After birth, your milk will usually come in around day 3 to 5 from the time of delivery, and possibly within 24-48 hours if this is not your first baby. Your breasts will usually feel very full and firm. You might also experience some tenderness and palpable lumps. As your breast tissue extends into the armpit area, you might note some swelling/lumps in this area, also. Some women run a low grade fever when the milk comes in.
Your breasts produce an overabundance of milk initially as it is an unknown at this point how much your baby will actually need. There is an enhanced blood flow to your breasts and some of the surrounding tissue at this time which causes the breasts to swell. The result is full, swollen, engorged breasts.
Engorgement varies from woman to woman. Not every mother experiences true engorgement. Some women’s breasts become only slightly full, while others find their breasts have become uncomfortably full.
Keep in mind; engorgement is a positive sign that you are producing milk to feed to your baby. It can last several days, or even up to a week.
Until your breasts adjust to the amount your baby needs:
1. Wear a supportive nursing bra, even at night – making sure it isn’t too tight.
2. Breast feed often, AT LEAST every 2 – 3 hours. Try to get the first breast you offer as soft as possible. Always offer the second breast, but if your baby is too full to take it, that’s perfectly fine. However, as this second breast will most likely be uncomfortably full, pump/hand express afterwards at least enough to relieve the pressure if needed. If the first breast offered is still uncomfortably full, even after feeding here, you can pump this breast to relieve the pressure, also.
3. If pumping, pump just enough to relive the pressure you are experiencing, don’t pump to empty as this will stimulate even more milk to be produced.
4. If your breasts are overly full when you are starting to breastfeed, consider pumping/hand expressing first to relieve some of the pressure in the nipple/areola and then try to latch the baby.
5. Hot, moist heat is sometimes helpful in helping the milk to flow more effectively. If used, apply this to breasts before you start to nurse, but for no more than 5 minutes.
6. Ice packs after feeding/pumping are helpful to reduce the swelling in the breasts. Apply for no more than 10 minutes.
7. Ibuprofen taken q 6-8 hours with food not only helps with pain relief, but also helps with bringing down the swelling of the breasts.
8. If your breasts are so full that the milk is not even flowing out, sometimes the use of cabbage leaves are helpful. To use this: select a head of green cabbage and rinse off. Refrigerate. Apply several leaves of the cool cabbage to your breasts with the bra holding them in place. When the cabbage leaves warm up to body temperature, remove them and replace them with more cool cabbage leaves. Take care not to use more than 3 applications of the cabbage leaves within 24 hours, or this could cause the opposite of the desired effect and can dry up your milk.
Look ahead. This too shall pass.
Once the engorgement eases, your breasts will be softer and still full of milk. During this time, most importantly, you can and should continue to nurse. Your baby is the best and most effective relief for engorgement. Unrelieved engorgement can cause a drop in your production of milk, so it’s important to breast feed right from the start, and as often as he wants to be fed, or at least q 2-3 hours. It would be wise to consult with an IBCLC if your engorgement is unrelieved.