My breasts feel extremely full and uncomfortable. What is happening and what
can I do about it?
Your milk will become more plentiful or "come in" some time between the second
and sixth day after you give birth. Before that time, your baby will receive "early milk"
known as colostrum, which will provide him with all the nourishment he needs, plus important
antibodies and other immune properties to protect him from illness. It takes about two weeks for
your milk to gradually transition into mature milk.
When your milk becomes more plentiful, your breasts may seem filled to bursting. This fullness is
due to additional blood and fluid traveling to the breasts, preparing them for producing milk, as well
as the increased volume of the milk itself. Some women only notice a little fullness, while others
experience quite a bit more. Usually, the fullness subsides in 12-48 hours. It is especially important
to continue to breastfeed your baby frequently since removing the milk from the breasts relieves the
engorgement by allowing room for the excess fluids to flow out of the region.
You can prevent or minimize the effects of engorgement by:
- Nursing early and often. Nurse as soon after the birth as possible, and at least ten times a
day after that.
- Ensuring that your baby is positioned well and is latched on properly. (See
How do I position my baby
to breastfeed? for more information on proper positioning and latch.)
- Nursing "on cue". If your baby sleeps more than two to three hours during the
day or four hours at night, wake him to nurse.
- Allowing baby to finish the first breast before switching sides. This means to wait until
baby falls asleep or comes off the breast on his own. There is no need to limit baby's time on
the breast.
- If your baby is not nursing at all, or is not nursing well, hand expressing or pumping your milk
as frequently as baby would nurse.
For some mothers, the normal sense of fullness continues, their breasts becoming hard and painful. Most
mothers find that frequent nursing helps to relieve any discomfort. Additional suggestions for dealing with
the discomfort of engorgement include:
With the palm of your hand and starting from the top of your chest (just below your collar bone), gently
stroke the breast downward in a circular motion, toward the nipple. This may be more effective when done
while you are in the shower or while leaning over a basin of warm water and splashing water over your
breasts.
- Warm Compresses, Massage, Cold Compresses
Some mothers find that applying a warm, moist compress and expressing some milk just before feedings helps
to relieve engorgement. Using heat for too long will increase swelling and inflammation, so it is best to keep
it brief. Cold compresses can be used between to reduce swelling and relieve pain.
A popular home remedy for relieving the discomfort of engorgement is cabbage leaf compresses. Rinse the inner
leaves of a head of cabbage, remove the hard vein, and crush with a rolling pin (or similar). They can be used
refrigerated or at room temperature. Drape leaves directly over breasts, inside the bra. Change when the leaves
become wilted, or every two hours. Discontinue use if rash or other signs of allergy occur. There have been
anecdotal reports that overuse of cabbage compresses can reduce milk production, therefore some experts suggest
mothers discontinue the compresses when the swelling goes down.
Contact your health care provider immediately if:
- Engorgement is not relieved by any of the above comfort measures.
- You begin experiencing symptoms of mastitis: fever of greater than 100.6°F (38.1°C),
red/painful/swollen breast(s), chills, "flu-like" symptoms.
- Your baby is unable to latch on to your breast.
- Your baby is not having enough wet and dirty diapers. (See
How can I tell if my baby is getting enough
milk? for more information.)
Engorgement can cause the nipples to flatten, or the dark area around the nipple, the areola, to become hard
and swollen. This can be a problem if the fullness makes it difficult for baby to latch on. A technique that can
help is reverse pressure softening. Reverse pressure softening, or RPS, softens the areola to make latching and
removing milk easier. It is not the same as hand expression (although it is okay if some milk does come out).
The following article is a description of RPS, with illustrations.
Reverse Pressure Softening
K. Jean Cotterman RNC, IBCLC (mellomom@gmail.com)
What is it?
Reverse pressure softening is a new way to soften the circle around your nipple (the a-re-o-la) to make
latching and getting your milk out easy while your baby and you are learning. Latching shouldn't be painful.
