What is breast engorgement?

Once your baby is born, your breasts are given a signal to start full milk production. Blood flows to your breasts, and your milk usually comes in 1 to 4 days after the birth. Breast engorgement is when the breast tissue overfills with milk, blood and other fluids and is a common problem in the early days and weeks of breastfeeding.

What are the symptoms of breast engorgement?

Engorgement can make your breasts feel very full, hard, swollen and painful.

Your nipples can become flat and tight. This can make it difficult for your baby to attach to the breast.

What causes breast engorgement?

Breast engorgement can happen if:

• your baby is not feeding and attaching well and your breasts aren’t drained well during a feed
• you are making more milk than your baby needs
• your baby misses a feed or is feeding infrequently

Breast engorgement can occur at any time you are breastfeeding, especially when your baby’s feeding pattern changes and they feed less.

Engorgement is usually temporary — eventually you will produce just as much milk as your baby needs.

How to prevent breast engorgement

To reduce the chance of breast engorgement:

• Feed your baby often and on demand (not by the clock) from birth, with at least 8 to 12 feeds in the first 24 hours. It helps to sleep in the same room as your baby to keep up the feeds.
• Wake your baby for a feed if your breasts become full and uncomfortable (especially at night time).
• Don’t limit your baby’s time at the breast.
• Avoid giving your baby any fluids other than breastmilk unless needed for a specific medical reason.
• Ensure your baby is positioned and attached correctly, to maximise the amount of milk they are getting.

How to relieve breast engorgement

If your breasts become engorged, there are things you can do to relieve the discomfort.

The best way to is to empty the breast, either by feeding your baby at the breast, or by expressing your milk. It’s okay to wake your baby and offer a breastfeed day or night if your breasts become full and uncomfortable between feeds.

The following tips might also help:

• Apply a warm washer to the breast, or have a warm shower before a feed, for comfort and to help the milk flow.
• Remove your bra before breastfeeding (and leave it off).
• Hand-express a little milk before feeding your baby, or try ‘reverse pressure softening’ (applying pressure around the nipples to push fluid back into the breasts).
• Gently massage the breast in a downward motion from the chest wall toward the nipple while your baby is feeding.
• Use a cold compress, like a cool gel pack from the fridge, or a chilled washed cabbage leaf over the breast to relieve inflammation.
• Express milk after a feed, either by hand or with a breast pump, if your breasts still feel full.

Sometimes, if the engorgement does not improve, a complete ‘pump out’ with an electric pump may be necessary to relieve the milk pressure that is causing increased blood and fluid within the breast tissue (ask your lactation consultant or doctor for help).

If you are still uncomfortable, ask your doctor for appropriate pain relief.

For help with breast engorgement prevention and treatment, contact a health professional, including your doctor, lactation consultant or breastfeeding counsellor, child health nurse, or call Pregnancy Birth and Baby on 1800 882 436.