Today’s Podcast
Episode 130  FAQ 10  Engorgement – Definition.    Why it happens. Prevention.  Treatment.

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Mother and baby will learn the art of breastfeeding with time, patience, gentle guidance, practice.
Breastfeeding is a combination of instincts and learned skills for both mother and baby and it may take a while for BF to become familiar to both of them.

Today we will be talking about – Engorgement.

Welcome to the club of early newborn breastfeeding and being one of many of us that are in the same boat. We are rather clueless about how the whole breastfeeding thing works. For some of us, just like other things in life, breastfeeding comes rather easily. For others, the learning curve is quite steep. For some, your bodies seem to cooperate during the early days and even though you are stumbling around, your body and baby figure it out and you are no worse for the wear.
and for others, like myself, we wind up with issues such as what we are talking about today – engorgement.

My goal today is to give you enough information so that you can decide for yourself – Are you doing okay on your own, or is it best to call an IBCLC for
expert help.

Definition: Engorgement is the swelling or congestion of body tissues.
When we are referring to breast engorgement, we are describing the painful swelling that occurs when the breasts become very full and very firm. Sometimes the breasts are actually hard and all these sensations lead to very painful breasts. They can feel very heavy, sometimes throbbing, you noticed your skin is quite stretched and sometimes this fullness and firmness leads to your armpits. Engorgement can affect one or both breasts.

Myth: I often hear moms say that they think engorgement is a normal part of early breastfeeding and that it can last for many days. This is a myth and I want everyone to know that it is not normal to be engorged for many days.

It is normal for your breasts to soften up after a good feeding or pumping.
In between milk removals, it is normal for your breasts to begin filling up again in preparation for the next feeding. This cycle of filling up, feeling heavy breasts before a feeding and feeling much lighter and softer after a feeding, is quite normal, particularly in the early weeks of breastfeeding.

When you continue to be heavy and firm, with little softening and relief after a milk removal, you are suffering from engorgement. When this happens, it is usually the result of the lack of milk removal, or the in frequency and in efficiency of the milk removal.

Here is what typically precedes engorgement:

At birth, with baby in arms and placenta out, this triggers shift in hormones that stimulate the production of milk. Increased amount of blood and lymph circulate in the breast and are the source of many nutrients from which the milk is produced. I like to say that all this goodness goes into the breast, which is a milk making factory, it goes through this process and comes out looking different colors at different times. Commonly you will first notice a yellowish color, within a few days you will notice or whitish or sometimes even bluish color.

Breastfeeding is often a learned skill for most of us and it takes quite a bit of practice to get pretty good at it. Sometimes during the learning phase our body seems to adjust to how much milk we need to satisfy our babies and other times we are making way more milk then our babies need or the milk removal is not efficient enough and engorgement occurs. When the milk is being removed frequently enough and efficiently enough, the body can handle this increase in fluids ( milk, blood, tissue fluid retension from IV) any engorgement that you have should be gone in 48 hours or less. If it lasts longer than 2 days, you will want to seek the help of an IBCLC.

Why? Why should you seek expert help if you are suffering from engorgement? I have 5 excellent reasons you should seek help for unresolved engorgement:

Here are the top 5 reasons:

1. Engorgement can make you feel ill.
2. Engorgement can make it difficult for you to get in a few good naps because you are so uncomfortable. In fact, it can be quite painful. I worked with a mom today that was so full and had such hard lumps that it literally hurt her to drop her arms along the side of her body.
3. Engorgement can make it difficult for your baby to achieve a good latch and breastfeed well. Your breasts are not just full, but they are hard. Your nipples may become flattened as the skin stretches under the pressure. Hard breasts and flat nipples are never a good combination as it makes it difficult for baby to achieve a good latch.
4. Engorgement can send a strong signal to your body to decrease the milk production, which puts you at risk for an overall low milk supply. You are probably saying to yourself? What does that mean.. engorgement sends a strong signal to your body to decrease the production. This is true. The longer the milk stays in your breast, the stronger the message that you don’t need to make all this milk. Spend a few days being engorged and by the 3rd or 4th day of poor milk removal, you are at risk of making less milk then your baby needs.
5. The pain and swelling from engorgement can cause a baby to have a hard time latching on & this improper latch or suck causes mom to have problems letting down/releasing the milk. You quickly realize that you are now in a very bad situation. You have all this extra fluid and you just can’t get it to flow. Your baby can’t latch on. If your baby does latch on, it is likely to cause painful feedings. This increases moms frustration & anxiety, which causes her to have problems letting down. Yes, it is a vicious cycle. One that I want to help you avoid so badly.

