Breast Engorgement

To prevent severe breast engorgement

If you are planning to breast-feed, do the following to prevent severe breast engorgement.

• Start breast-feeding as soon as possible after your baby is born, and continue to breast-feed often. This is the best way to prevent severe engorgement.
  • In the first few days after birth, breast-feed at least every 1 to 2 hours. Short periods of time between feedings may help reduce or prevent severe breast engorgement. During this time, you may have to wake your baby to breast-feed.
  • Feed your baby whenever he or she is hungry or at least every 2 hours.
• Make sure that your breasts are soft enough for your baby to latch on well. If your breasts are hard and too full of milk, let out (express) a small amount of milk with your hands or with a pump. Then put your baby to the breast.
• Empty your breasts with each feeding.
  • Your baby should breast-feed at least 15 minutes or more on the first breast before changing to the second breast. You will know it is time to move to the other breast when your baby becomes less eager to suck.
  • If your baby becomes full before your breasts are empty, Reference use a pump or Reference use your hands (manual expression) Opens New Window Reference Opens New Window to squeeze the remaining milk from your breasts to Reference store for later use. This is especially important during the early stages of breast-feeding.
  • Early engorgement will decrease as breast-feeding becomes more routine and your baby is able to feed for longer periods of time.
• Change your baby's breast-feeding position now and then to make sure that all parts of your breasts are emptied. For information on breast-feeding positions, see the topic Reference Breast-Feeding.
• Make sure your baby is latched on properly. If your nipples are flat, gently massage the nipple and Reference areola Opens New Window. This should stimulate your nipple to become more erect. Then gently support your breast with your thumb on top and fingers underneath. This added support will make it easier for your baby to latch on. View a slideshow of Reference proper latch-on for breast-feeding Opens New Window Reference Opens New Window.
• Discuss any breast-feeding problems or concerns with your doctor or a breast-feeding specialist (Reference lactation consultant Opens New Window).

When your baby is breast-feeding well, do the following to help prevent future breast engorgement problems:

• If your breasts are becoming overfull, take a warm shower, letting the water flow over your breasts. This should trigger the Reference let-down reflex Opens New Window, allowing some milk to leak out and slightly softening the nipple and areola. Remove excess milk and relieve pressure Reference by using a pump or Reference by hand (manual expression) Opens New Window Reference Opens New Window.
• If your milk is not flowing well and you are becoming overfull, place warm, moist towels on your breasts before breast-feeding. The moist heat should help your milk flow more easily.
• Anytime you are not able to breast-feed your baby, arrange for a time and place to manually express or pump milk from your breasts at least every 3 to 4 hours.
• When you and your baby are ready to Reference wean, gradually stop breast-feeding over a period of several weeks. Start by dropping the least favorite breast-feeding time. Wait a few days until your supply decreases, then drop another feeding, and so on. Gradual weaning is best for both you and your baby. It gives your breasts time to adjust gradually to your baby's decreasing demand, and it gives your baby time to develop new eating patterns. For more information, see the topic Reference Weaning.

To relieve breast engorgement

If you need to breast-feed but breast engorgement is preventing you from doing so, use these steps to keep your milk flow going and relieve your pain and swelling:

• Soften your nipple and areola before breast-feeding, to avoid nipple damage. When the nipple and areola are soft, the nipple protrudes more easily, allowing your baby to latch on well. View a slideshow of Reference proper latch-on for breast-feeding Opens New Window Reference Opens New Window.
  • If your breasts are freely leaking, you can use a warm compress for a couple of minutes before breast-feeding.
  • Gently Reference pump or Reference use your hands (manual expression) Opens New Window Reference Opens New Window to let out a small amount of milk. Be careful not to injure your breast tissue. An automatic cycling breast pump with the suction adjusted to low is best for relieving engorgement.
• Use gentle breast massage to promote milk flow.
• Breast-feed your baby more often, or pump your breasts if your baby won't breast-feed. Take care to empty your breasts each time. You can freeze pumped milk in clean containers or bags for later use.
• Reduce swelling and relieve pain. After breast-feeding:
  • Take a Reference nonsteroidal anti-inflammatory drug (NSAID) Opens New Window, such as ibuprofen (Advil or Motrin, for example), in addition to the nonmedicine treatments. When taken as directed, ibuprofen is safe to use while breast-feeding.^{Reference 1}
  • Try cold compresses. Apply a frozen wet towel, cold gel or ice packs, or bags of frozen vegetables to your breasts for 15 minutes at a time every hour as needed. To prevent tissue damage, do not apply cold to your bare skin. Place a thin cloth between the cold pack and your skin.
• Avoid constricting bras that press on your breasts. A tight bra can reduce milk flow through the ducts, eventually causing blocked ducts.

If you are bottle-feeding formula and you experience breast engorgement after childbirth, use one or more of the following measures to help relieve discomfort:

• Avoid pumping or removing a large amount of milk from your breasts. This stimulates milk production and makes engorgement worse. Remove just enough milk to make you feel more comfortable.
• Take ibuprofen (such as Motrin or Advil) in addition to the nonmedicine treatments.
• Try cold compresses. Place a frozen wet towel, cold gel or ice packs, or bags of frozen vegetables on your breasts for 15 minutes at a time every hour as needed. To prevent tissue injury, do not apply cold directly to bare skin. Place a thin cloth between the cold pack and your skin.
• Wear a supportive bra that fits well.

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