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What is engorgement and how can I minimise it?


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Engorgement is a condition where there is hardness in and painful swelling of the breasts due to the accumulation of milk. This is common during the first week right after birth when the mother’s milk starts ‘coming in’. As milk production greatly increases due to changes in hormone levels, the associated increases in milk, blood and fluid in the breasts causes them to feel uncomfortably full or even painful. Engorgement may also occur even after a regular breastfeeding pattern is established. Signs of engorgement Different mothers may experience the onset of engorgement differently. While it may be sudden and quick (resolved within 1 to 2 days) for some, others may experience pain and discomfort for up to 14 days. Generally, your breasts are likely engorged if they feel uncomfortably full, swollen, hard and/or lumpy. You may also be running a mild fever. Causes of engorgement Within the week after giving birth, engorgement is often experienced due to milk ‘coming in’. This feeling of discomfort may be prolonged as your newborn learns how to breastfeed effectively, and as you and your baby find a balance between milk production and demand. For newborn infants that require medical attention, limited mother and child contact in these early days may also lead to engorgement. Once the baby has started breastfeeding regularly, engorgement can also occur due to the following reasons:
  • The baby is not latching on properly, so the breasts are not fully drained after each feed
  • Too long a duration has lapsed between feedings
  • High milk production
  • Blocked milk ducts
Risks of engorgement Full breasts from engorgement may cause the nipple to flatten out, making it difficult for the baby to establish a good latch. This can then aggravate the problem as the breasts cannot be drained effectively. Improper latching may also traumatise the nipple. Breasts that are full for a prolonged period may result in a drop in milk supply. The pressure and build-up in the breasts can also disrupt the natural system that rids them of germs. This exposes the mother to a higher chance of getting mastitis. Dealing with engorgement New mothers may prevent engorgement by establishing the correct way to breastfeed early. Once your child is born, try to have immediate skin-to-skin contact and nurse your baby within 2 hours of giving birth. Nurse them on demand and do not limit their time at the breast. Remember to feed from both breasts. While at the hospital, seek help from nurses or lactation consultants to ensure that you baby is latching on correctly. Some of the ways to deal with engorgement include:
  • Frequent breastfeeding Be sure to feed your child both day and night as milk production is often more active during the night. If your breasts are very full, you may wish to express a little to ease the tension so that your baby can latch on better.
  • Milk expression using a hospital-grade pump If for some reason your baby is not able to feed from you or if you are producing more than your baby can drink, use an efficient pump to fully drain your breasts.
  • Warm shower/ warm compress You can take a warm shower or apply a warm compress to your breasts before feeding/expression. This stimulates your ‘let-down’ reflex, so that the milk can be drained more effectively.
  • Breast massage This can be done right before or in between feeding/ expression to stimulate your ‘let-down’ reflex. Massage your breast from the armpit towards the nipple.
  • Cold cabbage/ cold compress These may be applied to your breasts to relieve the pain and reduce the swelling. Take note not to do this more than twice a day, as it may reduce milk supply.
  • Pain-relief medication You may wish to take a mild painkiller (e.g. Paracetamol) for comfort.
You should not, however, stop breastfeeding if ever faced with engorgement. Although it may be uncomfortable, frequent feedings will help relieve the pain and discomfort faster. If these home remedies do not work and you begin to experience flu-like symptoms and have a fever (38 degrees C or higher), please seek medical help immediately. It is also best to see your doctor if you notice that your baby is not feeding well (less than 3 soiled and 6 wet nappies in 24 hours).