My breasts feel extremely full and uncomfortable. What is happening and what can I do about it?
Your milk will become more plentiful or "come in" some time between the second and sixth day after you give birth. Before that time, your baby will receive "early milk" known as colostrum, which will provide him with all the nourishment he needs, plus important antibodies and other immune properties to protect him from illness. It takes about two weeks for your milk to gradually transition into mature milk.
When your milk becomes more plentiful, your breasts may seem filled to bursting. This fullness is due to additional blood and fluid traveling to the breasts, preparing them for producing milk, as well as the increased volume of the milk itself. Some women only notice a little fullness, while others experience quite a bit more. Usually, the fullness subsides in 12-48 hours. It is especially important to continue to breastfeed your baby frequently since removing the milk from the breasts relieves the engorgement by allowing room for the excess fluids to flow out of the region.
You can prevent or minimize the effects of engorgement by:
- Nursing early and often. Nurse as soon after the birth as possible, and at least ten times a day after that.
- Ensuring that your baby is positioned well and is latched on properly. (See How do I position my baby to breastfeed? for more information on proper positioning and latch.)
- Nursing "on cue". If your baby sleeps more than two to three hours during the day or four hours at night, wake him to nurse.
- Allowing baby to finish the first breast before switching sides. This means to wait until baby falls asleep or comes off the breast on his own. There is no need to limit baby's time on the breast.
- If your baby is not nursing at all, or is not nursing well, hand expressing or pumping your milk as frequently as baby would nurse.
For some mothers, the normal sense of fullness continues, their breasts becoming hard and painful. Most mothers find that frequent nursing helps to relieve any discomfort. Additional suggestions for dealing with the discomfort of engorgement include:
- Gentle Breast Massage
With the palm of your hand and starting from the top of your chest (just below your collar bone), gently stroke the breast downward in a circular motion, toward the nipple. This may be more effective when done while you are in the shower or while leaning over a basin of warm water and splashing water over your breasts.
- Warm Compresses, Massage, Cold Compresses
Some mothers find that applying a warm, moist compress and expressing some milk just before feedings helps to relieve engorgement. Using heat for too long will increase swelling and inflammation, so it is best to keep it brief. Cold compresses can be used between to reduce swelling and relieve pain.
- Cabbage Compresses
A popular home remedy for relieving the discomfort of engorgement is cabbage leaf compresses. Rinse the inner leaves of a head of cabbage, remove the hard vein, and crush with a rolling pin (or similar). They can be used refrigerated or at room temperature. Drape leaves directly over breasts, inside the bra. Change when the leaves become wilted, or every two hours. Discontinue use if rash or other signs of allergy occur. There have been anecdotal reports that overuse of cabbage compresses can reduce milk production, therefore some experts suggest mothers discontinue the compresses when the swelling goes down.
Contact your health care provider immediately if:
- Engorgement is not relieved by any of the above comfort measures.
- You begin experiencing symptoms of mastitis: fever of greater than 100.6°F (38.1°C), red/painful/swollen breast(s), chills, "flu-like" symptoms.
- Your baby is unable to latch on to your breast.
- Your baby is not having enough wet and dirty diapers. (See How can I tell if my baby is getting enough milk? for more information.)
Engorgement can cause the nipples to flatten, or the dark area around the nipple, the areola, to become hard and swollen. This can be a problem if the fullness makes it difficult for baby to latch on. A technique that can help is reverse pressure softening. Reverse pressure softening, or RPS, softens the areola to make latching and removing milk easier. It is not the same as hand expression (although it is okay if some milk does come out). The following article is a description of RPS, with illustrations.
Reverse Pressure Softening
|One handed "flower hold."
placed where baby's
tongue will go
|Two handed, one-step method.
each one touching
the side of the nipple
|(You may ask
someone to help
press by placing
fingers or thumbs
on top of yours.)
|Two step method, two hands,
using 2 or 3 straight fingers
each side, first knuckles
touching nipple. Move ¼ turn,
repeat above & below nipple
|Two step method, two hands,
using straight thumbs, base
of thumbnail even with side
of nipple. Move ¼ turn, repeat,
thumbs above & below nipple
|Soft ring method.
Cut off bottom half
of an artificial nipple
to place on areola to
press with fingers
© 2004 Lactation Education Consultants. May be reproduced for non-commercial purposes.
More information on the early weeks of breastfeeding can be found in our Web resource collection.