If your areola is soft enough to change shape while feeding, it helps your baby gently extend your nipple deep
inside his mouth, so his tongue and jaws can press on milk ducts under the areola. (These motions differ from
those that artificial nipples force a baby to use.)
This new method is not the same as removing milk with your fingers. Don't expect milk to come from your
nipple while you soften your areola this way. (But it's OK if some milk does come out.)
When is it helpful?
Try reverse pressure softening in the early days after birth if you begin to notice firmness of the areola,
latch pain or breast fullness. (This full feeling is only partly due to milk. Delayed or skipped feedings may
also cause the tissue around your milk ducts to hold extra fluid much like a sponge does. This fluid never goes
to your baby.) Intravenous (IV) fluids, or drugs such as pitocin may cause even more retained tissue fluid,
which often takes 7-14 days to go away. Avoid long pumping sessions and high vacuum settings on breast pumps
to prevent extra swelling of the areola itself.
Feel your areola and the tissue deeper inside it. Is it soft and easy to squeeze, like your earlobe or your
lip? Or does it feel firmer and harder to compress, like your chin? if so, it's time to try reverse pressure
softening just before each time you offer your baby your breast. (Some mothers soften their areola before
feeding, for a week or longer, till swelling goes down, baby can be heard swallowing milk regularly, and
latching is always painfree without softening first.)
Why does it work?
Reverse pressure softening briefly moves some swelling backward and upward into your breast to soften your
areola so it can change shape and extend your nipple. It sends a special signal to the back of your breasts to
start moving milk forward (let-down reflex) where your baby's tongue can reach it. It also makes it easy to
remove milk with your fingertips or with short periods of slow gentle pumping, combined with gentle forward
massage of the upper breast, if you need to remove milk for your baby.
Where should I press?
It is most important to soften the areola in the whole one-inch area all around where it joins your nipple.
Soften even more of the areola if you wish. You may also want to soften a place where your baby's chin will be
able to move easily against the breast. Reverse pressure softening should cause no discomfort.
How do I do Reverse Pressure Softening?
K. Jean Cotterman RNC, IBCLC (mellomom@gmail.com)
Illustrations by Kyle Cotterman, Dayton, Ohio
- You (or your helper, from in front, or behind you) choose one of the patterns pictured.
- Place the fingers/thumbs on the circle touching the nipple.
- (If swelling is very firm, lie down on your back, and/or ask someone to help by pressing his or her
fingers on top of your fingers.)
- Push gently but firmly straight inward toward your ribs.
- Hold the pressure steady for a period of 1 to 3 full minutes.
- Relax, breathe easy, sing a lullaby, listen to a favorite song or have someone else watch a clock or
set a timer. To see your areola better, try using a hand mirror.
- It's OK to repeat the inward pressure again as often as you need. Deep "dimples" may form,
lasting long enough for easy latching. Keep testing how soft your areola feels.
- You may also press with a soft ring made by cutting off half of an artificial nipple.
- Offer your baby your breast promptly while the circle is soft.
| 
|  |
One handed "flower hold."
Fingernails short,
fingertips curved,
placed where baby's
tongue will go |
Two handed, one-step method.
Fingernails short,
fingertips curved,
each one touching
the side of the nipple |
(You may ask
someone to help
press by placing
fingers or thumbs
on top of yours.) |
| 
|  |
Two step method, two hands,
using 2 or 3 straight fingers
each side, first knuckles
touching nipple. Move ¼ turn,
repeat above & below nipple |
Two step method, two hands,
using straight thumbs, base
of thumbnail even with side
of nipple. Move ¼ turn, repeat,
thumbs above & below nipple |
Soft ring method.
Cut off bottom half
of an artificial nipple
to place on areola to
press with fingers |
© 2004 Lactation Education Consultants. May be reproduced for non-commercial
purposes. |
More information on the early weeks of breastfeeding can be found in
our Web resource collection.
Last updated 12/2/06 by jlm.
Page last edited Sun Oct 14 09:29:16 UTC 2007.
