Engorgement is a problem encountered very frequently by breastfeeding mothers, especially during the flow of milk. An effective drainage of the breasts with frequent feedings and small gestures to relieve breast tension can quickly overcome engorgement, and thus not jeopardize the continuation of breastfeeding.

Engorgement can affect one or both breasts. It can occur at any time during breastfeeding, but two periods have been identified as particularly risky:

The flow of milk, 3 to 4 days after the birth of the baby

During this key moment of lactogenesis, during which breast milk will replace colostrum, under the effect of hormones, a phenomenon of vascular dilation and an increase in blood flow and lymphatic fluid is observed. Associated with the increase in the production of breast milk, this phenomenon indicating the onset of lactation will manifest itself, in many mothers, by a very heavy, hot, tense chest.  

2 to 3 weeks after childbirth

While infants then often experience a “growth peak”, and very frequently ask to breastfeed.

Studies have in fact identified different risk factors for engorgement:

• Intravenous administration of large amounts of fluid during labor may be associated with earlier and more prolonged breast engorgement;
• women with increased sensitivity and breast tension in the premenstrual period may have a higher risk of suffering from severe engorgement when breastfeeding;
• primiparity: in mothers who have already had one or more babies, the engorgement of the flow of milk tends to resolve itself more quickly.

The engorgement is manifested by a hard, very sensitive breast, with tense skin and areola, sometimes accompanied by a sensation of heat irrigating to the armpits and more rarely, a slight fever. The suckling is then unpleasant, even painful, especially as the nipple, strained by engorgement, can be difficult for the baby to take in the mouth. 

Differentiate between engorgement and mastitis

It is important to differentiate engorgement from mastitis. This usually affects a single breast, with the presence of a patch of localized erythema, that is, a red, hot and swollen patch on the breast. Conversely, engorgement is generally bilateral, diffuse and is not accompanied by erythema of the breast. Fever is also a prime indicator. In the event of engorgement, its elevation remains minimal. 

Drainage to relieve engorgement

There is only one solution: drain. The best solution for this is still the baby, with very frequent breastfeeding which will help reduce breast tension and promote the milk ejection reflex. These repeated feedings are particularly important at the time of the flow of milk, both for the proper establishment of lactation and for the prevention of engorgement. Studies show that engorgement is less frequent when the newborn spends more time at the breast during its first 48 hours, or when it remains permanently with its mother.  

Breastfeeding positions to favor

It may also be helpful to review your breastfeeding position to be sure that the baby’s sucking is effective. Getting help from a breastfeeding specialist (midwife or IBCLC lactation consultant) can be a big help. More than “academic” positions like the Madonna, the physiological Biological Nurturing position, proposed by breastfeeding specialist Suzanne Colson, seems to facilitate good sucking for the baby, while being comfortable for the mother.  

Manual expression of milk

If the baby is not sucking well or insufficiently to relieve breast tension, it is recommended in addition to feedings to manually express his milk, or to express it with a manual or electric breast pump. Care should be taken to use a program at low speed, for a maximum of 10 minutes.   

In order to relieve the pain, it is possible to take an NSAID compatible with breastfeeding. Seek advice from your doctor, pharmacist or midwife. 

Along with frequent latching, possibly supplemented by a pumping of milk, a few small gestures and “grandmother’s recipes” can relieve engorgement, reduce tension and promote the ejection of milk.

Hot-cold alternation

Before breastfeeding, applying a warm compress, cloth or glove to the breast can help promote the flow of milk. The application of cold (cold gel pack, ice cubes in a cloth, sachets of peas) could relieve pain and inflammation thanks to a phenomenon of vasoconstriction. 

The cabbage leaf method

This technique consists of washing a few green cabbage leaves (preferably chosen organic), removing the large veins and then flattening them using a rolling pin. Optionally put them in a freezer bag in the freezer, then apply them to the breasts, between two feedings. A 2020 Cochrane review concludes that cold cabbage leaves may be preferable to routine care or cold gel compresses for the management of engorgement.

Gentle massages

In order to soften the breast before feeding, perform a gentle massage with the pads of the fingers, from the chest wall towards the nipple. The same Cochrane review concludes that the effectiveness of these massages would be improved with the application of compresses from plants (cactus / aloe).

Acupuncture

A 2016 Cochrane review found that women receiving acupuncture were less likely to develop an abscess and had less severe symptoms after five days than women receiving usual care.

To acquit:

However, bandaging the breasts or stopping hydration are strongly discouraged because they are ineffective, or even counterproductive.

Breastfeeding on demand

Feedings on demand as well as good sucking are the two keys to avoiding engorgement, and in general, to a good lactation. To rap, breastfeeding on demand involves:

• offer the breast to her baby as soon as he is awake (even when he is still sleepy);
• do not limit feedings, both in terms of the interval between each feed and the time spent at each breast. Switch sides when the baby stops nursing or falls asleep.

Practices that limit congestion

Studies suggest that certain breastfeeding practices may help limit engorgement:

• empty one breast with each feeding and alternate the proposed breast first;
• during the first 4 days after birth, massage the breasts after each feeding.