During your first week after giving birth, whether you're breastfeeding or not, your milk will come in and your breasts will likely swell, harden and become more tender.
What you're experiencing is postpartum breast engorgement, and it's perfectly normal. But why does it happen, and what can you do for relief?
What is breast engorgement?
Breast engorgement occurs when your breasts become overly full with milk and fluids — to the point where they feel firm and uncomfortable.
It typically happens three or four days after giving birth, when your breasts start transitioning from producing colostrum (the thick, sticky liquid your body begins making during pregnancy that nourishes your baby in her first few days of life) to transitional and then mature milk. And it occurs whether you’re planning on breastfeeding or not.
Breastfeeding moms can become engorged at other times too, often if they suddenly start nursing or pumping less often than usual.
What causes breast engorgement?
It all starts with a chain reaction that kicks off the moment you deliver the placenta after giving birth to your baby.
At that point your levels of the pregnancy hormones estrogen and progesterone drop, and prolactin, the magical hormone that signals your breasts to go into full milk production mode, begins to kick in.
Within a few days, all that prolactin stimulates your body to start producing milk. At the same time, blood and other fluids flow to your breasts to help keep things moving.
This process creates a feeling of intense fullness, swelling or pressure in the breasts. The good news is that the discomfort tends to dissipate as you nurse.
What are the symptoms of breast engorgement?
Breast engorgement symptoms are hard to miss — and chances are you’ll know what you’re dealing when it hits. While some women experience more discomfort than others, here’s what you can typically expect:
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- Breasts that are firm and warm to the touch. Engorged breasts tend to feel very hard rather than soft or bouncy. They might also feel unusually warm, and the skin might look taut or shiny.
- Breasts that feel swollen or painful. The fluids and milk can create a feeling of throbbing pressure.
- Flat or hard nipples. The skin around your nipples might be firm and taut too, making it difficult for your baby to latch on.
- A mild fever. Some women experience a low-grade fever (below 100.4 degrees Fahrenheit) or lymph node swelling, especially around the armpits.
Breast engorgement vs. mastitis
The risk of mastitis — a painful breast infection caused by a clogged milk duct — is highest during the first six weeks postpartum. So if you’re engorged, you might start to wonder whether you’re dealing with typical discomfort or something more serious.
Thankfully, there are signs that make it easy to tell the difference. While both engorgement and mastitis can cause breast pain and swelling, mastitis also brings on flu-like feelings: Think weakness or exhaustion, a fever greater than 101 degrees F, and chills.
With mastitis, breastfeeding tends to make the pain worse or create a burning sensation.
A breast with mastitis might look red or swollen, and the redness could be in a wedge-shaped pattern. You may also be able to feel a hard or thick lump in your breast — that’s likely the clogged milk duct that caused the mastitis.
How long does breast engorgement last after giving birth?
If you're breastfeeding, postpartum breast engorgement should diminish within two to three days.
After that, it'll take a few weeks for you and your baby to work out a mutual feeding schedule that satisfies her often unpredictable hunger and your breasts' ability to match it. That tingling sensation tells you it's baby's feeding time!
If you're not nursing, breast engorgement should subside within a few days.
What causes breast engorgement when a baby is not a newborn?
Engorgement is most common in the early days after giving birth, but it can potentially happen at any point while you’re breastfeeding.
Most often, you’re at risk for getting hit with that overfull feeling when there’s a sudden change to your breastfeeding routine. That can happen when:
- You go back to work, which can result in nursing or pumping less often.
- Your baby is less interested in breastfeeding, like when she has a cold or starts eating more solid food.
- Your baby starts sleeping for longer stretches at night.
- You suddenly stop breastfeeding or cut back very quickly.
How can you help your baby latch if you have breast engorgement?
Very full, firm breasts can flatten your nipples and make it harder for your newborn (who’s just getting the hang of nursing as it is!) to latch on. Not only does that make it harder for her to get the nourishment she needs — it means you have less of a chance to get that painful pressure released.
You can help your new eater get a better grip with reverse pressure softening. This technique helps to shift some of the built-up fluid around your areola and nipple further back into your breast, softening the area where your baby needs to latch.
To try reverse pressure softening, gently massage your areola with your fingers for a few minutes before nursing. The pressure will soften up your areola and make your nipple protrude more, making it easier for your little one to get a deep, wide latch.
How to relieve and manage breast engorgement
Engorgement is temporary, whether you’re planning on breastfeeding or not. The discomfort should ease up within a few days as your body adjusts, but in the meantime, there are ways to ease that gonna-pop feeling.
How to manage breast engorgement if you’re breastfeeding
Here’s how to manage pain and swelling while encouraging a healthy milk supply for your sweet pea.
- Try using a warm compress, which helps soften the areola and encourages letdown, before nursing and using a cold compress afterwards.
- Nurse often, at least every two to three hours. The more you feed your baby, the more opportunities there are to take the pressure off (and frequent nursing will help establish your supply).
- Try leafy greens. Yes, it'll look strange (almost as strange as it sounds), but placing clean, chilled, green cabbage leaves on each breast will prove surprisingly soothing. Remember to make an opening for your nipple first. Or try some cooling bra inserts, which are available in maternity or baby-supply stores.
- Use a bag of frozen veggies as a compress. Apply for 20 minutes on and 20 minutes off.
- Use your hand or a pump to express a little milk and relieve a bit of pressure. Don't express too much, though, because that will only make matters worse. The more you express, the more milk is made — and if it's more than your baby's ready to take, you'll wear the rest in engorgement.
- Massage your breasts gently while nursing to help get the milk flowing.
- Alter the position of your baby — try the cradle hold one time, the football hold at the next feeding — to ensure all milk ducts are being emptied.
- Make sure your bra fits well. It should be snug and supportive, but not too tight.
- For severe pain, consider taking acetaminophen after a feeding or asking your practitioner for another mild pain reliever.
How to relieve breast engorgement if you’re not breastfeeding
If you’re planning on feeding your baby formula, the trick is minimizing pain and tenderness while discouraging your body from making more milk.
- Bind your breasts. You can use an ace bandage to hold your breasts in for relief.
- Use ice packs or bags of frozen vegetables to help soothe discomfort.
- Wear a supportive bra, like a sports bra.
- Avoid any kind of nipple stimulation or pumping a lot of milk. If you’re really aching, it’s okay to hand express just a tiny amount to take the edge off. But try to do so as a last resort.
- Take a pain reliever like acetaminophen or ibuprofen.
When to contact your doctor or a lactation consultant about engorgement
Engorgement goes away on its own within a few days, and the worst of it only typically lasts for 12 to 24 hours. But it’s worth contacting your doctor or a lactation consultant if:
- Your baby isn’t able to get a good latch, even after you try reverse pressure softening.
- Breastfeeding is painful.
- You still feel swollen and engorged after a week.
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