NURSING
MOTHERS, INC.
Managing
Factsheet 29
Normal breast fullness occurs when your milk comes in, anywhere from two to ten days after the birth of your baby if you are a first-time mother. This fullness is not entirely due to increased milk volume; breast tissues also fill with extra blood and lymph fluids to prepare them for milk production. The key to minimizing fullness and avoiding painful engorgement is frequent nursing. Frequent nursing helps remove the colostrum and incoming milk so that normal fullness does not become engorgement. Careful attention to the baby's position at the breast, making sure the baby is latch done well, and not limiting the length of feedings will help prevent engorgement. It is a good idea during the first few weeks after birth to avoid unnecessary supplementing, unless your doctor advises otherwise. Additional fluids (water, formula, juice, etc.) can decrease your baby's interest in nursing and may lead to other problems.
Engorgement is not "normal" and does not have to occur. It may develop from the third to fifth day after birth if the baby does not feed often or long enough. You may experience any of the following symptoms: breast swelling and hardening of tissues, tenderness, warmth, redness, throbbing, pain, low-grade fever, and flattened nipples that are difficult for the baby to latch on to. These symptoms are not usually relieved by one or two nursings. Tenderness and swelling may be confined to the nipple and areola (the darker area of the breast around the nipple), or may affect the whole breast. You may notice engorgement on only one side, or on both sides. If you promptly treat engorgement, you can usually relieve the symptoms within 24-48 hours. Discuss any elevations in temperature with your doctor to rule out the possibility of an infection. Your doctor can also recommend medication to help relieve discomfort.
Causes and Treatments
· Milk has just come in. Nurse your baby often, eight to twelve times in a 24 hour period. Make sure your nipple and areola are soft enough for the baby to latch on to. You can hand express or pump enough milk to soften the area. Breast massage and warm compresses just before nursing can help improve circulation in the tissues. Apply gentle pressure in a circular motion, spiraling from the chest wall out to the areola. Cold compresses or ice pack between feedings can help reduce the swelling and relieve the pain.
· Missed or infrequent feedings. Extreme fullness can occur whenever your baby misses a feeding, no matter how old your baby is. Massage, warm compresses, more frequent nursing, and expression will help relieve the fullness. Whenever you are away from your baby, plan to express your milk manually or with a pump at the times your baby would normally nurse.
· Breastfeeding pattern. Ideally you should let your baby nurse as long as he desires at the first breast. You can lift your breast from underneath to help remove more milk. Watch for signs that he is done: after 15-20 minutes of active drinking, he may fall off the nipple or drift asleep. You can then burp him, change his diaper, and offer the second side. A baby that has "finished the first breast first" may or may not take the second side. Be sure to offer that side first at the next feeding session.
· Painful Engorgement. If you are painfully engorged, you will want to encourage your baby to nurse from both sides enough to soften the breast tissue. Try not to limit the feeding session to a prescribed number of minutes. This can contribute to engorgement. If the baby does not take enough milk, you may express extra milk after feeding or whenever you feel uncomfortably full. Express only enough to relieve your discomfort.
· Inadequate milk ejection reflex (let-down). The milk ejection reflex, or let-down, releases the milk in the breast and makes it available for the baby. If you do not experience let-down, most of your milk remains in the breast, in spite of your baby's sucking. An inhibited let-down may be the result of tension or stress. Try relaxation techniques, warm showers or compresses, and massage. Establish a comfortable and relaxing routine for your nursing sessions. You can also ask your doctor about medications that can assist let-down.
· Baby sleepy or not eager to nurse. Try various rousing techniques: undress the baby or change her diaper, change nursing positions, stroke the baby whit your fingers, wash the baby's face, push against her feet, or walk your fingers up the baby's spine. You can more successfully rouse your baby when she is in an active sleep state. Watch her for signs of eye and body movement. Expressing a little milk onto your nipple before offering the breast may encourage a sleepy baby to nurse. Try to avoid supplementing your baby's diet with water or formula at this time, unless otherwise instructed by your doctor, as this will discourage her interest in nursing and may lead to other problems.
Many women fear they are no longer producing milk in sufficient quantity once the signs of normal fullness or the hardened tissues of engorgement are gone. It is of comfort to know that healthy, milk-producing breast tissue should be soft and elastic. Your breasts may be a bit larger, but they shouldn't feel hard or tight.
It is a common myth that engorgement is an inevitable outcome of
breastfeeding. Feeding your baby frequently, using correct positioning,
and making sure the baby has latched on well will all help relieve the normal
fullness that follows birth and will prevent it from progressing to
engorgement.
Related Factsheets
Difficulty Grasping the Nipple or Nipple Preference
Breast Infections and Plugged Ducts
Signs Your
Baby is Getting Enough
Original: Lisa Davis 9/94; Revised: 1/03 Megan Allen
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