Managing Engorgement After Milk Comes In
After your full milk supply comes in (also known as lactogenesis II), you will feel your breasts become heavier and fuller. For some, lactogenesis II can change the nipple shape, which can temporarily change your baby’s latch, making it shallower and less effective. At times, this can lead to engorgement where the fullness is more pronounced and even uncomfortable.
Engorgement is important to pay attention to as it can impede milk let-down, prevent milk removal and impair feeding. If prolonged, engorgement can signal the body to reduce milk production and even result in infection called mastitis. Therefore, preventing and reducing engorgement are important to ensuring adequate feeding of your baby, maintaining your comfort, protecting your health, and sustaining your ability to produce milk.
If you have found that you are so engorged that you are unable to have a milk let-down, try manual expression to express your milk followed by nursing or pumping. Sometimes stress, especially around the perinatal period can prevent milk let-down. Doing things to reduce stress including getting a short nap, cuddling with your newborn, getting a massage, listening to soothing music, or whatever works for you, can help your mind relax and can help initiate this milk let down.
Once you are able to express your milk, make sure to nurse and/or pump frequently on demand according to your baby’s hunger signs, at least every 3 hours, while making sure to remove milk before engorgement occurs.
Note to mobile users: The following table is best viewed in landscape or horizontal view.
Comfort Measures for Engorgement
| Do | Do NOT |
|---|---|
| Breastfeed or pump about 8-10 times a day to provide milk and establish your milk supply | Do not pump in addition to nursing if your baby is softening your breasts, as this will make your milk production increase, leading to an oversupply of milk. |
| Wear a supportive bra or camisole | Do not wear a tight bra or anything that compresses your breasts |
| Use cold compresses all around your breasts to reduce swelling (20 minutes on, 20 minutes off) | Do not use heat on engorged breasts; heat encourages vasodilation which creates more swelling |
| Take ibuprofen to alleviate pain and swelling (if you have no contraindications) | Do not use sinus decongestants or other pharmaceuticals to reduce engorgement |
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