At first, your newborn’s feeds will be colostrum, a yellowish fluid high in antibodies and important elements that prime your baby’s immune system and protect him against infections. Although you will only produce small amounts of colostrum, this will provide all the nourishment your baby needs as he learns to coordinate sucking, swallowing and breathing in the first few days: it is much easier for a tiny baby to learn to feed without also having to contend with a large volume of milk.
Sometime between the second and sixth day after your baby’s birth, your milk will ‘come in’. For some women this is a gradual process with relatively little discomfort, but for many it can feel very sudden and surprisingly painful – you can feel as though your breasts are literally bursting! Your breasts may feel hot and hard and you may feel throbbing, with this swelling and hardness even extending up to your armpits.
This ‘fullness’ is not all ‘milk’ but is due to additional blood flow to your breasts and accompanying swelling of the tissues as your body prepares to nourish your baby. Fluid retention due to IV fluids during labour can also contribute to engorgement.
Although a bigger cleavage may have been something you have long aspired to, rock hard, engorged breasts can be quite frightening as you wonder, is this what happens when I breastfeed? The good news is that this feeling of extreme fullness which can be quite painful usually subsides naturally in a few days. Meanwhile, your discomfort can be relieved by good breastfeeding management and simple treatment.
Preventing engorgement
Although engorgement isn’t always entirely preventable, it can be minimised by feeding your baby frequently from birth so that your milk comes in more gradually: although your baby’s first sleep after birth may be a long one, after this sleep, gently wake him to feed at least 10 times in 24 hours – this could mean every 2 to 3 hours with perhaps one stretch of up to 5 hours at night. If your baby is sleepy and not feeding well, express milk to maintain your milk supply and minimise engorgement. Feeding frequently from birth will bring your milk in more quickly with less likelihood of engorgement and will also ensure that you baby gets more of the powerful immune boosting colostrum.
Relieving engorgement
If your breasts do become engorged (hard and painful), it is important to continue to breastfeed frequently – every two hours is ideal. Applying cool compresses between feeds (20 minutes on and 20 minutes off) will help relieve the swelling. If you have had IV fluids during labour and some of your engorgement could be due to this, apply cool compresses and lie on your back to encourage lymphatic drainage.
To help milk flow, you can apply a warm face washer to your breasts before feeds for a few minutes. Gently massaging your breasts towards your nipples may also help, especially if swelling is mainly in one area. This can be more effective if you massage while in a warm shower but try running the water against your back, rather than running warm water directly onto your breasts as this could increase the swelling.
If your breasts are hard or lumpy after feeds, it is important to gently massage the lumps and if your breasts still feel uncomfortably full, express a little milk until they feel soft and comfortable as overfull breasts can predispose you to blocked ducts and mastitis. Use hand expression or a quality breast pump on a low volume to avoid overstimulation or damage to swollen tissues. Some women worry that expressing even a small amount of milk will stimulate their breasts to overproduce. However, although your milk supply does depend on a balance of supply and demand, removing a little milk for comfort when you are engorged will help relieve congestion and discomfort.
Applying icepacks (with a cloth between the ice and your breasts) between feeds can reduce swelling ( if your nipples become white and sting when you apply ice, tell your health carers as it may indicate that you have a condition called vasospasm which is aggravated by cold).
Pass the cabbage
One simple home remedy that many women swear by is applying chilled cabbage leaves to engorged breasts: rinse leaves and cut a hole for your nipple (or arrange the leaves so that your nipple is uncovered – your baby won’t want to taste cabbage and just in case you can’t find organic cabbage you will want to avoid any potential pesticide residue on your nipples). Tuck cabbage leaves into your bra directly against your skin. As the leaves wilt, reapply fresh ones – leave cabbage leaves on for 20minutes three times a day. Don’t overuse cabbage leaves and discontinue treatment once engorgement subsides as overuse can reduce your milk supply.
If engorgement makes breastfeeding difficult
Engorged breasts can make it difficult for your baby to attach and feed if your nipples become flat as your breasts stretch – rather like a fully blown up balloon loses its ‘pointy’ bit. The key is to make the areola soft so that your baby can latch more easily and his tongue can remove milk more easily. You can try hand expressing a little milk until the nipple and areola soften or, if your areola is very firm (like the tip of your nose, rather than soft like your earlobe), try reverse pressure softening: Curve your fingers on one hand with your thumb and fingers opposing. Now with your fingers in this position, place your fingers around your nipple, pressing on your areola. With your finger and thumb tips, gently press your fingers in towards your chest wall. Using steady and firm pressure, count slowly to 50 (this shouldn’t hurt). This will press the fluid back and soften your areola, making it easier for your baby to feed.
Contact your health care provider
Seek advice from your lactation consultant, midwife or doctor if your baby is not latching and/or is not having enough wet and dirty nappies and, if you have an elevated temperature, feel hot, shivery, have flu-like symptoms, or a red hot patch on your breast, check with your doctor quickly as you may be developing mastitis.
