When your baby is born, your breasts go through their own metamorphosis. They can turn from pleasant appendages to weapons of mass lactation. As your hormones shift from being pregnant to breastfeeding, your breasts can swell up and become hard, red, and tender. This is called engorgement. It can last for a few days or continue for the first few weeks. For some moms, it can come and go for longer periods of time.
You may be wondering why engorgement happens and what you can do about it. Read on to learn more!
What are the symptoms of engorgement?
Engorgement usually happens in the first few weeks after your baby is born. It happens because your breasts are starting to make milk. As that transition happens, your breasts can go through growing pains.
Symptoms of breast engorgement can include:
Pain
Swelling and fullness
Redness
Warmth to the touch
Dilated veins
Low grade fever
Symptoms can vary, and you can have one or more of those mentioned above. One breast can also be more affected than the other.
Sometimes a low grade fever can mean more than engorgement. You can continue to breastfeed with a low grade fever, but you should also let your doctor know if the fever gets worse or lasts for more than a day.
What causes breast engorgement?
Your breasts are made of four kinds of tissue:
Fat
Milk ducts
Connective tissue
Breast tissue.
They also contain blood vessels and nerves.
When you are pregnant, your hormones, estrogen and progesterone, circulate at high levels in your bloodstream. After you give birth, they decrease and another hormone called prolactin starts to increase. Prolactin causes your breast tissue to change into milk making tissue. As your breasts are transforming, the blood vessels in your breasts also dilate to bring more blood to your breasts.
What happens when breasts get engorged?
When your breast tissue changes to milk making tissue, it forms structures called alveoli. Alveoli are where your milk is made. They are connected to your milk ducts. Milk ducts carry the milk through your breast from your alveoli to your nipples, where your milk comes out. As your breasts form more alveoli, they get bigger. Lactating breasts also have more blood flowing into them. The combination of more blood flow and enlarging breast tissue in a fixed space can end up compressing the milk ducts. This can make it harder for your milk to travel out of your breasts, so it gets backed up.
How to Help Engorged Breasts
Engorgement can be painful. The key to treating it is to both calm the swelling and empty your breasts. The combination of these two treatments can reduce the pain and help your breasts continue to make milk.
Here are some suggestions for treatment:
Apply an ice pack or cold compresses to your breasts for 10 to 15 minutes at a time to reduce swelling.
Take a warm shower or use warm compresses to encourage your letdown.
Encourage your letdown in other ways, like looking at a picture of your baby, smelling your baby’s clothing, or asking your partner to massage or gently rub another part of your body.
While encouraging your letdown, empty your breasts in one or more of the following ways by:
Nursing your baby every 2 to 3 hours (if not terribly painful)
Hand expressing your breasts for 10 to 15 minutes
Pumping with well-fitted flanges when you aren’t nursing or if your baby can’t nurse
Massaging your breasts while you nurse or pump
If these treatments don’t work, speak to your doctor about other treatments. Your doctor may suggest pain medication that is safe to take while nursing.
What Happens If You Don’t Treat Engorgement?
While engorgement is normal, it is not something you should ignore. It doesn’t usually go away on its own. If you don’t empty your breasts and reduce the swelling, your long term milk supply can reduced. On the other hand, if you empty your breasts too often, you can increase an already big supply. Finding a good balance is key.
Backed up milk can also be a good source of nutrition for bacteria. If your breasts stay engorged, they can become infected. This infection is called mastitis. It can spread quickly, cause fevers, and turn into an abscess. Even one bout of mastitis can reduce your overall milk supply.
If you have symptoms of mastitis, speak to your doctor right away. They may need to treat you with antibiotics and/or other treatments.
How to Prevent Engorgement
In the first few days after giving birth, engorgement is actually a good sign. It means your breasts are starting to make milk. It isn’t something that can be prevented. But after the first few days, engorgement should resolve as your breasts settle into equilibrium. If engorgement doesn’t resolve, here are some suggestions for preventing it from continuing to happen:
Make sure you are emptying your breasts regularly by nursing or pumping so you don’t get a backup in milk. This usually means every 2 to 3 hours in the first few weeks.
If your breasts fill up between nursing or pumping times, remove small amounts with hand expression to relieve the pain. Be careful not to remove so much that your breasts overfill again.
Use alternating warm showers/compresses and cold compresses to reduce swelling and pain.
If you are making a lot of milk and are concerned about oversupply, try some remedies to slowly decrease your supply. You may also want to work with your doctor or lactation consultant.
Frequently Asked Questions
Is Engorgement Normal?
Engorgement is normal during the first days or weeks after giving birth. It is a sign that your breasts are starting to make milk. Not every mom gets engorgement. Some moms make so much milk that engorgement can continue coming and going after the first few weeks.
Can I Ignore Engorgement?
It is not safe to ignore engorgement, because it doesn’t usually resolve on its own. If left untreated, engorgement can lead to a breast infection called mastitis and an overall reduction of your milk supply.
Why is Engorgement Painful?
Engorgement is when your breast tissue turns into milk-making tissue so your breasts get larger and the blood supply to your breasts also increases. The combination of these two things can compress your milk ducts, which can cause your milk to get backed up, which makes your breasts swell up even more. All of that increased volume and compression can be painful until it is relieved.
What are Good Ways to Treat Engorgement?
Good treatments for engorgement include a combination of encouraging your letdown using warm compresses and pleasant sensations, reducing inflammation with ice packs or cold compresses, and emptying your breasts by nursing, hand expressing, or pumping.
Summary
Engorgement can be painful. On one hand, it is a good sign that your breasts are making milk, but it can also be painful and should not be ignored. Follow our suggestions to relieve engorgement and prevent it from coming back.
Reviewed by: Linda Dahl, MD
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