

Overly Full Breasts (Engorgement)

By Rebecca Mannel, BS, IBCLC, FILCA and Ingrid Dixon, RN, BSN, IBCLC

It is normal for your breasts to feel warmer and heavier a few •• Make sure baby is latching well for every feeding.
days after your baby is born. It is NOT normal to have breasts •• If your baby is sleepy, keep him or her skin-to-skin
that are swollen and painful—this is called engorgement. When and nurse at any sign of hunger.
your breasts become engorged, they can feel overly full, pain- •• Some newborns may “cluster” feed (nurse every hour
ful, hard, and lumpy, which can make nursing your baby harder. or so for several feedings) and then take a 4- to 5-hour
You may have a slight fever (less than 101°F or 38.5°C). nap. Allowing baby to eat as often as he or she seems
hungry will help avoid engorgement. Watch your
baby, not the clock.
•• Once breast fullness occurs, allow baby to soften at
least one breast at each feeding. Switch sides when
one breast feels less heavy and full, not after a specific
amount of time has passed.
•• Change the breast you start each feeding with to
ensure that both breasts are being emptied often.
•• Wait to use a pacifier until breastfeeding is going
well, usually when baby is around 1 month old.
•• If you are separated from baby, express milk from
your breasts before they become too full and remove
milk often (any time baby would eat) with either hand
expression or a breast pump.

Overly Full Breasts. With engorgement, it can take a few minutes to get the milk
to begin to flow; be patient and try to relax.
Why It Is a Problem How to Treat
•• Overly full breasts can be painful.
•• Remove the milk.
•• Overly full breasts make it hard for baby to latch
|| Pump or hand express for a few minutes to soften;
deeply and remove milk.
•• Poor latch can lead to nipple injury and baby getting sometimes a warm shower or heat applied to
less milk at each feeding. breasts can help the milk to flow.
� Nurse baby once nipple/areola is softer.
•• Milk left in breasts will cause milk supply to go down.
•• Milk left in breasts can lead to mastitis (a type of – Use your fingers to push the fluid away from
breast infection), poor weight gain, and weaning your your nipple to help baby latch. This is called
baby earlier than you had planned. reverse pressure softening.
•• Engorgement can make breastfeeding really hard and •• Reduce the pain.
may make you feel like you want to quit. || Apply cold packs to your breasts between feeds/

expressions.
How to Avoid
Myths
•• Nurse within first hour after birth if possible and nurse
often (whenever baby shows feeding cues) or 8 or •• “Don’t pump as it makes it worse.” It is very important
more times in 24 hours. to remove milk when the breasts are too full or your
Downloaded from jhl.sagepub.com at UNIV ARIZONA LIBRARY on May 26, 2015
370 Journal of Human Lactation 30(3)

often to keep making enough milk for a young baby

who is fully breastfeeding.

When to Call for Help

An International Board Certified Lactation Consultant
(IBCLC) can help you if:

•• You cannot remove milk from your breasts.

•• You cannot get your baby to nurse.

Call an IBCLC or other health care provider if:

•• Your fever goes up over 101°F or 38.5°C.

•• You have pain or redness in 1 part of your breast.
•• You start to feel like you have the flu (headache, body
ache, tired, weak).
•• You have concerns about breastfeeding.

Other Inside Tracks

Reverse Pressure Softening. (Source: Cotterman KJ.) •• Hand Expression
Using fingers or thumbs, apply gentle, firm pressure at the base of the
nipple to move fluid away from the areola. Press for about 1 minute.
•• Hands On Pumping
Rotate pressure around until you have softened all sides of the nipple/
areola. Nurse baby as soon as nipple/areola feels softer.
Websites
milk supply will start to decrease. Breasts can swell in •• http://www.llli.org/faq/engorgement.html
the first week due to milk and other fluids that become •• http://www.salactationconsultants.co.za/Articles/
trapped. Removing milk helps reduce swelling, pro- Reverse%20Pressure%20Softening.pdf
tects your milk supply, and lets the other fluids drain
into tissue. Pump or hand express to soften the breast
so that baby can latch or if baby cannot fully soften Videos
the breast. You may need to express only once or a
few times to treat your overly full breasts. •• Reverse Pressure Softening: http://www.youtube.
•• “If I wait longer between feedings, I have more milk.” com/watch?v=g1CYw1uTiG4
Breasts may feel fuller, and you may get more milk •• Hand Expression (English or Spanish): http://www.
the first few days you do this. However, over time bfmedneo.com/BreastMassageVideo.aspx
you will start to make less milk because you are leav- •• Hands On Pumping: http://newborns.stanford.edu/
ing milk in the breasts. You need to remove milk Breastfeeding/MaxProduction.html

Find Help Fast Your local lactation consultant:


An IBCLC is an “International Board Certified Lactation
Consultant”: someone with special training to help breast-
feeding families. Go to “Find a Lactation Consultant” at www
.ilca.org to locate a lactation consultant in your area. You can
also ask your doctor or a nurse at your hospital.

© 2014 International Lactation Consultant Association. ILCA’s INSIDE TRACK may be reprinted so long as the content remains unchanged, and
photocopies are distributed free-of-charge. ILCA’s INSIDE TRACK may not be shared electronically or posted on any other website. Questions? Call
+1.919.861.5577

Downloaded from jhl.sagepub.com at UNIV ARIZONA LIBRARY on May 26, 2015