What is breast engorgement?
Engorgement refers to swelling within the breast tissue, which can be painful. In some women with engorgement, the breasts become firm, flushed, warm to the touch, and feel as if they are throbbing. Some women develop a slight fever (eg, less than 101ºF or 38.3ºC).
The best treatment for engorgement is to empty the breasts frequently and completely by breastfeeding. It may be more difficult for an infant to latch-on (form a tight seal around the nipple and most of the areola) when the breasts are engorged because the nipples become flattened. A correct latch-on allows the infant to obtain an adequate amount of milk and helps to prevent nipple soreness and injury.
If the breasts are engorged, expressing milk by hand or breast pump can help to soften the areola and allow the baby to latch on more easily. However, it is important to avoid overstimulating the breasts with hand and/or pump expression because this could worsen engorgement.
How to treat breast engorgement?
While some women believe that cabbage leaves help to relieve engorgement pain, there is no clear evidence that they are any more effective than cold compresses or breast massage.
Hand expression — Hand expression of milk between feedings may be necessary to avoid engorgement. There are a number of techniques to express milk by hand.
Milk ducts open in several areas on the nipple; after let-down, milk should squirt easily from multiple openings when you gently push the area behind the nipple.
One suggestion is as follows:
- Hold the hand in a c-shape, with the thumb on top. The fingers should be 1 to 1.5 inches behind the nipple. Keep the fingers together to avoid cupping the breast and apply gentle pressure with the thumb on top of the breast, pressing straight back against the chest.
- While pushing against the chest, roll the thumb and fingers towards the nipple. Work around the entire breast. It may help to use both hands.
-Continue pressing inward and rolling the fingers over the breast tissue. You may need to apply pressure closer to or further away from the nipple to find the right area.
Breast pump — It is also possible to use a breast pump to relieve engorgement, although you should not pump for more than about two to five minutes, as this could stimulate even more milk production. Pumps are often inefficient at removing milk during early engorgement.
It is important to use the correct size flange if a breast pump is used. The flange is the piece that is held against the breast and draws the nipple in to pump milk. Using a flange that is too small can injure the nipple and cause pain. In addition, using a flange that is too small may decrease milk supply because it does not allow for adequate milk to be removed.
Cold pack or showers — Use of a cold compress or ice pack can be helpful in relieving the discomfort of engorgement. Heat packs or hot water bottles are not recommended to treat engorgement because this can increase tissue swelling. However, using heat and massage just before a nursing session may improve milk flow. Standing in a warm shower, allowing the spray to fall on the breasts, can promote milk release.
Massage — Massaging the breast gently prior to a feeding may promote milk flow and help to soften the breast. Using the fingertips, gently knead the breast in a circular motion, working from the chest wall and moving towards the nipple.
Reverse pressure softening — Reverse pressure softening can help to move some of the swelling away from the nipple so that the infant is able to latch on the breast more easily. Lying down while performing reverse pressure softening can enhance the technique’s effectiveness.
- Place the middle three fingers of each hand on the left and right side of the nipple. The fingertips should be touching the edges of the nipple.
- Push the fingers back firmly but gently against the base of the nipple, towards the chest wall and count to 50. This may need to be repeated.
- Once the nipple/areola is softened, try to latch the baby to the breast.
