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How to avoid severe breast engorgement while breastfeeding

This baby's frequent, unrestricted breastfeeding helped his mother avoid engorgement.
This baby's frequent, unrestricted breastfeeding helped his mother avoid engorgement.
Photo courtesy of L. Radcliff

Most women will experience some form of engorgement about 3 to 5 days following the birth of their babies. If breastfeeding is progressing the way it should, this sensation of very full and mildly swollen breasts will only last a few days, and the baby will continue to nurse well, offering some relief every couple of hours. One mother who recently delivered her first baby boy in a Fresno hospital put it this way, "Engorgement wasn't as bad as people told me it would be. Even though my breasts felt like they were too full, I was actually comforted by the fact that I could hear my baby swallowing so much, and I also could feel them soften after he was done." A period of this type of engorgement that lasts a few days is normal, as the body transitions from colostrum to full milk volume.

Sometimes, however, engorgement crosses the line and becomes so severe that it interferes with milk flow. Pathological engorgement, as this is called, has many causes which are preventable. Awareness of the various forms of breastfeeding mismanagement that can lead to severe swelling and poor milk flow may help new mothers avoid this ailment. For example, early use of supplemental formula tops the list of engorgement's causes. When bottles are given too early, before the milk supply is well established, the baby will breastfeed less frequently than he otherwise would have, leading to a condition known as "milk stasis." If the milk is not removed from the breast efficiently and often, the result can be severe engorgement. In fact, any factors that lead to infrequent, delayed, or limited feedings in the first few days can cause pathological engorgement to occur.

For these reasons, Fresno women should be advised to resist the urge to supplement their babies with formula in the hospital setting unless there is a medical need for the supplementation. If there is such a need, mothers may request that the additional milk be given via a feeding tube at the breast, so that the baby will continue to nurse effectively and often.  If feeding at the breast is not possible, then a fingerfeeding device may be used, but mother must pump frequently to avoid engorgement until baby is nursing well. In the event that severe engorgement does occur, it is very important for new mothers to request the help of an International Board Certified Lactation Consultant as soon as possible, because prolonged engorgement can lead to poor milk supply and early weaning.