If you are experiencing very full breasts, it is important that your milk is removed frequently and effectively, particularly in the first few weeks so that you continue to have a good milk supply for your baby.

With extreme engorgement the breasts can be hard and uncomfortable with tight, translucent skin. If you are finding it difficult to latch your baby to the breast or the breast remains very full following a feeding, call the Parent Talk Line to speak with a nurse. If it is a weekend, click here for other local resources or call Telehealth Breastfeeding Support 1-866-797-0000.  Unresolved engorgement can have a long term negative effect on your milk production.

Here are some tips for managing engorgement

  • Feed frequently: at least every 1.5 to 2 hours around the clock; let baby breastfeed as long as possible, no time restrictions at the breast. Offer both breasts every feed
  • Apply cold compresses to the breasts between feedings or pumping sessions for approximately 15-20 minutes
  • Warm compresses can be used for a few minutes prior to a feeding if the mother desires. Use a warm, wet towel to cover the entire breast. It may facilitate milk let-down in the early stages of engorgement. See below – rationale for using warm compresses
  • Gentle expression can help soften the areola to assist with latch-on 
  • Use a breast pump on a low setting, if necessary to empty the breast enough to facilitate a latch-on. Pump after the feeding to empty breasts if baby has not effectively decreased the fullness by breastfeeding.  If a pump is not available, hand express
  • Vary breastfeeding positions to help promote drainage of the breast; use gentle massage during a feeding if it is comfortable-A supportive bra may be helpful; avoid underwire styles
  • An over the counter  anti-inflammatory medication compatible with breastfeeding for pain and swelling may be helpful
  • Contact a health care professional if any of the following symptoms are present: temperature of more than 100.6 degrees F (38.1 degrees C), chills, body aches, localized pain or flu-like symptoms. Breastfeeding is not contraindicated when these symptoms occur

Video

 Hand expression and therapeutic breast massage to relieve discomfort and assist with breast drainage

HEAT VS. COLD Compresses

  • Some experts currently recommend the use of cold compresses on the breasts between feedings to reduce swelling. In the past, the use of heat prior to a feeding was encouraged “to help milk flow.” Although there is little research to prove the effectiveness of either heat or cold treatments, the experience of many breastfeeding specialists shows that the use of cold is more effective. Some theories to support this new recommendation are that cold reduces vascular and lymphatic congestion, reduces swelling and enhances milk flow.  
  • When using cold compresses, always use a layer of fabric between the skin and the cold source. There are products available commercially for cold treatments but usually crushed ice in a plastic bag or the ever-popular frozen vegetable ice pack works just as well (bags of peas or corn mold well to the area needing coverage).
  • Be aware that cold on or near the nipple can impede a let-down.  
  • The use of heat increases vascular congestion and swelling and may impede milk flow. While it may feel soothing, if you choose to use warmth you should only apply heat immediately prior to latch-on or pumping and for no longer than 3 to 5 minutes. Prolonged application of heat has the potential to increase swelling. A warm shower with spray directed at the back, not on the tender, sensitive breasts, may help relieve breast tension and improve milk flow as well. Some women have reported good results from immersing the breasts in a basin of warm water while doing some gentle massage prior to a feeding. Others have reported that using a few drops of olive oil applied to the skin of the breast (not on the nipple) helps avoid skin discomfort when doing breast massage.

For more information

New Perspectives on Engorgement by Mary Kay Smith. IBCLC

Reverse Pressure Softening, use of cabbage leaves and epsom salts by Dr Jack Newman