by Dr Jenny Boyd, General Practitioner
With the onset of copious milk production breast engorgement may occur as the body directs more blood and fluids to the breasts to stimulate milk production, causing congestion and swelling. As the body adjusts in response to baby’s feeding, this congestion and swelling settles.
Breast engorgement can also occur at various times throughout the breastfeeding journey due to inadequate milk removal. It can happen in a mother who breastfeeds her baby regularly and then for some reason cannot feed as often, for example due to illness. Engorgement can be a result of trying to wean off breastfeeding too quickly. It can also result from expressing between regular feeds as this stimulates the body to produce more milk than is required.
Engorged breasts are painful and can result in baby struggling to latch on well which can in turn lead to cracked nipples and more pain.
Managing Breast Engorgement
Treating engorgement makes breastfeeding easier, helps with milk production and prevents complications such as mastitis.
- Advise the woman to continue to feed often and avoid routine or scheduled feeding or in any way restricting the baby’s access to the breast. Allow the baby to effectively drain the breast, ensuring the engorged areas soften before changing to the next
- Ensure a good latch. If baby is struggling to latch on, hand express a little milk to soften the areola
- Advise the woman to wear a well fitting bra
- Advise painkillers e.g. paracetamol, ibuprofen if required
The use of hot/cold packs and cabbage leaves is anecdotal and while there is not enough evidence to justify this as a recognised therapy there are reports that it does ease symptoms1:
- In between feeds apply an ice pack to reduce swelling but before a feed apply a warm flannel to aid milk flow
- Chilled cabbage leaves applied to the breasts after feeding can also be helpful
Overabundant Breastmilk Supply
by Dr Clare Macdonald, General Practitioner
Maternal breast milk synthesis rate and volume of lactating tissue varies from woman to woman; inevitably therefore some women will experience an abundant supply, especially in the first weeks following delivery while the supply/demand process is establishing. This often settles spontaneously after the first few weeks as baseline prolactin levels reduce.
Persistent oversupply can cause breast discomfort for the mother and distress for the baby. The key to management is ensuring optimal positioning and latch, feeding responsively and judicious use of expressing where necessary.
Maternal indicators that there is oversupply:
- Uncomfortable breasts with a sensation of fullness that doesn’t fully resolve after feeding
- Excessively leaking breasts eg. soaking through breast pads and clothing (minor leaking is normal, commonly settling after the first few months)
- Frequent blocked ducts/mastitis
Infant indicators that there is oversupply:
- Being ‘overwhelmed’ by milk volume at let-down; coughing and spluttering on feeds
- Clamping down on the nipple during feeds to control the flow
- Fussing and pulling off the breast during feeds
- Frequent, green stools
- Eventually, the infant may associate feeding with discomfort and distress due to the forceful letdown and can display faltering growth despite the abundance of milk.
Milk synthesis and supply is inherently linked to milk removal (by the infant or breast pump). See our webpage on the ‘Anatomy and Physiology‘ of breastfeeding.
Managing Overabundant Breastmilk Supply
- Ensure the woman has access to a skilled infant feeding specialist who can observe and provide support with achieving optimal positioning and attachment
- Encourage feeding the baby at the onset of early feeding cues so the baby is hungry but not distressed
- Advise expression of a little milk (eg. by hand expression) before feeding if overfull breasts are preventing achieving a good latch (but taking care not to express too much as this can perpetuate the problem)
- Feeding whilst reclined or lying on one side may help, by reducing the initial high flow of milk
- Consider offering only one breast per feed- this ensures the breast is effectively drained as fully as possible and prevents further stimulation of the other nipple (which will in turn increase milk synthesis)- this should be recommended only after a specialist breastfeeding assessment
- Cold, or warm compresses can help the discomfort of breast fullness
- Specialist support can also assist with further measures to reduce supply if necessary
NICE CKS: Breastfeeding Problems Revised January 2017 – Includes information on the management of breast engorgement and breastmilk oversupply.
UNICEF Baby Friendly Initiative: Hand Expression Video Demonstrating the technique of hand expression, useful to assist in managing overabundant milk supply.
- Mangesi L, Zakarija-Grkovic I. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews. 2016;Issue 6. Art. No.: CD006946.