Engorgement
Engorgement of the breasts
What is normal?
When a baby is born and put immediately skin to skin on the mother’s abdomen/chest, and the baby is then allowed the time to crawl to the breast, this is an important pre-condition to breastfeeding. Unfortunately, this normal process is rarely allowed to happen after most hospital births. Why? Partly because of lack of knowledge that this is a normal process that is important and is a part of beginning breastfeeding. And even if hospital staff know about the breast crawl, the time it takes (about an hour on average), is not believed compatible with “normal” obstetrical routines in most hospitals.
If the baby starts breastfeeding within the first hour after birth, as recommended by the World Health Organization, and the baby continues breastfeeding, painful engorgement in the days immediately after of the breasts is not likely to occur.
On the other hand, because the vast majority of babies and mothers do not get this opportunity to start breastfeeding immediately after birth, it is generally believed that engorgement of the breasts on or about the 3rd day after birth is a good thing, that it means that the mother’s milk has “come in”. As a society we have forgotten what normal is. And our health professionals, including obstetricians and nursing staff are not immune to this amnesia of what is normal.
Painful Engorgement
Therefore, it should not be accepted that painful engorgement of the breasts on or about the third day is normal and a good thing. In fact, painful engorgement is a sign that the breastfeeding is not going very well; that the baby has not been latching on well and not been drinking well up until that time, and that the breasts have not been well emptied during the first 3 days or so.
Painful engorgement is due partly: 1. The large amounts of intravenous fluids given to the mother in a typical birth almost everywhere in the world. Women in labour generally do get intravenous fluids in case their blood pressure drops or in case significant bleeding occurs, but if neither of these issues occur, it is not necessary to run the fluids at a rapid rate. 2. The baby not latching on well and therefore not drinking well at the breast. And not “emptying” the breast.
Painful engorgement of the breasts about the third or fourth day after the baby is born can be prevented by getting the baby to latch on well (see also the Latch Quiz) and the baby drinking well immediately after birth. See the information sheets Breastfeeding—Starting Out Right, The Importance of Skin to Skin Contact, and Protocol for Managing Breastmilk Intake.
If your breasts do become painfully engorged, it is important to do something, because pain is not necessary, because engorgement prevents the baby from latching on well, so that a “vicious circle” of engorgement->baby unable to latch well->more engorgement->more engorgement and pain. Furthermore, such engorgement reduces the mother’s milk supply and is an explanation why so many mothers “do not produce enough milk”.
Massaging the breasts in a downward motion is not recommended as a treatment for engorgement and on top of everything aggravates the mother’s pain. Continue to breastfeed the baby, making sure s/he latches on well and drinks well. However, if you should get engorged to the point where the baby is not able to take the breast, then there is a way to decrease the swelling.
HOW TO DO REVERSE PRESSURE SOFTENING
Try this if pain, swelling, creates problems during the early days of after the birth of your baby. The key is making the areola soft right around the base of the nipple, for better latching. See the video of reverse pressure softening.
A softer areola allows the baby to get more of the areola into his/her mouth and thus stimulate the breast so that the baby gets milk from the breast. Note that mothers transfer milk, not babies. The baby stimulates the breast so that the milk flows from mother to baby.
CABBAGE Leaf COMPRESSES
1. Cabbage leaves may also be used to help decrease the engorgement, Some studies suggest cabbage may accomplish this more quickly. If you are unable to get the baby latched on, start applying cabbage leaves, start expressing your milk, and give the expressed milk to the baby by spoon, cup, and get help quickly. Finger feeding is not a good way of feeding the baby and should be used only to prepare a baby who does not latch on to take the breast, as in this video of a two month old baby born 8 weeks prematurely who was exclusively breastmilk fed by bottle and latched on after a short period (30 seconds) of finger feeding.
2. Use green cabbage.
3. Crush the cabbage leaves with a rolling pin if the leaves do not take the shape of your breast.
4. Wrap the cabbage leaves around the breast and leave on for about 20 minutes. Twice daily is enough. It is usual to use the cabbage leaf treatment less than two or three times.
5. Stop using as soon as engorgement is beginning to go away and you are becoming more comfortable and can get the baby to latch on well.
You can use acetaminophen or ibuprofen, or other medication for pain relief. As with almost all medications, there is no reason to stop breastfeeding when taking analgesics.
Some women get a lump, sometimes fairly large in the armpit about 3 or 4 days after the baby’s birth. Cabbage leaves may be used in that area as well to help the lump go away more quickly, although it is not necessary as the swelling is normal breast tissue.
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, 2021
Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).