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Physiological engorgement

For the first few days after giving birth, breasts remain soft and produce colostrum, the first milk. Colostrum comes in many colors and the amounts may seem small, but it is produced
in just the right amount. Colostrum is rich in immune factors that protect your newborn baby.
Within 72 hours, you will notice changes in your breasts. They will become full, firm, warm, and perhaps tender as milk production increases and colostrum begins to change to mature milk. The term for this change in breast fullness is physiological engorgement.
Mild to moderate discomfort is common and normal. Some women experience this for only 24 hours but in other women, engorgement may be more intense, and can last for several days.
Your breasts will adjust over time, making exactly the right amount of milk for your baby. In cases of extreme or prolonged painful engorgement, get help from a lactation consultant, or healthcare professional. Your baby helps you manage this physiological engorgement by removing milk frequently. This means you should breastfeed at least 8-12 times each 24 hours. If your baby is not latching properly or feeding frequently, your breasts may become overly full. (You can also pump to relieve engorgement).
This fullness reduces the elasticity of the breasts and nipples, which can lead to more latch problems, and/or sore nipples.
Physiological engorgement should clear within the first 4-5 days. If it persists please consult a health professional who can support you.

Pathological engorgement

If the problem persists, or the feeling of intense fullness or pain occurs after the first 7-10 days then this could be a pathological engorgement, caused by the breasts not being drained properly.
Poor attachment is usually the cause of blocked ducts, which subsequently leads to engorgement.
The breast will become tender, maybe in one specific place and there may be a reddening of the area.
Change of position for breastfeeding may help and also massage of the affected area prior to and sometimes during a feed.
Frequent feeding will ensure milk flow continues but ensure the latch is good by getting the advice from a health professional.

If the milk is not removed, it will remain in the breasts and chemical signals are released which will
decrease milk production. Unrelieved, prolonged engorgement leads to lowered milk supply and possible mastitis.
 

Mastitis

Mastitis describes a situation of an inflammation of the mammary gland or the breast tissue. Mastitis can be caused by internal or external pressure that leads to a milk stasis in the breast. Prolonged engorgement can lead to mastitis and so can untreated cracked nipples.


Signs of mastitis include:

  • tenderness in one particular area of the breast
  • hot and red area of the breast
  • General feeling of being unwell
  • flu like symptoms
  • fever

You should consult a health professional for diagnosis and treatment.


Treatment:

  • Frequent feeding and/or expression to relieve the engorgement and encourage milk flow
  • Rest
  • Massage of the breast, especially the effected area
  • Hot flannels prior to feeding to encourage let down
  • Medication my be necessary - see your health professional for advice

References

Cotterman KJ. Reverse pressure softening: a simple tool to prepare areola for easier latching during engorgement.
J Hum Lact. 2004 May;20(2):227-37.
Humenick SS, Hill PD, Anderson MA. Breast engorgement: patterns and selected outcomes.
J Hum Lact. 1994 Jun;10(2):87-93.
Fetherston C. Mastitis in lactating women: physiology or pathology? Breastfeed Rev. 2001 Mar;9(1):5-12
Lawrence R and Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. St. Louis: Mosby;
2005:278-281.
Olsen CG, Gordon RE Jr. Breast disorders in nursing mothers. Am Fam Physician. 1990 May;41(5):1509-16.
Roberts KL. A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. J
Hum Lact. 1995 Mar;11(1):17-20.
Sandberg CA. Cold therapy for breast engorgement in new mothers who are breastfeeding [Masters thesis].
St. Paul, MN: College of St. Catherine; 1998.
Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement
during lactation. Cochrane Database Syst Rev. 2001;(2):CD000046.
Walker M. Breastfeeding and Engorgement. Breastfeeding Abstracts. 2000 Nov;20(2):11-12. Available at:
www.lalecheleague.org/ba/Nov00.html