January 20, 2020
This is interstitial swelling, or edema in tissues that surround the glands and ducts. This tends to be most severe in first-time mothers, and represents a fluid shift to the breasts early postpartum in order to begin the process of ramping up milk production1. Engorgement can be uncomfortable and at times severe. It often leads to difficulty latching the infant onto the breast because the infant may not be able to compress the swollen, firm areola. Sore, cracked nipples are a common consequence of engorgement, due to shallow latching. Unrelieved engorgement may lead to a loss of milk supply due to involution of the milk-producing cells.
Every mother should receive anticipatory guidance on how to manage engorgement before she leaves the hospital. Education should include:
- How to manually express milk to soften the areola
- The use of ice or cold compresses while lying on her back to alleviate the swelling
- The importance of frequent nursing to prevent severe engorgement
- Reverse pressure softening as a technique of applying pressure on the areolar tissue circumferentially around the base of the nipple, to reduce areolar edema, allowing protrusion of the nipple, and enabling a deep infant latch https://www.youtube.com/watch?v=2_RD9HNrOJ8
- Breast massage between and before nursing to help diminish swelling2. An excellent resource for teaching breast massage is at http://bfmedneo.com/our-services/breast-massage/
- Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #20: Engorgement, Revised 2016 Breastfeeding Medicine 11(4) 2016
- Witt AM, et al. Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. J Hum Lact. 2016 Feb;32(1):123-31.