Around the second or third postpartum day, milk rise takes place (in other countries it is called milk let-down). The breast increases in size and consistency and can be annoying, although it subsides in a few days. However, in some cases excess fluid accumulates, which we know as edema; We then speak of engorgement or breast engorgement . It happens most often between the third and fifth days postpartum.
The chest becomes hard, full and painful. Sometimes this makes it difficult for the baby to latch on and it is very difficult for him to express the milk, which aggravates the problem.
In addition to being painful for the mother, engorgement can affect the infant, who becomes frustrated because he cannot latch on properly and does not empty the breast as he should. This improper latch-on can also lead to cracks and soreness in the nipple. And what’s more, engorgement seems to increase the likelihood of early weaning.
Its exact incidence is not known, but it is quite frequent. Some studies suggest that a third of women suffer from engorgement in the first weeks after childbirth; other studies indicate that engorgement affects up to two-thirds of nursing mothers.
What to do if I suffer from engorgement?
Given the high frequency of this problem, many treatments and remedies have been tried with greater or lesser success. Although some do seem to work, the scientific evidence is still low and new high-quality studies are needed. Next we will review some of the most used remedies.
cabbage leaves
There are several studies looking at the effect of placing cabbage leaves on the mother’s chest. The effect of putting them frozen, cold or at room temperature has been studied and there seems to be no difference. Although in some studies there is an improvement in symptoms (pain decreases, the breast softens and even the duration of breastfeeding is increased), there is still not enough evidence. However, it is a cheap remedy, unlikely to be harmful, and can be relaxing for mothers. We can place the whole cabbage leaves after having removed the central stem or in pieces. We place them on the chest, inside the bra and we change them when they wither or get hot.
Hot or cold compresses
Several studies analyze the effect of applying hot and cold compresses before feeding or cold compresses after them and it seems that they could be as effective as other treatments. However, in engorgement there is inflammation, so applying heat can be counterproductive; If you do, and as recommended by the Clinical Practice Guideline on breastfeeding, you can take a hot shower or apply hot compresses just before feeding to promote the flow of milk. Applying cold (for example in the form of thermal packs) does seem to reduce pain and engorgement.
reverse pressure softener
This technique is based on displacing the edema backwards, towards the interior of the chest. It has been shown to soften the areola area and make it easier for the baby to latch on. We can carry it out in several ways, all consisting of pressing for a few minutes (between 1 and 3 is usually enough) the area of the areola that surrounds the nipple. Here we explain in detail how to do it and different methods.
breast massage
There are several studies comparing different types of breast massage to treat engorgement and they do seem to improve breast pain and engorgement. The Breastfeeding Clinical Practice Guideline recommends massaging the breast before feeding to encourage the release of milk and the baby’s latch-on.
Manual or breast pump expression
When the infant cannot latch on well, the Academy of Breastfeeding Medicine recommends pumping for a few minutes so the baby can soften the breast and the baby can later latch on.
Unnecessary pumping is not recommended at this stage and all lactating mothers should be trained to express milk manually.
When there is engorgement, the breast pump, especially if we use it with very high pressure, can be counterproductive, as it can increase the edema in the areola area and make it even more difficult for the milk to come out.
Medicines
Nursing mothers can take acetaminophen and ibuprofen as pain relievers to decrease pain; ibuprofen also has the advantage of being anti-inflammatory. Both drugs are safe during lactation. To check the compatibility of other medications with breastfeeding, you can consult the website www.e-lactancia.org
Other options
Studies have also been carried out with medicinal plants, oxytocin, ultrasound, acupuncture… with little data regarding their efficacy.
Can it be prevented?
We have commented that engorgement is a very frequent and very painful problem for the mother; therefore, the ideal would be to be able to avoid its appearance. Although more studies are needed, there are certain risk factors that seem to predispose to greater engorgement, as well as some measures that could prevent or reduce it.
– Multiparous women have milk rise earlier and these discomforts, as well as engorgement, if it appears, tend to resolve earlier.
– The administration of large amounts of intravenous fluids during childbirth is associated with higher levels of edema as well as an earlier and more prolonged perception of fullness and breast tenderness.
– It also appears that women who experience premenstrual breast tenderness and engorgement are more likely to experience more intense postpartum breast engorgement.
– On the other hand, breast engorgement is less frequent when infants breastfeed more times in the first 48 hours of life and if the mother and baby share a room.
– On the other hand, emptying one breast at each feed and alternating the breasts offered first does seem to work to reduce or prevent engorgement.
Summarizing…
Early and frequent emptying seems to prevent or minimize engorgement. So, this is one more reason to offer the breast on demand and frequently after delivery (newborns should have between 8 and 12 feeds a day).
In the event of engorgement, we can apply softening reverse pressure immediately before feeding to encourage the baby to latch on. To treat the pain, we can take paracetamol and ibuprofen (the latter also has an anti-inflammatory effect). Applying cabbage leaves and/or cold also seems to lessen the symptoms of engorgement.
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