I NO longer see private patients at this time! Please go to ILCA.org to find a lactation consultant near you! Feel free to peruse my blog, which still has good information on it!

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

ENGORGEMENT

ENGORGEMENT

Is This Supposed to Happen?

Every new mother will notice some degree of fullness in her breasts as her milk supply increases after delivery.  Your breasts will feel heavier and warmer, and sometimes uncomfortable.  It usually occurs between day 2 and 6 after your baby is born, and won’t last more than 24 hours.  If your breasts and areola remain soft and elastic, and your milk is flowing well and the baby is able to latch without a problem, there is no need for concern.  Some mothers have several peaks of this fullness, which then resolves. 

What Can I Do to Prevent or Minimize Engorgement?

• Breastfeed your baby as soon as possible after birth. 
• Alternate the breast that you offer first for a feeding. 
• Breastfeed the baby every 1 to 3 hours--at least 10 times or more in 24 hours. 
• Do NOT skip feedings. 
• Watch for the baby’s feeding cues to determine when to feed ( mouthing, bent arms, clenched fists, fists near face    or mouth) Feed as soon as you see any of these feeding cues.  Crying is a late feeding cue.  The baby will feed better if you feed him before he starts crying. 
• If baby is very sleepy, during the day, wake to feed every 2 to 3 hours.  At night, or sometime within a 24 hr period,   you may allow one 4 to 5 hour stretch between  feedings. 
• Make sure the baby empties the first breast before switching sides.  Don’t limit time at breast.
• With good positioning and latch, the baby should feed well and the breasts should be soft after a feeding.  If that is not the case, be sure to get help from a qualified professional lactation consultant.      
• Avoid using a pacifier during the first month of breastfeeding.

When Does Engorgement Typically Occur?

• Engorgement usually begins on the 3rd to 5th day after the baby is born. 
• If you had a cesarian section, it could occur 24 to 48 hours later. 
• With proper treatment, it should subside  within 12-24 hours.  Without good management, it can last up to 7 to 10 days     
• Prolonged engorgement causes milk stasis and predisposes a mother to mastitis as well as decreasing milk   production. 

What Are the Symptoms of Engorgement?

• Every mother experiences engorgement differently, but there are typical symptoms.
• The breast will feel hard with taught skin.  The skin may appear shiny with distended veins.  The skin may feel extra warm, throbbing, and be somewhat tender.
• These symptoms can occur in one or both breasts, part of the breast, or all of the breast.
• Some mothers have engorgement that extends up into their armpit.
• Engorgement in the areola can make the nipple more flat and make it difficult for the baby to latch-on well.
• Some mothers experience a low-grade fever.
• Some mothers experience a peak of engorgement which then decreases.  Others have several peaks.  Some have quick resolution, others resolve more slowly. 

More to follow about how to treat engorgement....


Full text with endnotes available upon request.

This is copyrighted November 2010 Kathleen L. Gale RN, IBCLC, RLC

Post Partum Depression Video

Here is a link to a video about post partum depression from Kathleen Kendall-Tackett's website.  Please take the time to watch it.  If you are concerned about how you are feeling emotionally, don't discount your feelings.  Being a new mother is a major life changing event!  Not only that, if you had a difficult or traumatic delivery, or if it just didn't go the way you had dreamed, that can also add to the emotional struggles a new mother has.  


New mothers are often so busy, that they don't take time to take care of themselves.  We know that it is very important that a mother be emotionally engaged and available for her baby--not just taking care of physical needs.  So, if you have any concern about  feeling depressed, don't delay calling your OB/Gyne or other health care giver.  If you are having irrational thoughts of wanting to hurt yourself or your baby, call 911 right away.  Get the help you need.


Crisis Hotline for post partum depression:  1-866-364-6667

Post Partum Depression Video

How Can I Increase My Milk Supply?

There are a number of things you can do to increase your milk supply.   There are a number of things you can do.

1. Make sure you have a good latch (see latch videos listed under resources)  If latch is painful or nipples are sore, get help from an IBCLC qualified lactation consultant
2. Increase your frequency of nursing to 12 times or more in 24 hrs. Make sure you breastfeed or pump at least one time during the night.
3. Do lots of skin to skin with the baby (mom or dad) Put only a diaper on baby, put baby on your bare chest,  and cover with blankets as needed.  Skin to skin does amazing things for the baby and also stimulates mother's milk producing hormones.
4. Pump 8 to 12 times in 24 hrs after every feeding for about 15 minutes.
5. Check for proper flange fit--nipple should not be touching the sides of the flange tube when pump is working
6. Use breast massage or compression
7. Use herbs that increase your milk supply such as More Milk Plus. You should notice a difference within 48 hrs if it is going to work. 

Breastfeeding Tidbits

• Babies thrive on direct contact and social interaction with you.
• Car seats are for when you are traveling in the car

Don't leave your baby in the car seat when you are out of the car. Babies need to be in different positions in order to strengthen all the muscles of their neck and torso. Hold the baby, or use a sling or baby carrier if you need to get some things done. These things will also help prevent the flattening of the back of their head. Carrying the baby around in the car seat is terrible for your arm and back as well.

Breastfeeding Tidbits!

• If you are breastfeeding, avoid using the gel hand sanitizers.

Just wash your hands with soap and water instead. Why? The gel sanitizers have alcohol in them. Alcohol can irritate your hands as well as the sensitive skin around the nipple and areola when you hold your breast to latch baby. The alcohol fumes are toxic to baby. I've seen cases where babies have had "breast aversion" because their mommy was using hand sanitizer after all diaper changes.