What to Know About Breast Engorgement.

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Breast engorgement is a problem that is common in the early days and weeks of breastfeeding. 

Once your baby is born, your breasts are given a signal to start full milk production. 

Blood flows to your breasts, and your milk usually comes in 1 to 4 days after the birth.

 Breast engorgement is when your breasts get full and sore.

Relieving and Treating Engorged Breasts

For the first few days after giving birth, a new mother’s breasts remain soft. They will produce colostrum. 

Colostrum, the first milk, is available in just the right amount, and is rich in immune factors that protect newborns. 

Sometime during the next few days, the breasts will become full, firm, warm, and perhaps tender. 

When this occurs, people say: “the milk is coming in!” The scientific term for this event is: engorgement. 

Engorgement is normal, and lasts for various periods of time depending on the individual woman.

Some women experience only a day or so of mild, easy-to-manage engorgement. 

For other women, engorgement may be more intense, and can last from several days to two weeks.

Some women seem to bring in a larger early milk supply. 

Others seem to experience more breast swelling. 

For these women and their babies, the engorgement period may seem more difficult. 

The breasts will adjust over time, eventually making exactly the right amount of milk for the baby.

It is the baby’s job to help the mother through engorgement by removing milk.

 If the baby is not latching properly or feeding frequently enough, the breasts may become overly full.

 This reduces the elasticity of the breasts and nipples. 

When the breasts are too firm, some babies cannot grasp enough tissue to latch on well. 

They may suck overly hard trying to pull in the breast tissue. 

This can lead to sore nipples. 

If poor latch results in poor emptying of the milk, the build-up can cause breast engorgement to become severe. 

The breasts may redden and become painful. 

Mothers may sometime develop a low-grade fever.

 (Fever may also signal infection, so at the first sign, call the doctor.)

Along with making mothers feel ill, severe engorgement may interfere with milk production. 

The milk pooling in engorged breasts releases chemical signals that tell the body to decrease milk production.

 If unrelieved, prolonged engorgement can contribute to insufficient milk supply or begin the weaning process.

Prevention:
 

Begin breastfeeding as soon as possible after the birth, to give the baby time to learn to breastfeed before the breasts become full and firm.

Unless medically indicated, avoid early use of bottles and pacifiers while the baby is learning to breastfeed.

Once the milk comes in, breastfeed at least 8 times in 24 hours to prevent over fullness.
Ask for help from the hospital lactation consultant so that latch-on problems are solved as soon as possible.

Any time a feeding is missed, use hand expression or a breast pump to remove the milk.
Always wean gradually

Treatment:
 

Use moist heat on the breasts for a few minutes, or take a brief hot shower before breastfeeding. 

This may help the milk begin to flow. Note: Use of heat for extended periods of time (over 5 minutes) may make swelling worse.

Use cold compresses for 10 minutes after feedings to reduce swelling.

Gently massage and compress the breast when the baby pauses between sucks. 

This may help drain the breast, leaving less milk behind.

Ask your health care professional about medications such as ibuprofen to reduce pain and inflammation.

A well-fitted, supportive nursing bra makes some women feel better. Others prefer to go bra-less during engorgement.

Gentle breast massage and relaxation techniques may help improve milk flow and reduce engorgement

Hand expression or brief use of a breast pump may help soften the nipple and areola so that the baby can get a better latch.

Some women find that a single use of a breast pump to soften severely engorged breasts diminishes painful inflammation. 

They then return to frequent breastfeeding as the main way to manage engorgement.

Pumping, hand expressing, or nursing to comfort prevents the negative consequences of retained milk. Relieving the milk pressure will not make engorgement worse.

If the baby is premature or complications interfere with breastfeeding, a hospital grade pump can help the mother through engorgement until her baby can breastfeed.

Fever higher than 101° F or severe pain may signal a breast infection. Call your medical care provider for advice if this occurs.

How do you relieve engorgement?

Engorged breasts are painful.

 

 They feel heavy, hard, warm and sensitive —as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. 

Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

Most mothers experience some engorgement in the first weeks after birth. 

With changing hormone levels, your breasts swell and enlarge as milk production increases. 

It may seem as though they are filling up with milk, but engorgement is more than milk storage.

 Your body directs extra blood and fluids to your breasts to boost milk production. 

This causes congestion and swelling which will decrease as your body adjusts.

  • Minimizing early engorgement
  • Treat engorgement to…
  • When to treat engorgement
  • After the first few weeks
  • Causes of engorgement
  • Treating engorgment
  • Be sure your baby is sucking effectively
  • Reverse pressure softening
  • Keep comfortable
  • Watch out for signs of mastitis

Minimizing early engorgement
New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like
watermelons!

Try these suggestions
Breastfeed your baby frequently from birth—at least 8–12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.

Newborn at breast
If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.

Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.

If your newborn is unable to breastfeed, hand express frequently until your milk ‘comes in’, then combine with using a hospital-grade electric breastpump to help establish your milk production and relieve engorgement. 

Your milk can be given to your baby until he is able to nurse.

Treat engorgement to…
Make breastfeeding easier

Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well.

 A poor latch-on can give you sore nipples. 

Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production

When milk isn’t removed from your breasts, you will produce less milk. 

Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis

Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. 

When milk is removed, blood circulation improves and swelling reduces. 

Use the suggestions below to reduce swelling and keep your milk flowing. 

Many mothers have a slight temperature when their breasts are engorged. 

Temperatures under 38.4ºC are not usually associated with infection. 

Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:
A missed feed or expressing session.

This can easily happen during holidays and festivities or when visitors arrive. 

Encourage your baby to feed more often, or express more frequently if you’re apart from your baby.

Feeding a baby on a scheduleIMG_3176

Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. 

Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.

Expressing milk.

 

Some books advise expressing to keep milk production one step ahead of a baby’s needs. 

However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.

Weaning from the breast too quickly

If you experience engorgement during weaning, you may need to slow down the process. 

This will give your breasts time to adjust to the reduced demand for milk.

 If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement
Reduce swelling and keep milk flowing:

Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2–3 hours from the start of one feed to the start of the next. 

Let your baby finish on the first breast before switching to the second
Avoid using bottles or dummies.

 If a supplement is needed try using a spoon, flexible feeding cup or syringe.

Between feeds, apply ice for 15–20 minutes at a time between feeds to reduce swelling.

Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). 

Wrap them in a lightweight towel to protect your skin.

Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. 

Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn’t ready to feed.

Use gentle massage from the chest wall toward thenipple area in a circular motion.
Be sure your baby is sucking effectively:

Skin to skin newborn, close-up of breastfeeding showing good latchPosition your baby with his chest and tummy in full contact with your body. 

With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. 

This way he’ll take a large mouthful of breast. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on – when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

Reverse pressure softening
works by moving fluid away from the nipple area.

Press all five fingertips of one hand around the base of the nipple.

 Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.

You can also press with the sides of fingers.

 Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be.

If this isn’t enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.

emmataylor3
A well-fitting, supportive bra may help. 

Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours

Use only until swelling goes down as long-term use may reduce milk supply. 

Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

Inflamed, hot, red, localised areas of your breast.

Temperature over 38.4ºC or flu-like symptoms.

Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids.

 If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis

Engorgement should improve within a day or two.

 If not, contact an LLL Leader for further suggestions. 

You may need to improve your baby’s breastfeeding technique or find ways to reduce your milk supply. 

These are not difficult problems to solve, especially if treated promptly.

How do you get rid of engorged breasts when not breastfeeding?

Breast engorgement means your breasts are painfully overfull of milk. 

This usually occurs when a mother makes more milk than her baby uses. 

Your breasts may become firm and swollen, which can make it hard for your baby to breastfeed. 

Engorged breasts can be treated at home.

Engorgement may happen:

When your milk first comes in, during the first few days after birth.
When you have a regular breastfeeding routine but can’t nurse or pump as much as usual.

If you suddenly stop breastfeeding.

