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What causes your breasts to engorge, ache, harden, and feel like they’ll burst any second, and what can you do for breast engorgement relief?

What is breast engorgement?

During your first week after birth, whether you’re breastfeeding or not, your breast milk will come in and your breasts engorge, this peaks on the third or fifth day and then gradually subsides within a few days for most. Breast engorgement occurs if the baby removes less milk from the breast when feeding than the amount that the mother produces. Your breasts may become bigger, even astonishingly huge, tender and hard as stone and painful. Continuing nursing difficulties can cause engorgement, such as if the breasts are not fully emptied, if the baby is having difficulty attaching to the breast or if you have decided not to breastfeed or if breastfeeding is suddenly stopped. It is a common problem and can even happen later on when there is a longer time between feeds.

Problems of engorgement

If relief is not found it can lead to further accumulation of milk, obstruction of lymph and blood drainage; so the breast becomes hot and painful and milk does not flow. Infections can develop. The engorgement of the breast can also prevent baby from keeping the nipple in her or his mouth. A negative feedback loop can then be initiated as the inadequate suckling leads to breast milk production being supressed. Consequently baby is not getting enough milk and this can slow its normal growth. These problems can lead to early abandonment of breastfeeding.

How to reduce breast engorgement

Advice to help has proved controversial and includes:

  1. Heat therapy – warm packs and water baths.
  2. Cold therapy – refrigerated bags of peas, with towels covering the skin for protection.
  3. Alternating heat (before nursing) and cold therapy (after nursing).
  4. Cabbage compression or using bra inserts.
  5. Breast massage.
  6. Milk expression (feeding on demand and altering the feeding position to ensure the breast is being fully emptied, and/or milk expression by hand (often in the shower) – some midwives advise against using breast pumps for milk expression as they can aggravate the situation due to increasing the milk supply too much).
  7. Anti-inflammatories.

Cold can restrict blood flow and warm packs can aggravate the swelling. Experience and research suggests hot packs before expressing milk seems to work best. Though getting a hot pack to adequately cover the breast, without damaging the nipple can be difficult. In Asia, a Chinese Medicine technique called Gua sha is used and has proved effective.   In 2010 a randomised controlled trial of 54 women suffering breast engorgement was carried out. Half were given Gua Sha treatment (2x for 15 minutes) and the others received usual care of 20 minutes hot packs and massage. Measurements at 5 and 30 minutes after intervention showed greater improvements among the Gua Sha group of reduced breast engorgement, breast temperature and pain levels when compared to the usual care group. If your usual care is not working sufficiently, try Gua Sha. I offer Gua sha to women with breast engorgement, you can have this treatment without acupuncture. Look for a Gua sha specialist if you cannot get to one of my practices.

Prevention better than cure

At the London Birth Practice, their independent midwifes will visit new mums and babies every day for the first week. Their midwives explain “this is partly to observe and support the recovery after the birth but mainly to give breastfeeding support.” Because of this care, they rarely see engorged breasts. The top tip to help prevent engorged breasts is frequent, regular feeding, ensuring the breast is emptied. A good deep latch is essential.   London Birth practice comment that if this didn’t prevent or improve engorgement that they would then contact a lactation consultant, they explain, “the baby’s latch can be checked and its tongue checked for restriction, such as tongue tie, which may stop the baby from emptying the breast”.

Chiu Jin Yu et al.  Effects of Gua-Sha Therapy on Breast Engorgement: A Randomized Controlled Trial. Journal of Nursing Research h VOL. 18, NO. 1, MARCH 2010