Engorgement

In the first week after giving birth, your breasts are often very swollen and tender, which is normal and almost never related to engorgement. This is because it is uncommon to get engorgement, or mastitis as it is also called, in the first 10 days after childbirth. But it’s still good to be aware of sore breasts and milk clots – and to learn a little about what you can do to prevent engorgement.

What causes engorgement?

As mentioned above, milk clots are common for breastfeeding mothers and usually disappear after the baby has fed for a while. But sometimes milk clots develop into an inflammatory reaction – known as engorgement. The reason for this is that the milk ducts become blocked and the milk flow cannot pass through sufficiently. It may be due to pressure on the breast (e.g. from an underwired bra) or because the baby’s latch on the breast is too shallow.

It is most common to experience engorgement in the first two months, before the breast and baby have found their rhythm, but it is good to know that it can also occur when the baby is older. Often, the risk is greater when breastfeeding becomes a little more irregular – so keep the tips to prevent engorgement in mind for as long as you are breastfeeding or if, for example, you want to stop breastfeeding to avoid engorgement. Engorgement can also be caused by bacteria entering the breast, often through sores or cracks in the nipples.

How can you avoid engorgement?

The best thing you can do to try and avoid engorgement is to avoid wearing clothes and nursing bras that squeeze your breasts – it’s also important that your baby has a good sucking technique. A milk clot here and there can often be massaged out by gently rubbing your finger towards the nipple while the baby is breastfeeding, making it easier to empty the milk ducts. There is no evidence to support the idea that being cold causes milk to become engorged – however, it is known that the breasts are sensitive to wind and draughts, and that warmth can help to relieve engorgement.

Engorgement can cause a fever

Symptoms of engorgement often appear suddenly and usually only in one breast. The area where the milk duct is blocked may become warm, tender, red and hard. It is quite common for engorgement to cause a fever and sometimes you feel really ill with chills and muscle pain, like a bad case of the flu. Sometimes breastfeeding can be painful and there may also be sores or cracks on the nipple.

Tips for engorgement

There are many suggestions for relieving engorgement if you have it.

• Don’t stop breastfeeding if you have engorgement – breastfeeding is the best way to get rid of the problem. Ideally, you should breastfeed at fairly short intervals. Sometimes you may even need to wake the baby more often to help empty the sore breast.
• Place a finger on the hard area and massage by gently rubbing towards the nipple while your baby sucks.
• Always start with the sore breast as the baby sucks the most in the beginning.
• Take painkillers if you need to reduce your fever and be able to breastfeed without too much pain.
• If your baby has difficulty grasping the nipple, you can first express some milk by hand to make the areola less firm. You can also use a pump to relieve the pressure, but if it’s very painful, try taking a hot shower and applying the jet to the sore breast, while gently expressing some milk before breastfeeding.
• As well as a warm shower, a heated pad over the breasts can help to relieve engorgement.
• Hold your baby skin to skin as this increases the release of breast milk and makes breastfeeding easier.
• Wear loose clothing that does not press against your breasts or leave marks on your skin.
• This is where the baby’s sucking technique becomes particularly important: in addition to getting a good grip, try placing the baby so that his or her chin points towards the tense area, as this is the best way to empty the breast. Sometimes you may need to try a few different breastfeeding positions to get the right position.
• Make sure you get some rest and try to relax between feeds, especially if you have a fever or feel ill. A shoulder massage or other skin contact can also increase the release of oxytocin, which increases the flow of milk.
• Make sure you drink enough.

How long does engorgement last?

Engorgement usually lasts for up to three days, but if you follow the tips above, it usually gets better gradually. However, if you develop a fever and the soreness in the breast has not subsided within 12 hours, it is a good idea to call your doctor for help, and the same applies if the engorgement does not disappear after a few days or recurs regularly. In rare cases, engorgement can develop into a breast abscess, requiring antibiotic treatment.

Please note that all information above is based on Swedish recommendations.