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Common Breast Issues- Engorgement

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CabbageEngorgement is swelling and tenderness of the breasts occurring in the postpartum period and is caused by the increased flow of blood and milk into the breast. Breasts become swollen, hard, and painful.

Engorgement symptoms usually appear between day 3 and 5 after childbirth. Here are some tips to avoid engorgement:

  • Frequent nursing helps to avoid engorgement.
  • Try to have your baby nurse and completely drain the breast. Offer both breasts at each feeding. Be sure to alternate the breat offered at each feeding. This will help ensure that both breasts are being emptied.
  • If you are unable to breastfeed or your baby does not nurse well, gently pump or manually express both breast to soften breasts and remove milk. Manual hand expression can be very effective to remove milk. If a breast pump is used, care should be taken to avoid high suction pressure which can increase tissue swelling making the problem of engorgement worse. 
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    There are several effective hand expression techniques. To hand express milk, a collection container will be needed and expression should be performed with clean hands. Breast massage and a warm, moist compress before beginning hand expression can help to improve milk removal.
    • One method of hand expression is to place your clean fingers approximately an inch away from your nipple. Gently press your fingers and thumbs back towards your chest wall. Press your fingers and thumb together; relax; and repeat. Move your fingers around your nipple and continue this process to empty all areas of the breast. Watch a video animation here...
    • Another technique for hand expression was developed by Dr. Jane Morton. Place fingers and inch away from the areola at the 3 o'clock and 9 o'clock position. Press fingers back to the chest wall, gently compress the breast, then release. As Dr. Norton says, think "Press, Compress, Relax." Alternate between breasts during hand expression. Here is a video of Dr. Norton demonstrating her technique.

Below are some tips to relieve engorgement: 

  • Wear a supportive bra without underwire (underwire can cause plugged milk ducts).
  • Apply a warm, moist compress to breasts for 2-5 minutes before nursing or take a warm shower.
  • You may need to express your breast (manually or with a pump) until you feel some relief.
  • Use gentle breast massage before and during breastfeeding.
  • If needed, take acetaminophen (Tylenol) or ibuprofen (Motrin) for pain relief. Both are safe to use during breastfeeding.
  • If breast are severely swollen, you may need to apply a cold compress or cold cabbage leaves to your breasts for approximately 20 minutes after nursing. To use cold cabbage leaves to relieve engorgement, follow these steps:
    • Prior to applying cabbage to the breast, be sure that you are not allergic by doing a "patch test". Place a small, crushed cabbage leave on your forearm, secure it in place, and allow the cabbage to set on your skin for 1-2 hours. If there is no reaction, proceed with the following steps.
    • Wash and peel the individual leaves on a GREEN cabbage.
    • Chill the washed leaves in the refrigerator.
    • After nursing your baby, remove the cabbage leave from the fridge. Remove the large vein on the leaf and gently crush the leaf before use.
    • Use enough cabbage leaves to cover the entire breast tissue and leave the nipple uncovered (approximately 20 minutes).
    • Remove the leaves once wilted and see-through. Cabbage can be reapplied 3 to 4 times within a 24 hour period (approximately every 4-6 hours).
    • Since frequent cabbage use can decrease milk supply, it is advised to stop using cabbage leaves as soon as engorgement/ discomfort begin to subside.
  • For swollen, firm, engorged breasts, try reverse pressure softening. This technique helps to soften the areola and allows your baby to latch onto the breast. To perform reverse pressure softening, follow these steps (be sure that hands are clean and fingernails are trimmed and short):
    • Place your fingers on either side of your nipple, at the base of the nipple.
    • Firmly and gently press your fingers back towards your ribs and hold for 1 to 3 minutes. This displaces the fluid causing the swelling and softens the areola allowing for an easier latch.
    • It is very important to know the difference between engorgement and mastitis. Mastitis is an infection of breast tissue and requires medical treatment. Signs and symptoms of mastitis include:
    • Tender, red breast that is warm to touch (mastitis usually affects one breast)
    • Flu-like symptoms
    • Fever
    • Chills
    • Breast pain

    Treatment of mastitis usually involves 1-2 weeks of oral antibiotics. As with any antibiotic, be sure sure to complete the entire course of antibiotics.

 How To Perform Reverse Pressure Softening

 


 

 How To Relieve Engorgement - Breastfeeding

 
 

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Sources:
Academy of Breastfeeding Medicine (2009). Clinical Protocol #20: Engorgement. Breastfeeding Medicine; Volume 4, Number 2. 
Jack Newman. Handout #24 Miscellaneous treatments. January 2003
Texas Department of State Health Services Nutritional Services and Texas Association of Local WIC Directors. Lactation Counseling and Problem Solving. Attended January 2011.
Use of cabbage for Engorgement handout from HALCEA meeting (2010)
Walker, M (2011). Breastfeeding Management for the Clinician (2 edition). Boston: Jones and Bartlett Publishers.
 

 

 

 

 
 
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