Engorgement!!

                                               ENGORGEMENT
Most of us have been there, breasts that look like swollen melons, painful and sometimes itchy…….We wonder what has happened to our breasts! Will they ever go back to normal? Engorgement is a common and treatable problem, recognising the signs and treating it early is key.
For most mothers their milk usually comes in 2-5 days post partum. As this occurs the breasts normally become full and the areolar remain soft. The fullness usually lasts for approx. 24 hrs, the milk should flow normally and the baby should be able to latch on without difficulty.
 
Signs of Engorgement:
Engorgement can develop anywhere from the 3rd-5th day post birth and with appropriate treatment it should subside within 12-24 hours. The skin on the breasts may look tight and shiny, the breasts may appear swollen. Often mothers feel very full and uncomfortable, they may also have a throbbing sensation in the breasts. The breasts will feel hard and sometimes lumpy. Engorgement may occur in both breasts but it can arise in only one or sometimes in the areolar.
 
Causes of Engorgement:

• Infrequent feeds
• Scheduled feeds
• Baby not emptying the breast effectively
• Abrupt weaning

 
Tips to Relieve Engorgement:
Massage is an excellent way to relieve engorgement, it’s very important that it is gentle and light. Causing pain while massaging hard will inhibit let down and effect milk flow. Lying down on your back and massaging towards the armpit can encourage the excess fluid in the breasts to drain back towards the lymph nodes under the arm this can be done before or after feeding.
Cold compresses or clean cabbage leaves are very soothing and help to reduce inflammation in the breasts. Applying cold both before and after feeds is extremely helpful. Wet face cloths kept in the fridge or frozen peas wrapped in a towel are really useful. Heat is not advisable as it will increase inflammation.
Frequent feeding is so important for relieving engorgement, keeping your baby close where possible, feeding on demand and watching for early hunger cues. Always establish a good latch as this allows the baby to effectively drain the breasts.
If your breasts remain full and engorged after feeding hand expression can be very helpful, gentle massage prior to hand expressing aids with the let down. Only express to comfort and you can store and keep any milk obtained. Maya Bolman has a wonderful video on hand expression and breast massage. Here is the link https://bfmedneo.com/our-services/breast-massage/
If the areolar is engorged and taut it can be very difficult for your baby to latch on to the breast, in this situation Reverse Pressure Softening can be used. Here is the link to Jean Cottermans handout on reverse pressure softening http://www.health-e-learning.com/articles/RPS_JCotterman_ver2005.htm
 
Finally if your symptoms worsen ,you are feeling unwell or have any concerns about mastitis contact your IBCLC, PHN or GP. 
 
Further Resources:
https://kellymom.com/bf/concerns/mother/engorgement/
 
https://breastfeeding.support/engorged-breasts/
 
https://www.laleche.org.uk/engorged-breasts-avoiding-and-treating/