Engorgement: An Often Misunderstood Condition

by Donna Walls, RN, ICCE, IBCLC, ANLC

When a mother tells you she’s engorged- check in and ask what she means. Too often our patients use the term meaning their breasts are fuller, heavier. Physiologically, this early filling is normal and this process, lactogenesis 2,  is the transition from colostrum to mature milk that occurs in the first days after birth.

Unfortunately, this process is too often referred to as “milk coming in”, interpreted by many new mothers as there is no milk for the newborn until they feel the filling. We know the number one concern in the first days is not having enough milk and continuing to use the “milk coming in” phrase perpetuates this myth. Changing your wording can have a major positive impact on a new mother’s confidence in her ability to make enough milk for her newborn. Referring to lactogenesis 2, when the breasts become rounder, fuller, firmer and heavier, as “milk change over” or “newborn milk changing to mature milk” can help mothers to understand the adequacy and importance of early colostrum feedings.

The condition of engorgement is actually pathological and can cause reduction or cessation of milk production if not alleviated quickly and effectively. When teaching prenatal class or helping a new mother in the postpartum days educate her as to the difference between normal filling and engorgement:

Normal Filling Engorgement
breasts warm hot, shiny
skin indentable skin unindentable
normal temp low grade temp
nipple graspable nipple flattened, tight
baby able to latch unable to latch

Factors which may increase the risk of engorgement are:

  • Use of IV fluids in labor
  • Separating mother and baby resulting in “missed feedings”
  • Scheduled rather than cue based feedings
  • Housing newborns in the nursery at night
  • Limiting or timing of length of feedings
  • Overstimulation- “extra pumping” in the first days
  • Use of “too tight” bras, wraps or clothing

Implementing effective treatments quickly is the key to resolving the discomfort and possible harm to breastfeeding. First, review baby led feeding or assure the mother understands cue feeding. Underscore the importance of non-separation of mother and baby to facilitate mothers’ observation of cues and states optimum for feeds. Ask them to discontinue if they are doing “extra” pumping, as mothers often mistakenly feel this may be helpful in having enough milk. A very effective technique is the water gravity massage, having the mother hang her breasts in tepid water (either in a clean sink or reusable tub) while doing a gentle massage from the base of the breast toward the nipple. As soon as milk begins to flow have the mother place the infant at the breast to begin nursing and effectively remove milk. This may be repeated later in the day if necessary,

As childbirth educators, doulas, nurses or midwives we can be an integral part of reducing the incidence and consequences of engorgement with education and early interventions and Including educating all caregivers in preventive care practices and implementing interventions quickly when engorgement is recognized.

Resources
Mary C. Brucker, Applying Evidence to Health Care With Archie Cochrane’s Legacy, Nursing for Women’s Health, 2016, 20, 5, 441
Anne Fallon, Deirdre Van der Putten, Cindy Dring, Edina H Moylett, Gerard Fealy, Declan Devane, Anne Fallon, Cochrane Database of Systematic Reviews, 2016
BREASTFEEDING MEDICINE Academy of Breastfeeding Medicine Protocol #20, Volume 4, Number 2, 2009  Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2009.9997
Bolman M, Saju L, Oganesyan K, Kondrashova T, Witt A. Recapturing the Art of Therapeutic Breast Massage during Breastfeeding. Journal of Human Lactation. 2013;29(3):328­331. doi:10.1177/0890334413475527
 Witt AM, Bolman M, Kredit S. “Breast Engorgement:  Clinical Course, Home Treatment and In-Office Education Breastfeed Med. 2014 Nov;9(S1)

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