When your baby suddenly starts breastfeeding less than usual. 

This may happen when your baby is starting or increasing solid foods or when your baby is ill and has a poor appetite.

Your breasts start making milk about 2 to 5 days after your baby is born. 

(Before that, they make colostrum, which contains important nutrients that your baby needs right after birth.)

 It’s normal for your breasts to feel heavy, warm, and swollen when your milk “comes in.” 

This early breast fullness is from the milk you make and extra blood and fluids in your breasts.

 Your body uses the extra fluids to make more breast milk for your baby.

This normal breast fullness will probably go away in a few days as you breastfeed and your body adjusts to your baby’s needs.

 Your breasts may become painfully engorged if you aren’t breastfeeding your baby often or if the feedings don’t empty your breasts.

Your breasts will be engorged for several days if you don’t or can’t breastfeed after your baby is born. 

This will gradually go away if your breasts are not stimulated to make milk.

 At present, there is no approved medicine to “dry up” your milk supply and prevent engorgement.

If you have any concerns or questions, you can work with a lactation consultant. This is someone who helps mothers learn to breastfeed.

What are common symptoms?
Symptoms of engorged breasts include:

  • Swollen, firm, and painful breasts. If the breasts are severely engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the touch.
  • Flattened nipples. The dark area around the nipple, the areola, may be very firm. This makes it hard for your baby to latch on.
  • A slight fever of around100.4°F (38°C).
  • Slightly swollen and tender lymph nodes in your armpits.
  • What can happen if breast engorgement gets worse?
  • If engorgement is severe, your breasts get very swollen and painful. Severe engorgement can make it hard for your baby to latch on to the breast properly. As a result:
  • Your baby may not get enough milk.
  • Your breasts may not empty completely.
  • Your nipples may become sore and cracked. This may cause you to breastfeed less, and that makes the engorgement worse.
  • Severe engorgement can lead to blocked milk ducts and breast infection, which is called mastitis. Mastitis needs to be treated with antibiotics.

How is it treated?

If engorgement is making it hard to breastfeed, use the following steps. They can relieve your symptoms and keep your milk flowing.

Soften your breasts before feedings. 

You can apply a warm compress for a couple of minutes before you breastfeed. 

Or you can use your hands or use a pump to let out (express) a small amount of milk from both breasts.

Try to breastfeed more often. 

Pump your breasts if your baby won’t breastfeed. Take care to empty your breasts each time.

Take ibuprofen (such as Advil or Motrin) to reduce pain and swelling. Ibuprofen is safe for breastfeeding moms when taken as directed.

 But it’s a good idea to check with your doctor before you take any kind of medicine while breastfeeding.

If your breasts still feel uncomfortable after nursing, try a cold compress to reduce swelling.

You can use a frozen wet towel, a cold pack, or a bag of frozen vegetables.

Apply it to your breasts for 15 minutes at a time every hour as needed.

To prevent damage to your skin, place a thin cloth between your breast and the cold pack.

If you are not breastfeeding, use one or more of these steps to relieve discomfort:

Do not pump or remove a lot of milk from your breasts. 

If your breasts are very painful, it’s okay to remove just a little bit to make you more comfortable.

Apply a cold pack to your breasts for 15 minutes at a time every hour as needed. 

To prevent damage to your skin, place a thin cloth between your breast and the cold pack.

Take ibuprofen (such as Advil or Motrin) in addition to using non-medicine treatments. Be safe with ibuprofen. 

Read and follow all instructions on the label.

Wear a bra that fits well and provides good support.
How can you prevent breast engorgement?
You may be able to prevent engorgement if you keep milk moving out of your breasts and take care not to let your breasts become overfilled.

Breastfeed whenever you notice signs that your baby is hungry, such as eagerly sucking on fingers or rooting. 

During the first few days and weeks, breastfeedings usually occur every 1 to 3 hours around the clock.

Make sure that your baby is latching on and feeding well. 

If your breasts are hard and overfilled, let out (express) enough to soften your nipples before putting your baby to the breast.

