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Engorged Breasts

Engorged Breasts

If you're reading this page, the chances are that you are suffering from engorged breasts or breast engorgement!

You have my sympathy. Essentially, there are two types of breast engorgement, physiological and pathological.

Physiological engorgement

When the mature milk first comes in somewhere around day 4, it is quite common for some women find that their breasts become extremely hard, painful and engorged with too much milk. This is common and should lessen in a day or two as your milk production adjusts to meet your baby's needs. But it could occur again any time if you don't feed (or express) frequently enough.

Help prevent or treat it by breastfeeding on an unrestricted basis, checking your baby is well positioned, and expressing a little milk between feeds if necessary. Give your baby the expressed milk by cup or spoon after a breastfeed if he needs it.

Pathological engorgement

In some women the congestion builds up so much that the breasts become pathologically engorged - extremely swollen, as well as lumpy, hard, tense, oversensitive, painful, inflamed, hot, red and shiny, with the skin pitted like orange peel and easily bruised. You'll probably feel hot all over and shivery, you may indeed have a low fever, and you may sweat profusely. You'll also be thirsty. Drink as much as you want. Don't limit fluids as some people used to suggest. Some women feel weepy, either because of the discomfort, or because it coincides with the ‘baby blues' or actual postnatal depression.

Breast swelling tends to flatten the nipples, making it difficult for a baby to get a good enough mouthful of breast to latch on and feed well. High pressure in the breasts also squashes and flattens milk-producing cells, making them unable to produce much milk. While this may be good in the short term, in that reduced milk production reduces any further build-up of pressure, it's bad in the longterm because the cells' ability to produce milk can be damaged.

Unfortunately, poor management of engorgement is one of the commonest reasons for a woman's milk supply to fail in the early days, yet such failure is preventable. Women whose milk dwindles after a week because of engorgement could almost all have breastfed successfully had they only known what to do. Another problem with engorgement this bad is that it encourages mastitis, infection and blocked ducts.

Dealing with Engorgement

If you've had poor advice (and one leading American specialist believes engorgement is a problem caused by doctors!) you can take steps to deal with the resulting engorgement and lay the foundations for successful breastfeeding in the months ahead.

Ten steps for treating painful engorgement:

1. Breastfeed frequently, day and night. Breastfeed or express whenever your breasts feel full, even if your baby hasn't asked for a feed, or is asleep. He should have no bottles, and shouldn't use a dummy.
2. Encourage your milk to let down before you feed (or express or pump). Do whatever helps you relax, and swing your arms vigorously, first in one direction 20 times, then in the other 20 times. While warmth encourages the let-down, it also encourages congestion, so it's better not to have a hot bath or put hot flannels on your breasts.
3. Express or pump before a feed if you need to soften your breast to make it easier for your baby to feed. A baby who tries to take a tense areola into his mouth is unlikely to latch on properly; instead he'll chew the nipple, which will make it sore, and he'll also get very little milk. This is because he simply can't take a big enough mouthful of the swollen, tense areola to drain the milk reservoirs, and because the pain he causes by chewing your nipples will prevent you letting down your milk. If you're badly engorged, you'll find an electric pump more comfortable than hand expression or a hand pump.
4. Make sure your baby is well-positioned so he can suck and milk effectively. You'll know he's taking milk well if you see him swallowing regularly and purposefully, he's satisfied by feeds, and your breasts are softer after a feed. Use breast shells for half an hour before a feed if you need to make your nipples stand out better.
5. Feed your baby at least for long enough to remove fullness and lumpiness.
6. Gently massage the breast when your baby pauses between bouts of swallowing.
7. Express or pump after a feed to remove any remaining lumpiness. Such lumpiness is most likely if your baby is too tired, apathetic or unwell to suck and milk the breasts effectively for long. There's no need to empty your breasts fully.
8. Express or pump between feeds if your breasts ever feel full, tight or tender and you don't want to wake your baby.
9. Relieve tenderness and pain - see below. This is as well as doing numbers 1-8 above.
10. Give yourself a pat on the back. You're doing a superb job by breastfeeding and taking steps to overcome this temporary problem. Keep going!

Relieving Tenderness and Pain

There are many ways of doing this.
BulletWear a supportive bra, checking that its fabric band or underwire beneath the breasts doesn't cut into them.
BulletSee whether cooling your breasts for about 20 minutes makes them more comfortable by decreasing congestion, though don't do this in the half-hour before you're likely to feed, as it might hinder your let-down.
Bullet  An ice pack – for example, a packet of frozen peas, a plastic bag filled with ice (crushed ice is more comfortable than cubes), or a chilled gel-filled cool-pack. Wrap any of these in a piece of cloth to protect your skin.
Bullet  A chilled cabbage leaf.
Bullet  A cold flannel - wrung out in ice-cold water.
Bullet  A cold water splash.
Bullet Some women find that warming the breasts before a feed - with a warm shower or a wrapped hot water bottle, for example - helps the milk to flow, though it might make the breasts temporarily more uncomfortable.
Bullet Aromatherapists suggest very gently massaging or smoothing in a little oil or cream containing two to three drops of rose or peppermint oil in a tablespoonful of carrier oil (for example, sweet almond), but don't get this on your areolae or nipples as its taste could put your baby off feeding.
Bullet Painkillers aren't much help for the pain, but if you want to take something, paracetamol is considered safe.

Good luck!


Buy Dr Stanway's Book - Breast is Best - Here

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