Prevention: What can you do to prevent engorgement?

The top tip that I have for you to prevent engorgement is:

Initiating breastfeeding within the first 1-2 hours of birth. Learn what babies hunger cues are feed your baby when you notice these cues. Do not hold your baby off from feedings based on the what the clock or a book or anyone else tells you. If you cannot or are going to be separated from your baby for many hours, you need to begin removing the milk on a regular basis. Preferably you will begin removing the milk by hand expressing. This allows you to have better control, helps you capture the milk in a small container easier than when pumping, and typically enables you to collect more milk.

This gives me the opportunity to talk to you about hand expression. This is a good tool to have handy for when you do not have a pump available and you are very, very full.
I will put a video in the show notes that walks you through hand expression.

This also gives me an opportunity to talk to you about one of my most favorite mom invented products, the breast bowl which Mel has created. Listen to Episode # and you will meet Mel, hear her story about why she created her beautiful glass blown breast bowl. This is a beautiful glass bowl that you can use when hand expressing. The milk sprays into this beautiful and colorful glass bowl.

Additional and other necessary tips to prevent engorgement:

Frequent and efficient feedings are both great helpers to reduce the incidence of engorgement. Efficient means – the milk is actually being removed. No sleeping or poorly latched babies allowed. This just will not get the job done. Avoid pacifiers so you can observe baby and not missing feeding cues. Unless it has been shown to be medically necessary, do not supplement baby with formula in a bottle. Always request expert if you are unsure about proper position, latch, milk removal. If you are new to breastfeeding and feel latch is pretty good, it is still great preventive medicine to have a latch check by an IBCLC. Just in case you are not sure, I will repeat – it is the frequency and efficiency of the milk removal that will help to prevent engorgement.

Relieving Engorgement:

If significant improvement is not seen in 1-2 days, I urge you to seek professional help.

1. Warm showers with very warm or comfortably hot water on your back. Try hand expressing some milk. You may have to spend a few minutes hand expressing before the milk begins to flow.

2. Warmth on your breast tissue for about 10 minutes before a feeding.

3. If you are concerned baby is not removing the milk efficiently, begin hand expressing or pumping after or in place of each breastfeeding.

4. You can try Reverse Pressure Softening – RPS. Go to the show notes for this episode for more information on RPS.
5. These are simple techniques you can do at home. There are other steps that you can take to help relieve engorgement and to make you feel more comfortable during this short lived phase. You will want to discuss these with your IBCLC

My focus on todays show is on engorgement in the very early days of breastfeeding.

While the most common time period for mothers to suffer with engorgement is the very early days of breastfeeding, it can happen anytime – yes even when your baby is many months This is not what we are going to focus on in today show, however, I would like to list the most common reasons why engorgement occurs after the first week of lactation. Usually when breastfeeding or milk removal has an abrupt change, such as a baby sleeping through the night or longer than usual. Another common time is during the weaning process. If it is gradual weaning, less likely to occur. If it is parent led weaning, you are more likely to experience some degree of engorgement. When a mom is told to abruptly wean because of a health issue or surgery. This abrupt change can often cause engorgement.

The biggest take home message I would to share with you is:

1. Please do not accept the myth that engorgement is normal.
2. Please take steps to get help as quickly as you can if you are realizing that your baby is not doing a good job of removing the milk,
3. And if you are having a difficult time removing the milk,
4. Definitely do not let engorgement go beyond 24 hours if you are not making progress.

Lori J. Isenstadt, IBCLC

Lori j Isenstadt, IBCLCLori Jill Isenstadt, IBCLC  has spent much  of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years.  Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant.   Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges.  Her membership site, All About Mothering helps moms navigate their journey from pregnancy through their postpartum days. She is an international speaker, book author and the host of the  popular itunes podcast, All About Breastfeeding, the place where the girls hang out.  You can reach Lori by email at: [email protected] or contact her at:  allaboutbreastfeeding.biz and allaboutmothering.biz

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