ENGORGEMENT Part II

What are Tips for Treating Engorgement?

• Cold Compresses- use for 10 to 20 minutes before breastfeeding as well as between feedings for 20 minutes at a time. You can use bags of frozen peas or corn, or a disposable diaper that is dampened and put in freezer for 20 minutes.  Use a layer of cloth between your skin and the cold compress.  
• Gentle Breast Massage-  Around your breast like the numbers on the face of a clock. 
• Moist Warm Compresses for only a few minutes- Just before you breastfeed or pump- or run your fingers lightly over your breasts and use deep breathing and relaxation to stimulate the milk ejection reflex (milk flow or let-down).  Contrary to much that you will find in books, articles,online, or even from practitioners, current research shows that heat for more than a few minutes can increase swelling and inflammation, making your situation worse.
• Reverse Pressure Softening- if your breast is so hard and swollen that it is difficult for baby to latch, use reverse pressure softening.   Surround your nipple with your fingertips from both hands, flatten your fingers against your breast as best you can, and press firmly towards your chest wall for about two minutes.  This will force fluid out of the cells, softening the areola, so that baby can latch-on more easily.  When switching breasts, do the same on the second breast.
• Remediate Let-down Inhibitors- In order to empty your breasts, you need to have multiple “let-downs” during a feeding.  You can have the baby at the breast for hours, but if you don’t have multiple let-downs, you will not be emptying your breast.  Some mothers feel the let-down and some don’t.  If milk is flowing and the baby is swallowing, you have had a let-down.  There are a number of things that interfere with having a let-down, including pain, fatigue, stress, and anxiety--ironically, all things that most new mothers are dealing with.  Try to nap several times a day with the baby, get all the help and support you can, and use deep breathing and relaxation techniques when you start feedings and when you notice the baby falling asleep or not sucking and swallowing.

•   Breast Compression- can be  used when baby’s sucking pauses.  Take a broad part  of your hand or fingers and compress somewhere (especially on hard areas) distant   from the nipple.  Press and hold it until the baby pauses, then lift and repeat. 

• Empty First Breast, then switch- When baby is no longer sucking and swallowing at  the first breast, even with compression, it is time to switch sides.  If the baby pulls off or falls asleep it is time to switch sides as well. If baby still hungry, you may go back to  first breast after doing both sides.

• Skin-to-Skin- should be done when switching sides.  Burp the baby, change if needed,then put skin-to-skin until ready for next breast.  The baby may rest up to 20  minutes between sides, and this is still considered part of the same feeding.  STS does amazing things for you and your baby! 

• Good Latch and Positioning- A good latch should not be painful after 30 seconds.  If it is, get help so that the baby can empty your breasts completely and efficiently, thus softening your breasts and stimulating your milk supply. 

• Protect Your Milk Supply- If the baby is not breastfeeding well and emptying your breasts, protect your milk supply and decrease your engorgement by using hand expression or pumping.  Use deep breathing to relax and help yourself to have more frequent let downs, thus emptying your breasts more thoroughly.  If you use an electric pump, set it on the minimum setting and gradually increase it to the highest comfortable setting.  Lubricate your nipple with olive oil when pumping.

• Expect Cluster Feeding- the baby will cluster feed at times.  This is most common in the late afternoon and  evenings.  This is normal newborn behavior and stimulates your milk supply. 
• Use Pain Relief- if needed, you may take over the counter Acetaminophen (Tylenol) alternating with Ibuprofen to decrease the inflammation and for pain relief if OK with your healthcare provider. 
• Use Cabbage Leaves- Yes! Cabbage leaves!  Chilled, green cabbage leaves have been used to treat engorgement for many years.  There is much anecdotal evidence for it’s effectiveness, as well as some research showing that it causes a significant reduction in pain.  When compared to gel packs, two thirds of the mothers preferred the cabbage leaves because of a stronger, more immediate effect.

           How to use Cabbage leaves:

•   Get organic, green cabbage if possible
•   Remove the outermost leaves
•   Take the next 2 or more leaves, wash, dry, remove hard middle vein
•   Crush leaves in your hand
•   Place leaves inside your bra over all of engorged areas- including area by armpit if that is also swollen  and tender.
•   When leaves are wilted and warm, remove and replace with fresh leaves
•  Continue to treat between feedings until you feel relief and are able to empty your breasts by breastfeeding or pumping. 
•  Stop using as soon as relief is obtained.

What Should I Avoid?

• Do not apply heat to your breasts between feedings.  Current research shows that this causes an increase in the swelling and inflammation of breast tissues.  It is best to use cold between feedings.  If you are unable to have a let-down, you can use heat for just a few minutes to help your milk start to flow.
• Do not restrict fluid intake.  Drink to thirst.  Fluid restriction will not decrease engorgement.
• Avoid tight fitting, restrictive bras--they can lead to plugged ducts and mastitis
• Don’t allow visitors to interfere with or delay feedings.  Politely tell them you need to feed the baby.   As much as you want to share your joyful new arrival, while you and baby are learning to breastfeed and trying to establish a good milk supply, privacy and minimal interruptions are important.
• Avoid pacifier use in the first 8 to 10 weeks.

When Do I Need to Contact my Lactation Consultant (IBCLC) or Health Care Provider?

• If engorgement is not relieved by these measures.  The sooner you can get help, the better!
• If your baby is unable to latch or is not having enough wet or dirty diapers.
• If you have symptoms of mastitis : hot, reddened, painful area on breast, chills, body aches, flu-like symptoms, temperature of 100.6 degrees F or more.
• If you have questions or concerns.

This is part II of a two part article on Engorgement.  If you would like the full article with endnotes, please contact me.  

May reproduce once for personal use only.  Otherwise request permission to reprint.

Copyright:  November 2010  Kathleen L. Gale RN, IBCLC, RLC