It is normal for a new mother's breasts to feel heavy, warm and a little uncomfortable when the milk first comes in. The breasts should soften when the baby feeds but, in the first week or two, may still not feel empty. When the breast starts to make milk the tissue between the milk ducts swells and causes this feeling. The sensation is similar to premenstrual symptoms - but more intense. The good news is that this tenderness will go away, usually by the end of the second week.

However, some women find that their breasts become very painful and so swollen that it is difficult or impossible to latch the baby. There are two causes for this, which are described below.

1. Excessive Swelling (Edema)

Most often excessive swelling is due to edema, which may occur as early as the first day postpartum. Often, you will notice it in your hands and feet as well. This problem may be caused by intravenous fluids during labor, the fluid-retention effect of Pitocin and the redistribution of excess fluid that normally accumulates during pregnancy.

What to do?

If your breasts are hard, but very little or no milk comes out when you pump, the problem is most likely edema. You will need to reduce this swelling in order to express the milk. If the milk is not removed, your long-term production may be reduced.

Incorrect pumping may make this condition worse as it can draw more fluid into the area under the pump flange! Pump only one breast at a time, massaging the breast as you do so. Your goal is to extract any milk that is available while you massage out the edema. Firm circular motions (the same that you would do to check for a breast lump) work well for both goals. Stop when milk no longer comes out. Short (5 to 10 minutes) and frequent (every 1 to 3 hours) pump sessions are your best bet.

Research shows that twenty-minute applications of cold are very effective at reducing the swelling and allowing milk to flow more freely. You can do this any time, even right before pumping or breastfeeding.

A brief application of heat (maximum 5 minutes) can help release milk. Longer use of heat can draw more fluid into the breast. Massaging the areola around the base of the nipple may help release your milk. This will also move away some of the unwanted fluid so that you can pump or breastfeed more effectively.

Some mothers wrap their engorged breasts in cold cabbage leaves. Take out the large veins and flatten the leaf. There is certainly nothing harmful in doing this and, anecdotally, it has helped some women.

2. Too Much Milk

Some mothers have a very rapid onset of high milk production. Milk will be leaking, baby will be gulping and gaining weight, and the breasts will be much softer after breastfeeding.

What to do?

Massage the most uncomfortable spots while you feed so that you can soften them. Make sure the baby is totally satisfied. If at the end of the feed your breasts are still painfully full, it is okay to pump out just enough milk so that your breasts are tolerable. Do not empty them as this could cause more production. You may also have some edema and may benefit from following the suggestions above.

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