Mother nature is often very kind to us when we first start breastfeeding and so, in the early days, we are often provided with way more breastmilk than our babies can eat. Your breasts have no idea yet whether you are feeding one baby, two babies, three, four, or more babies. This may cause your breasts to swell with much more milk than is being removed and get hard and uncomfortable, called engorgement.
Following the birth of your baby, breastmilk is under endocrine control, the hormones in the bloodstream. As progesterone levels drastically drop due to the removal of the placenta, the body is signaled to start the production of breastmilk, whether or not you are planning to breastfeed at all. The first milk your baby receives is called colostrum, a thick clear or yellow substance packed full of great nutrients and antibodies.
Usually between 2-3 days after the birth of the baby, the milk transitions, later becoming mature milk, often referred as the milk “coming in” around day 3-5. For many, this can cause breast fullness, tingling, swelling, and leaking of the breasts. The baby’s cues may also change at this time and they may begin nursing much more often just before the milk arrives.
As your baby’s appetite increases, the production of breastmilk is taken over by autocrine control, the hormones released by the cells of the breast rather than the bloodstream, called supply and demand. From this point on, the more milk your baby removes from the breast, the more milk the breast produces to keep up with baby’s changing needs. As the baby weans and less milk is removed from the breast, the breast begins to produce less, causing a decrease in supply as that amount of milk is no longer needed by the baby.
When the milk comes in, if it is not removed often by the baby, it can lead to a condition called engorgement. Engorgement can be described as swollen breasts that are tight and shiny, redness and/or heat, mild fever, and mild or severe pain. When the breasts are engorged, it can cause latching baby to be difficult, as the breast is hard and tissue does not mould to easily fill the mouth of the baby.
For some, the experience of engorgement is one that causes them to quit breastfeeding altogether. As you continue to breastfeed your baby and breastmilk production stabilizes, engorgement becomes more of a thing of the past, usually only occurring if skipping one or more feedings.
To avoid engorgement, ensure the baby is well latched at the breast every time. If the latch is poor, often indicated by pain, insert your little finger into the corner of the baby’s mouth to break the suction and try to latch again – do this as often is necessary to get a good latch. Feed the baby often and allow the baby to feed as long as they will on one side, to adequately drain the breast. Massaging any lumpy areas while feeding can help remove any clogs. If the baby doesn’t want to take the other breast, express just enough to make that breast comfortable. Using a pump can increase engorgement, so hand express if possible or limit the amount of time spent pumping. It can be helpful to stimulate a ‘let down’ and then apply gentle pressure to the tissue of the breast to allow the milk to flow freely from the nipple without needing to continue expressing, which can cause the breast to swell even more.
Heat stimulates milk production and cold does the opposite. If trying to stimulate a let down for the purpose of expression, a warm compress can be applied. Try to avoid excessive stimulation however, such as a warm shower, which can increase engorgement. A cold compress after a feed can soothe discomfort and decrease swelling of the breast.
Remember, engorgement is not forever and that if you experience engorgement, there can be relief!