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Have you gone from not-too-well-endowed to va va va voom in a mere 48 hours? Sure, you're happy that your milk is "coming in" but your breasts feel like they're ready to burst. Fortunately there are ways to help prevent this and continue breastfeeding comfortably.

Engorgement is defined as the painful swelling of the breasts caused by increased blood and lymph, as well as the sudden increase in milk supply. While the experience of engorgement is not the same for all mothers, writes Marsha Walker, RN, IBCLC, in "Breastfeeding Abstracts," "[It's] a normal physiologic process with a progression of events, not a result of trauma or injury to tissues ... Four patterns of engorgement have been described: a single experience of firm, tender breasts followed by a resolution of symptoms; multiple peaks of engorgement followed by resolution; intense and painful engorgement lasting up to fourteen days; and minimal breast changes."

Answers to Your Engorgement Questions

• Are some women more likely than others to become engorged? Women who have already breastfed often experience more engorgement but faster resolution than first-time breastfeeding moms. Other women more likely to become engorged are moms with multiples, those who have a very abundant milk supply, women with breast implants, and women with small breasts (due to a smaller storage capacity, which necessitates more frequent feeds). Other factors leading to engorgement include a delay in initiation of the first feed, infrequent feeds, timed feeds, and supplements.
• When do most moms notice an increase in breast fullness? Usually two to six days after birth, your breasts may feel heavy and warm. This corresponds with your increasing milk supply. With normal breast fullness, your breasts will still be relatively soft and compressible. With frequent and effective breastfeeding, this fullness usually lasts less than a day or two and should not cause your baby any difficulty latching on.
• How will I know if normal breast fullness has become severe engorgement? When severe engorgement occurs, it's usually between the third and seventh day after birth. Your breasts feel very hard, with tightly stretched, shiny skin. They may be hot, tender, achy, and red. Your areola may be firm (feeling like the tip of your nose rather than your earlobe) and your nipple may flatten out, making it very difficult to get your baby latched on or to even express your milk. You may also run a low-grade fever. Engorgement can occur only in the areola, only in the body of the breast, or in both areas.
• Can engorgement lead to other problems? It may be difficult for your baby to latch on if you're engorged. Insufficient feeds can lead to more engorgement and ultimately a compromised milk supply. When milk is not properly drained from your breasts the process of involution (drying up) begins, just as if you had decided not to breastfeed. Breast engorgement can also lead to nipple pain, cracked nipples, and abscesses, and may lead to the termination of breastfeeding.
• What can I do to prevent severe engorgement and relieve the pain and swelling?
  
  
  • Frequent feeds help engorgement. The more your baby sucks, the less engorgement you'll experience. Breastfeeding every two to three hours, including nighttime feeds, can help prevent or reduce painful engorgement. When nursing, allow your baby to finish the first breast before offering the other. If your baby is sleepy, wake her every two to three hours to nurse.
  • Use warm, moist heat for a short period of time before nursing. Heat can increase swelling, so use this only long enough to get your milk flowing. Limit to no more than a few minutes before putting your baby to your breast.
  • Express your milk prior to a feed. Hand expression or gentle pumping, at the lowest setting, can soften your areola. This makes your breasts more graspable, making it easier for your baby to nurse and also gets your milk flowing.
  • Try breast compression/massage. Gently massage your breasts from the outer quadrants toward the nipple before and during a feed. You can also compress the breast with the heel of your hand, moving to different places on your breast, when your baby stops sucking. Both methods help get your milk flowing and encourage your baby to nurse.
  • Express just enough milk for comfort between feeds. If you're uncomfortable, hand express or pump just enough milk so that your discomfort is relieved.
  • Cool compresses and/or cabbage leaves provide relief after breastfeeding. Cool compresses can be applied for 30 minutes at a time to relieve swelling, pain, and warmth. Cabbage leaf compresses can also help. Tuck a few cabbage leaves inside your bra and change every two hours, or when they wilt, as long as breasts remain firm. Do not continue once engorgement resolves as they can reduce your milk supply. Researchers have studied the effectiveness of chilled cabbage leaves and gel packs and found a significant reduction in pain with both methods, though two-thirds of moms preferred cabbage leaves because of their stronger, more immediate effect (Kathryn L. Roberts, Journal of Human Lactation, 1995).
  • Talk to your doctor about using a pain reliever/anti-inflammatory. Most pain relievers have been approved by the American Academy of Pediatrics for use by nursing moms.
  • Express your milk if your baby is having difficulty nursing. If your baby doesn't nurse long enough to soften your breasts, it's important to express your milk. Regular milk expression, with an automatic electric double breast pump, not only relieves engorgement but protects your milk supply and can help prevent a breast infection. Start on the lowest setting and express your milk for around 10 minutes.
  • Work with a board-certified lactation consultant (IBCLC). If you have severe engorgement or problems nursing, it's important to get help from an IBCLC who can watch a complete feed and offer recommendations.

Safety Notes

• Wearing a tight bra or binding your breasts can cause plugged ducts or mastitis. Choose a comfortable, supportive bra that does not put pressure on your breast tissue.
• Engorgement can leave you more vulnerable to a breast infection. If you experience symptoms of mastitis, such as red and painful breasts, body aches, chills, flu-like symptoms, and a temperature over 100.6, it is important to see your physician immediately.