Lactogenesis II, or when the milk “comes in”, often occurs 3 to 5 days after birth. Engorgement can happen during this period, causing painful and swollen breasts. It may be more pronounced in parents who have received lots of IV fluids during labor. With proper treatment, it will typically resolve in 12 to 48 hours.

An engorged breast can cause swelling in the areola tissue, which can draw the nipple inward, creating a “flat nipple”. This “flat nipple” can make it difficult for baby to latch and feed effectively. A technique called reverse pressure softening can help your baby to latch, see here: Reverse Pressure Softening   Engorgement can also contribute to plugged milk ducts.

There are strategies to prevent engorgement. Breastfeed early and often. Aim to nurse baby 8-12 times in 24 hours. If your baby is not able to nurse directly at the breast, hand express or do a very minimal amount of pumping to help move a bit of milk. Ensure baby is feeding well, latch and positioning are comfortable, observe for drinking (swallows).

Before nursing, briefly apply warm compresses to the breasts, alternating with cold compresses/ice. Cold cloths or ice packs may also be helpful after nursing. Ibuprofen can be taken as needed. Gentle breast massage can be used. Avoid deep massage as it can increase inflammation the breast. While nursing, optimize baby’s latch to encourage effective feedings and good milk removal.