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: 

• Keep your baby touching you most of the time by lying on your chest, in your arms, and at your side. Making sure your breasts are available for nursing most of the time means that your baby will be less frantic about their need to nurse and will likely be calmer and easier to latch–and kinder to your nipples as a result.
• Try “relaxed nursing” or laid-back breastfeeding. Get comfortable in the “couch slouch” you’d watch television with.  Not flat, not straight up (hospital beds can be especially good for leaning back). Lay your baby chest-down on your own chest, between your breasts.  Baby may curl up and go to sleep, which is fine.  Just being on your chest helps keep your baby’s blood sugar, temperature, breathing, and heart rate normal. If baby starts rummaging around looking for your breast, or seems restless, or just makes movements with their mouth, offer to nurse.  You are able to help assist your baby in latching, but follow baby’s lead rather than leading them.  Shift your breast and your baby in any way that feels right to you, but fit it to what baby is trying to do.  They knows what they are looking for, and it’s probably not one of the special holds the books show.  Babies may even nurse in their sleep, if you put baby’s face near your nipple.
• If your breasts or nipples are sore, ask for help. Your soreness may be normal, or it may not be. Some fullness and a little nipple discomfort for a few days is not uncommon.  But bruising, broken skin, or outright pain?  It’s not good for you, and it probably means your baby is having some trouble taking milk out easily. Read more about nipple pain and the potential causes here. And reach out for help and support from the closest LLL Leader. If you’re uneasy about any advice you get, try someone else.

WHAT IF I’M ALREADY BADLY ENGORGED?

• Keep your baby with you – on your chest, in your arms, at your side. Body contact can actually help, and it makes frequent nursing more likely.
• Nurse or express your milk at least every 2 hours during the day and at least twice during the night. The more milk that collects in your breasts, the harder it will be to nurse.  By taking milk out often, you make it easier for all the fluids in your breast – not just the milk – to move around.
• Move your breasts around gently and massage them in any way that feels good. It may help shift excess fluids.
• Lie back, which keeps your breasts higher than usual. Fluids follow gravity.
• A bag of frozen vegetables can be a cold compress. Wrap it in a towel and put it on your breast(s) for about 20 minutes, then take it off for about 20 minutes.  The breaks “wake up” your breasts and are more effective than steady cold.
• Use cabbage leaves to help bring down swelling – an old remedy in the “can’t hurt, might help” category. Discard the outer leaves of a head of green cabbage.  (Red cabbage could stain.)  Now peel off one or more leaves, crumple each leaf gently in your hand, and put the leaves on your breast.  They should feel nice and cool, and can be held in place with a bra or shirt.  Leave them on until you get tired of them, and repeat as often as you like. If anything, it’s a nice cool, soothing feeling.
• Stand in a shower and let the hot water land between your shoulder blades. You may find yourself leaking in the shower.  If not, it’s still relaxing.
• Combine any of the above methods. Perhaps standing in the shower while jiggling your breasts is what does the trick.

WHAT IF MY BABY CAN’T NURSE WELL ENOUGH OR OFTEN ENOUGH TO GET MY MILK PRODUCTION GOING AND KEEP IT GOING?

• In the first couple hours post-birth, you’re likely to have the most colostrum. If your baby can’t nurse soon after birth, you can hand express and give your baby colostrum with a spoon.  (See this page for information on hand expression. Pumping colostrum is generally less effective than hand expressing because it is so thick.)
• Once your milk starts to increase quickly (a few days after birth), you can try a good electric pump. Do a bit of gentle breast massage and hand expression before you start, in the middle of the pumping session, and again at the end to help increase supply through stimulation.
• Don’t worry about making “too much” milk. Set your “milk thermostat” high in these early days and you can always back it down.  If you set it too low it can be tough to bring it back up.

WHAT IF I’M TOO FULL FOR MY BABY TO LATCH ON?

• Hand express before you try to nurse. You don’t have to soften your whole breast, just the area around your nipple where their mouth – especially their lower jaw – needs to go.  Think about trying to latch onto onto a soccer ball versus a soft water balloon.
• Press fluid gently out of the way. It’s another way to soften the breast around your nipple to give your baby more softness to latch onto. You might try using your fingertips or the sides of your index fingers to make slight dents in the area around your nipple.  Do any pressing gently and for a short time; nothing you do to your breasts should hurt.
• Find more information and pictures on this reverse pressure softening technique here.

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.