How Do I Know If My Breasts Are Engorged?

by Susie Hamilton
Breast Pumps Direct
Product Expert

Are you experiencing soreness, swelling and tender lumpiness in your breasts and/or nipples within the first week or two of breastfeeding? Do your breasts feel hard or tight, possibly back to your armpit? Well, chances are your breasts are engorged with your new byproduct for your baby...breast milk! This is the beginning of what you may have often heard referred to as your milk “coming in”.

Most women who have previously nursed for another child may know that this is what comes within the second to sixth day of nursing. However, if this is your first go round, the painful onset to successful nursing may leave you feeling not so great about this new venture. Have no fear, after the first few weeks your breast and your baby will be so used to nursing that you will actually look forward to your feedings. This is the first of many successive painful experiences when choosing to be a dedicated parent, or should I say that began with pregnancy and labor?

The fullness of your breast will normally decrease within the first two to three weeks if your baby is nursing often and latched on correctly. An adequate number of feedings for a newborn baby is between eight to twelve each day. Due to the extreme fatigue that most newborns feel it may seem difficult to get your baby to want to nurse this often. However, you must wake the baby and once he is in position to nurse encourage his mouth to open and latch on. If he still seems resistant or even better, still totally asleep, try placing your knuckle at the top of his jaw, near his earlobe and apply a tiny bit of pressure and wiggle. This will stimulate him to wake and hopefully feed. Be persistent, he will make sure he gets plenty of sleep so you need to make sure he gets plenty of opportunities to nurse as well.

Frequent feedings are your best bet to minimize the amount of milk that stays in your breasts, therefore easing the discomfort of engorgement. Though it will take a few weeks for your breasts to soften and yield to your milk production, most cases of painful engorgement will subside within 12-48 hours if correctly tended to.


What do I do if my baby cannot latch on because my nipples are engorged?

Engorgement can happen in one or both breasts. It can occur only in the areola, or only in the fatty tissue or in both (the entire breast). At times when your nipples are so tight that they flatten and make it difficult for your baby to latch you must express enough milk to help them soften.

At the point of engorgement, your breasts are so full that once you have stimulated your milk flow, it will probably start emptying with a bit of force. At least enough to give your infant a taste of what is to come and help him work up an appetite. There are many ways to encourage your “let down” or milk flow.

  • Apply a warm, wet cloth to your breast or take a warm shower and concentrate the water on your breast area. The heat will ease the pain which helps your body to naturally relax. Your milk is much more likely to let down if your body isn't subconsciously tense from pain.
  • Try massaging your breast right before a feeding. A useful technique is taking your pointer and middle finger together and starting at the most painful part of your breast (generally where it is lumpiest) apply pressure in a circular motion. Continue to do this on your whole breast until you get some relief. Massage coupled with moist heat is almost a sure success.
  • Use a breast pump to start your milk flow and then offer your breast to your baby. If your infant doesn't immediately latch on and nurse, continue to pump until you have emptied a good bit of your milk then try again. This will offer your baby some practice and continue to relieve your engorgement. Freeze what you have pumped for a later date. If you are looking for a pump that will relieve engorgement, consider the Dr. Brown's Natural Flow breast pumps which have been clinically proven to effectively and painlessly relieve engorgement pressure.
  • Nipple shields can be worn if you prefer. These are simply thin silicone nipples that you place on the breast that are more flexible than a taut nipple and easier for your baby to latch on to. It is argued that nipple shields may cause nipple confusion in babies learning to nurse but the goal here is to drain the breast in order to relieve pain as well help you continue to breastfeed. So, start out with the nipple shield and once your flow has slowed down simply unlatch your baby and remove the nipple. Try to get your baby to latch on again without the nipple shield. It will be much less frustrating for you both if you aren't in as much pain.


What can I do to ease the pain in between feedings?

To soothe the pain in between feedings you can apply cold compresses of some sort. This will not only help to reduce the swelling but also to relieve the burning sensation caused by the tightness of a full breast. Be sure to place a thin cloth (washcloth, handkerchief, etc.) between your breast and an ice pack. You can simply take a plastic bag, such as a Ziploc and fill it with ice to serve as a cold compress.

In addition, an old wives tale about applying cabbage leaves to your breasts is said to help draw out the pain. You must take a cabbage leaf for each breast and slice out the vein in the center. Then cut out a hole big enough for the tip of your nipple and wrap the leaf around your breast. You should wear this inside of your bra until the leaf begins to wilt from body heat, and then replace with another leaf. Do this until you feel the pain has eased up.

If you feel the pain is bad enough to require medication you can check with your doctor about taking some over the counter pain relievers such as ibuprofen or acetaminophen. Try to take these as infrequently as possible since it will eventually make its way to your baby through your breast milk. Do not resist taking medication if your pain is severe or if you begin to run a fever, it is better to relieve your pain than to withhold from nursing because of it.


Is this going to affect my baby?

Engorgement is a natural part of the breastfeeding cycle; it is not a sickness or presence in your breast that can be passed onto your baby. Once your milk has come in and you have maintained a frequent feeding schedule with your baby your body will begin to settle into a schedule of its own. For instance, if you begin nursing your baby every two hours and your average feeding lasts about 30 minutes your breasts will begin to replenish your milk at a rate that corresponds to that time. At about 1 ½ hours after you’re last feeding, your breast will be full again for another session. Depending on how much your baby takes in will also determine the amount your body will supply. Hence the phrase, “supply and demand.” If you can find the strength and patience to just trust your body to do its job (as you did in pregnancy and labor), you will find that the affects on your baby will be beneficial to his health and bonding experience with you.