breasts are too painful, remove them a little bit to make yourself more comfortable.

If you are breastfeeding

• Take pain relief medication approved by your doctor.
• Feed more regularly, ideally every 1 to 3 hours throughout the day and night. Let your baby breastfeed for as long as they want, but try to aim for at least 20 minutes per feeding. If your baby is asleep, it’s OK to gently wake them up for feeding.
• Unless recommended by your pediatrician or lactation consultant, avoid giving your baby formula in between breastfeeding sessions.
• If your pediatrician or lactation consultant does recommend giving your baby formula, pump or hand-express milk to relieve engorgement. Just be careful not to express too much to avoid excess production.
• Soften your breasts between feedings. You can do this by applying a warm wet towel, immersing your breasts in a bowl of warm water, or taking a warm shower. This will encourage milk-letdown. If your baby isn’t ready to feed, let out a small amount of milk from both breasts.
• Between feedings, apply a cold compress or ice pack for 15 to 20 minutes to reduce swelling and inflammation. Place a thin cloth between your skin and the ice pack to prevent skin damage.
• Alternate feeding positions and breasts to drain milk from all areas of the breasts and so your baby empties your supply.

Don’t hesitate to seek medical help!

Your body needs time to adjust its milk production to your baby’s needs. However, if breast engorgement persists longer than usual and/or you are seriously struggling with pain, please get medical help as soon as possible. A pediatrician, doctor, or lactation consultant will advise you or prescribe treatment appropriate to your particular needs. Remember, it is important to take proper care of your health during this time. Plus, your baby needs you to be as healthy as you can be.

For more tips about parenthood, make sure to check out Beginning.com’s post-pregnancy masterclasses.