Engorgement

By Jennifer Clark, IBCLC. Revised September 2022.

Increased risks of engorgement:

IV fluids in labour
Previous baby
Previous breast surgery
Missed feeds or baby sleeping for longer than usual
Poor positioning and attachment
Weaning too quickly
Oversupply of milk
Use of breast pumps and expressing more milk than is needed for baby
Tight clothing or something restricting the breast
Breast trauma, for example, vigorous massage

Management

Allow baby to feed as regularly as they want too. Having skin to skin can help encourage baby to feed more regularly.
Ensure good positioning and attachment
Hand express to soften the breasts and help remove milk if the baby is struggling to latch.
Reverse pressure softening - place a finger either side of the nipple and gently push back 3-4 cm and hold for 10 seconds, do this all around the nipple to push fluid back off the nipple as well as hand expressing milk in this area to soften the nipple and areola. The aim of this is to improve the babies latch and therefore milk removal.
Breast gymnastics and massage – upper limb stretches as well as gently moving the breasts in circular motions. Link - https://vimeo.com/65196007
Lymphatic drainage – the aim of this is to move fluid from the breast into the lymph nodes in the armpit. Gentle stroking motions from the areola to the armpit as well as circular motions will help move fluid from the breast. Link - https://static1.squarespace.com/static/5cae1b90a09a7e52e72c667e/t/5daa2c7b4990dc3d5fa76556/1571433600382/Lymphatic+massage+handout.pdf
Ice packs on the breast for up to 20 minutes, hourly if possible. Swelling responds best to cold so use this as often as possible. Warm compresses can be used before feeding/expressing to aid letdown. Cold (green) cabbage leaves have also been found to be very soothing as they fit well around breasts.
Gravity – laying on your back will help move fluid away from the breasts. Doing reverse pressure softening and lymphatic massage while on your back will also help.

Referenced from : ABM Clinical Protocol #20 Engorgement - https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/20-engorgement-protocol-english.pdf

Definition - ‘‘the swelling and distension of the breasts, usually in the early days of initiation of lactation, caused by vascular dilation as well as the arrival of the early milk.’’ (ABM, 2016). Fullness to some degree post birth is normal, however, severe swelling/oedema of the breasts can be difficult to manage. Engorgement usually occurs between day 3-5 but can occur as late as day 9-10 if milk is delayed. Delayed milk production can occur due to things such as caesarean section. Breast tissue can extend into the armpit so some mothers may have swelling here too. Engorgement is usually reduced if the baby spends a lot of time at the breast in the first 48 hours post birth.

Pictures shows engorgement in the breast