Engorgement & Mastitis

Engorgement is caused by a build-up of milk, blood, and other fluids in the breast. Symptoms include painful, swollen breasts, shiny red skin, and difficulty breastfeeding. Baby may be irritable and find it either difficult to attach to the nipple, or frustrated and unable to extract milk as freely as they usually would. This is due to the inflammatory nature of engorgement. You may find it difficult to hand express milk, with a full, hard breast, and supple, slippery nipples.

Engorged breasts happen when the breasts become overly full of milk, causing them to feel swollen, firm, painful, and sometimes warm. This commonly occurs in the early days of breastfeeding or if milk is not being removed efficiently. Another common time to suffer engorgement is around 6 weeks, when baby happens to settle for a bit longer at night, or parents start to venture out with baby after baby's 6 week vaccines, and feeding is not as frequent as being at home.

Managing Engorged Breasts

1. Frequent Nursing or Pumping

   • Breastfeed your baby often (every 2-3 hours), ensuring a good latch.

   • If your baby isn’t feeding well, express milk manually or use a pump to relieve pressure. Ensure not to pump for too long - limit it to 15 minutes per breast.

2. Gentle Massage & Hand Expression

   • Before feeding, gently massage your breasts in a circular motion.

   • Use hand expression to soften the areola, making it easier for the baby to latch.

3. Cold Compresses

   • Apply a cold compress/ice pack or chilled cabbage leaves to the breasts for 15-20 minutes straight after feeds to reduce swelling and inflammation. Do not leave the ice pack on and fall asleep!

4. Warm Compress or Shower Before Feeding

   • Applying warmth before breastfeeding can help milk flow more easily.

   • A warm shower can also help with letdown.

5. Reverse Pressure Softening

   • Apply gentle pressure with your fingers around the areola to shift excess fluid and help the baby latch.

6. Supportive Bra

   • Wear a well-fitting, non-restrictive bra to provide support without compressing the breasts. Avoid wire bras for the first 6 months, or the duration of your breastfeeding journey if possible. There are maternity brands that make 'flexi wire' bras.

7. Pain Relief (If Needed)

   • If pain is severe, taking an anti-inflammatory (like ibuprofen) can help, but consult a healthcare provider first.

Preventing Engorgement

• Feed on Demand – Don’t wait for scheduled times; nurse when your baby shows hunger cues, but wake them around the 4 hour mark if you feel your breasts are becoming full and leaking and need to feed. Don't go more than 5 hours without feeding your baby or expressing your milk.

• Ensure a Proper Latch – A good latch helps drain the breast effectively.

• Avoid Skipping Feeds – If you miss a feeding, express milk to prevent buildup.

• Alternate Breasts – Switch breasts at each feeding to keep milk flow balanced. If you feel you have too much milk, consider 'Block Feeding'. Consult with a lactation consultant for advice on low supply, or over supply.

• Gradual Weaning – If stopping breastfeeding, do it gradually to allow your body to adjust. Do not suddenly skip entire feeds or expressions in the early days.

Avoiding Mastitis

Mastitis is a painful inflammation of the breast tissue, often caused by blocked milk ducts, engorgement, or infection. Here are some tips to help you prevent mastitis while breastfeeding:

1. Ensure Proper & Frequent Milk Removal

• Breastfeed Often – Feed your baby at least every 2-3 hours, especially in the early weeks.

• Alternate Breasts – Switch breasts at each feeding to ensure both are emptied regularly.

• Empty the Breasts Fully – If your baby doesn’t empty a breast, pump or hand express to relieve fullness.

2. Check Your Baby’s Latch

• A poor latch can lead to incomplete drainage and clogged ducts.

• Ensure your baby has a deep latch, covering both the nipple and part of the areola.

3. Avoid Engorgement & Clogged Ducts

• If you feel a hard lump or tenderness, gently massage the area while feeding.

• Apply a warm compress before feeding and a cold compress afterward.

• Try different nursing positions (e.g., football hold, laid-back breastfeeding) to help drain all areas of the breast.

4. Wear Comfortable Clothing

• Avoid tight bras or clothing that put pressure on the breasts, which can cause blockages.

• Choose a well-fitting supportive nursing bra without underwires.

5. Stay Hydrated & Healthy

• Drink plenty of water to maintain good milk flow.

• Eat a balanced diet rich in vitamins and get enough rest to support your immune system.

6. Address Early Signs Immediately

• If you notice redness, pain, or warmth in your breast, act quickly:

  • Continue frequent breastfeeding to keep milk flowing.

  • Massage the affected area gently downwards towards the nipple during feedings.

  • Apply warm compresses or have a warm shower before nursing to help clear the duct.

  • Apply ice packs to both breasts after feeds

  • Rest and drink plenty of fluids to prevent infection.

7. Avoid Sudden Weaning

• Gradually reduce feedings to allow your body to adjust.

• Express small amounts if discomfort occurs while weaning.

If symptoms like fever, chills, or worsening pain develop, it may indicate an infection requiring medical attention. Contact Moana Care ASAP if you feel any engorgement, pain or difficulty feeding your baby.

More information on Engorgement available through ABA