More than mild engorgement in the breasts is usually a sign that the breastfeeding is not going very well. It is due to the combination of milk stasis (the milk is not coming out) and oedema (swelling due to water retention in the area). Severe engorgement about the third or fourth day after the baby is born can usually be prevented by getting the baby latched on well and drinking well from the very beginning. See the information sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact, and Protocol for Managing Breastmilk Intake. See also nbci.ca for videos to help use the Protocol for Managing Breastmilk Intake. If you do become engorged, please understand that engorgement goes away within 1 or 2 days even without any treatment, but can be uncomfortable during that time. Massaging the breasts in a downward motion is not recommended as a treatment for engorgement. Continue to breastfeed the baby, making sure he gets on well and nurses well and the engorgement will resolve. However, if you should get engorged to the point where the baby is not able to take the breast, or if there is more than minimal discomfort in the breast and/or areola (the coloured part surrounding the nipple), then there is a simple way to temporarily move swelling away from the areola:
Developed by K. Jean Cotterman RNC-E, IBCLC
Try this if pain, swelling, or fullness creates problems during the early days of learning to breastfeed. The key is making the areola very soft right around the base of the nipple, for better latching.
Cabbage leaves may also be used to help decrease the engorgement, as can ice packs and cold compresses. Some studies suggest cabbage may accomplish this more quickly. If you are unable to get the baby latched on, start cabbage leaves, start expressing your milk, and give the expressed milk to the baby by spoon, cup, finger feeding or eyedropper and get help quickly.
(Please note: We have not had much experience with this approach but have heard some good things about it. We include it to provide an alternative to the above). (This technique is adapted from handout Patient’s Treatment for Engorgement, by A. Stolz, with notes from Lawrence, R; Ingle, B; Hunt, A)
The breasts may be soaked in a tub or basin of epsom salts for a few minutes to help with engorgement.
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!
©IBC, updated July 2009
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.