When Breastfeeding Moms Have Too Much Milk
By Melissa Clark Vickers, IBCLC
In one sense, engorgement is part of a very normal process that prepares a new mother to breastfeed her infant. The breasts enlarge with mature milk and other fluids, typically within the first three to five days after birth. Up until this time, the breasts have colostrum, a highly-concentrated first milk. This “liquid gold” is perfect for the newborn’s tiny stomach and digestive system as he learns to milk the breast effectively.
When he is ready to handle larger meals, the breasts are ready with more milk. Eventually, the breasts will settle into a pattern of making milk based on the infant’s needs, as judged by how much he takes from them.
What Is Engorgement?
When the mature milk comes in, generally there is no mistaking that it has arrived! The breasts are noticeably larger and feel “full.” There generally is no pain associated with this fullness, and while it may feel different—especially to the first-time mom—it doesn’t prevent a baby from nursing well. This fullness is completely normal and technically isn’t considered “clinical engorgement.”
Clinical engorgement is a serious condition in which the breasts become so full that they feel like rocks. The swelling may extend well into the armpits and upward toward the neck. The breasts are typically hot to the touch and painful and interfere with a baby’s nursing.
The best way to prevent engorgement is to nurse your baby as often as possible in the early days.
Remember that in order to effectively nurse the breast, Baby has to be able to compress the areola, the dark area surrounding the nipple. With true engorgement, Baby can’t get onto the breast far enough to milk the sinuses below the areola. It is a little like trying to nurse a basketball!
Unfortunately, when that milk is not effectively removed, initially more milk will be added to these already distended breasts. If the condition isn’t treated, the breasts will take this as a signal to cut back on milk production. Obviously, this is a condition to be avoided when possible and treated quickly if it does happen!
The best way to prevent engorgement is to nurse your baby as often as possible in the early days. Aim for at least eight to 12 feedings every 24 hours, and let your baby nurse at the breast as long as she will. Offer both breasts at each feeding, and start the next feeding with the breast she takes the least from during the last feeding.
If you experience any pain while nursing, ask for help, as this is a sign that something—most likely positioning—is not quite right. Feedings don’t have to happen like clockwork, and it is OK to cluster some feedings and have one longer three- to four-hour interval. The total number of feedings is more important than the spacing. Look for wet diapers and bowel movements that change from the black, tarry meconium to the mustard-colored normal breastfeeding stool. What comes out the diaper end is the best indication that something is going in the other end!
If your baby is sleepy, keep him close by and learn to watch for cues that he is hungry and ready to eat. Babies will cycle in and out of deep sleep every 90 minutes or so and in a light sleep stage will often nurse quite well. Look for Baby’s eyes to move under his eyelids and smacking motions and noises from his mouth. He may suck on his hands as well. When you see these signs, go ahead and offer the breast to him. Don’t wait for him to wake up and scream for his next meal!
Engorgement can happen—and generally, the more complicated your labor and delivery, the more likely it is to happen. Complications that include various pain medications during labor, and such interventions as forceps delivery and deep suctioning of the newborn, can make Baby more sleepy and unreceptive to frequent breastfeeding. And for whatever reason, you may miss feedings. Sometimes, even when Mom does everything “right,” engorgement still happens. It is important to catch it as early as possible, and it is important to know how to treat it—just in case.
The key to relieving engorgement is removing the milk. That seems pretty obvious, doesn’t it? Sometimes it isn’t easy to do, though. When there is so much milk and extra fluid in the breasts, this can put pressure on the milk ducts such that they close down—like standing on a garden hose. Compresses are an effective method of helping that milk to flow. As a general rule, heat gets the milk flowing, and cold reduces swelling. Apply hot compresses to your breasts before nursing, and cold compresses after nursing. Disposable diapers make wonderful compresses, by the way.
Sometimes, even with hot compresses, there is so much tissue swelling that the milk still won’t flow. If this happens, try using a cold compress for 10 minutes or so and then wait 20 minutes or so and try the heat again. A warm shower feels good on a full breast as well.
If the areola is so tight that Baby can’t compress it, try gently hand-expressing just enough milk to soften the areola. Your baby will be the most effective pump once she can latch on correctly. It is OK to use a breast pump to remove some of the milk as well, but it is best to use a hospital-grade pump with intermittent suction on the lowest setting. Too much pressure on an engorged breast can actually cause tissue damage.
Engorgement is temporary and can usually be resolved fairly quickly—if not prevented in the first place! If it happens to you, get help and repeat to yourself, “This, too, shall pass!”