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Engorgement
Brand new baby? Tight, full breast? Baby having trouble latching on? You probably have “first week engorgement.” And there are some simple solutions.
Did you know that you’ve been making milk since your first trimester? Maybe you leaked, maybe you didn’t. But that first milk – colostrum – was there. Colostrum is thick and yellowish and sluggish and more salty than sweet, but it’s full of antibodies and protein. This first milk is specially formulated for your newborn. It coats your baby’s stomach and intestines with antibodies. It fuels your baby in small amounts.
In the next couple of days though, the blood supply to your breasts increases to start up the milk factory, causing fullness. (If you’ve had IV fluids, that fullness may be more than normal.) Sugar enters your early milk, which pulls water into it. It turns more white than yellow. From now on, your milk will be sweet and sloshy, and there will be a lot more of it… provided your body gets the message it’s looking for.
Your colostrum happened automatically. Sugar and water ramped up automatically. But now your breasts want to know how much milk to make. Is milk removed? Then milk will be made. Is milk not removed? Then the flood of mature milk gradually subsides, the breasts soften, and the “factory” of milk production shuts down. This is why continued frequent nursing and/or expression of milk in the first days and weeks is especially important.
Here are some ways to keep your milk production up or get your production back on track:
WHAT IF I’M ALREADY BADLY ENGORGED?
WHAT IF MY BABY CAN’T NURSE WELL ENOUGH OR OFTEN ENOUGH TO GET MY MILK PRODUCTION GOING AND KEEP IT GOING?
WHAT IF I’M TOO FULL FOR MY BABY TO LATCH ON?
WHAT IF I BECOME ENGORGED AND MY BABY ISN’T A NEWBORN?
Sometimes an older baby gets sick and doesn’t eat as much for a few days. Or maybe it’s a growth spurt that boosted your production but ended quickly, temporarily leaving you with more milk than either of you wants.
Engorgement in just one part of your breast could be from a plugged milk duct in that area. Anything that reduces or stops milk flow can cause a blockage in all or part of your breast. If the backup continues too long, you could end up with a breast inflammation or infection called mastitis. But odds are that just nursing more often, hand expressing, or pumping – all with some gentle massage – will break up the blockage. You’ll find more low-tech tips on getting your milk moving again in this page on plugged ducts and mastitis.
REMIND ME WHY I’M BOTHERING?
If your baby is three or four days old, you may be feeling especially overwhelmed. It can be easy to fall into the “forever trap” of thinking that this is the new normal. In reality, these first few days are especially intense, but they do pass quickly. Keeping your baby in body contact with you, nursing freely, and following the baby’s lead can keep most early problems, including engorgement, from happening. Give yourself permission to relax and follow your baby’s lead.
Mild engorgement doesn’t need more than the comfort measures listed above. But if milk builds up in your breasts too much for too long, milk production can shut down partially or completely for this baby. Staying engorged for too long can also lead to a breast infection called mastitis. So even for your own health or you are looking to wean, it’s worth dealing with engorgement.
It takes most people a few weeks to a few months to feel fairly comfortable with being a new parent, and first-week problems feel especially big. Once you get past any early hurdles like engorgement, you and your child can have months or years of happy nursing ahead of you.
RESOURCES
Helping to Get Breastfeeding Off to a Good Start: Latch, LLL USA
Helping to Get Breastfeeding Off to a Good Start: Skin-to-Skin Contact, LLL USA
Helping to Get Breastfeeding Off to a Good Start: Frequent Access, LLL USA
What to do about breastfeeding pain including engorgement VIDEO, Global Health Media
Breast Engorgement VIDEO, Global Health Media
Attaching Your Baby at the Breast VIDEO, Global Health Media
Engorged Breasts, LLL Great Britain
Reverse Pressure Softening, KellyMom (also in Russian)
Beginning Breastfeeding, LLL Great Britain
PERSONAL STORIES
My Breastfeeding Experiences, LLL USA blog
What I Wish I Knew About Breastfeeding the First Time Around, LLL USA blog
Weaning from the Pump, LLL USA blog
Our Latching Story, LLL USA blog
Annika’s Story: Overcoming Obstacles and Breastfeeding Advocacy, LLL USA blog
IS YOUR CONCERN OR QUESTION NOT COVERED HERE?
Please contact a local LLL Leader with your specific questions.
Medical questions and legal questions should be directed to appropriate health care and legal professionals.
Page updated January 2020
Resource adapted from LLLI materials.
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