As soon as your baby (and your placenta) are delivered, your body gets the hormonal signal that it’s no longer growing a baby on the inside, but instead needs to grow a baby on the outside. So, the milk-making factory opens up.
Colostrum is the perfect first food for your baby, but two to five days after birth (sometimes a little longer if you’ve had a cesarean birth), you will notice a sharp increase in the amount of milk you’ve got. Your breasts may feel heavy, swollen, hard or even warm to the touch. This is your milk ‘coming in,’ and the related engorgement typically lasts no more than a day or so. While it’s cause for celebration (because it often signals easier feeding), it can also be quite uncomfortable for some women.
To relieve engorgement:
- Nurse frequently: Expect your newborn to want to nurse 10 to 12 times per day. If you’ve got a sleepy baby, be sure to wake him to nurse every 2 to 3 hours around the clock. Be sure your baby is latched well and you’re hearing or seeing swallows for most of the feeding. Regular milk removal will keep you comfortable as the swelling recedes.
- Apply ice between feedings: You can use an ice pack (or a bag of frozen peas or corn) on your breasts for pain relief between feedings. Limit the ice to only 20 minutes at a time.
- Try warm, moist heat right before a feeding: This may help get milk flowing right before a feeding, but should be used for more than a couple of minutes. You can use a washcloth run under warm water, a heating pad or rice sock, or take a hot shower with the water hitting your back.
- Consider Reverse Pressure Softening (RPS): If your baby is having trouble latching due to the engorgement, you can use your fingers to press some of the fluid back while helping your nipple to stand out. A description of the steps for RPS can be found here.
- Express some milk: You don’t want to express so much that your body thinks it needs to make more, but just enough to make yourself comfortable. You can use an electric pump, manual pump, or hand expression to do this. Sometimes pumping for a minute or so before a feeding can help the nipple to stand out and get the milk flowing, making it easier for baby to latch.
- Use cabbage leaves: Yep, regular green cabbage from the produce department. Wash some leaves and remove the hard spine, then place them inside your bra. When they wilt, replace with new ones. Keep the head of cabbage in the fridge and the cold will provide additional comfort. Be cautious of overusing cabbage leaves, though, as they can decrease your milk supply.
- Take pain relievers: Over-the-counter pain medications, such as acetaminophen or ibuprofen, can be used short-term if the engorgement is especially painful.
Not all women leak milk – even with engorgement. If you do, you can wear pads to capture the leakage and keep your clothes dry. Disposable nursing pads are fine, but you may want to try washable ones. Whichever you are using, be sure to change them often to avoid bacteria growth (which could cause or worsen sore nipples).
If you are engorged, be sure to watch for any signs of plugged ducts or mastitis. If you notice any red, hard areas of the breast that are tender to the touch, these could be plugged ducts. If they’re accompanied by a fever and fatigue, you may have mastitis.
Prolonged engorgement typically signals a problem with milk transfer – for some reason, baby is not removing milk well. The help of a lactation consultant is essential during this time. We want to be sure baby is getting enough milk so that your body knows to keep making enough milk. And we want you to be comfortable in the process.