How to handle engorgement, excerpt from the Womanly Art of Breastfeeding

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Excerpted with permission from the Womanly Art of Breastfeeding (Random House), 8th edition, by Teresa Pitman, Diana West and Diane Weissinger

Engorgement is too much fluid in the breast. In the first week after birth, it’s a combination of milk and increased circulation. Engorged breasts feel heavy, full, tender or painful, and hot. Over-fullness can make latching difficult, and without a well-nursing baby or some other means of frequent and effective milk removal, you can end up with tight, shiny breasts that are too congested for milk to leave.

In the first three to five days after birth, milk production blossoms. Blood circulation to your breasts increases. If you had IV fluids during labour, some of the fluid the tubing pumped into your body will also go to your breasts.

It’s important to resolve engorgement as quickly as possible to avoid compounding the problem. Extreme engorgement can damage your milk supply.

What you can do

During labour, avoid IV fluids, which can significantly increase engorgement. After birth, removing milk from the breasts is critical to helping the other fluids drain as well.

Keep your baby with you, and nurse as often and as long as he’s willing, beginning as soon after birth as possible.

If your breast is too firm for your baby to latch onto, you can use ‘Reverse Pressure Softening.’ Press all the short-nailed fingertips of one hand around the base of your nipple to make a ring of dents. Press for the length of a lullaby, then immediately offer to nurse. Try this at least every hour or so.

Gentle hand expression may help. Pumping on a high setting pulls more fluid into the areola, compounding the problem.

Lie flat on your back when you rest. Gravity will help drain fluids away from your breasts.

Part of engorgement is inflammation; ask your doctor for an anti-inflammatory medication that is compatible with breastfeeding.

Use green cabbage leaves, which may help reduce swelling. Tear off some inner leaves, tear out the hard central stem, crumple the leaves gently in your hand, and apply them to your breast (not over your nipple, so the taste isn’t left behind). Doesn’t that feel wonderful? You can wear them inside a bra or under a tight shirt to keep them in place. Replace with fresh leaves whenever you want.

Wrap a bag of frozen peas in a small towel and use it as a cold compress, alternating about twenty minutes on and twenty minutes off. If you feel like a hot shower, let the water play over your back, not your chest. Inflammation responds best to cold.

Engorgement can return at later times – perhaps when your baby sleeps through the night the first time. Hand-expressing or pumping just until you are comfortable can help and your breasts will adjust soon.

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