Empty your breasts with each feeding. Empty one breast completely before you switch to the other side. 

You can tell that it’s time to switch sides when both of the following things happen:

Your baby’s sucking slows down a lot or stops.
You can no longer hear your baby swallowing.

Does ice help with engorgement?

Breast engorgement is the painful overfilling of the breasts that can occur during breastfeeding. It usually occurs when your breasts make more milk than your baby can drink, when you are unable to breastfeed or pump, and when you stop breastfeeding your baby.

Breast engorgement can make it hard for your baby to latch on to your nipple. Your baby may then be unable to breastfeed. 

This makes engorgement worse.

If you are breastfeeding, engorgement should get better in 12 to 24 hours and should disappear within a few days. 

If you are not breastfeeding, you will get better in 1 to 5 days or when your body stops making breast milk.

Follow-up care is a key part of your treatment and safety.

 Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. I

t’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?
If your doctor or midwife gave you medicine, take it exactly as prescribed. Call your doctor, midwife, or nurse call line if you think you are having a problem with your medicine.

Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.

Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol.

 Too much acetaminophen (Tylenol) can be harmful.

If your baby is having a hard time latching on, let out (express) a small amount of milk with your hands or a pump. 

This will help soften your nipple and make it easier for your baby to latch on.

If your breasts are uncomfortably full, pump or express breast milk by hand just until they are comfortable. 

Do not empty your breasts all the way.

 Releasing a lot of milk will cause your body to produce larger amounts of milk. 

This can make breast engorgement worse.

Gently massage your breasts to help milk flow during breastfeeding or pumping.

Apply a frozen wet towel, cold gel or ice packs, or bags of frozen vegetables to your breasts for 15 minutes at a time every hour as needed. 

(Put a thin cloth between the ice pack and your skin.)

Avoid tight bras that press on your breasts. A tight bra can cause blocked milk ducts.
To prevent breast engorgement
Put a warm, wet face cloth on your breasts before breastfeeding. 

This may help your breasts “let down,” increasing the flow of milk. 

Or you can take a warm shower or use a heating pad set on low.

 (Never use a heating pad in bed, because you may fall asleep and burn yourself.)

Change your baby’s position occasionally to make sure that all parts of your breasts are emptied.

Make sure your baby is latched on properly.

Talk to your doctor, midwife, or a lactation consultant about any problems you have with breastfeeding.

How long does engorgement last when milk comes in?

What is Normal?
It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (“comes in”) 2-5 days after birth. 

This rarely lasts more than 24 hours. 

With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

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How to prevent or minimize engorgement
Nurse early and often – at least 10 times per 24 hours. Don’t skip feedings (even at night).
Nurse on baby’s cues (“on demand”). If baby is very sleepy: wake baby to nurse every 2-3 hours, allowing one longer stretch of 4-5 hours at night.

Allow baby to finish the first breast before offering the other side. Switch sides when baby pulls off or falls asleep. Don’t limit baby’s time at the breast.

Ensure correct latch and positioning so that baby is nursing well and sufficiently softening the breasts.

If baby is not nursing well, express your milk regularly and frequently to maintain milk supply and minimize engorgement.

Signs & Symptoms of Engorgement
When? Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment).

How does the breast feel? The breast will typically feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth, tenderness, and/or throbbing. 

Engorgement may extend up into the armpit.

How does the areola feel? The areola will typically feel hard (like the tip of your nose or your forehead) rather than soft (like your earlobe), with tight skin that may appear shiny.

 The nipple may increase in diameter and become flat and taut, making latch-on challenging.

You may also have a low-grade fever.

Moms’ experiences of engorgement differ. Engorgement:

  • May occur in the areola and/or body of the breast;
  • May occur in one or both breasts;
  • May build to a peak and then decrease, stay at the same level for a period of time (anywhere from minimal to intense), or peak several times.
  • Tips for treating engorgement
  • Before nursing
  • Gentle breast massage from the chest wall toward the nipple area before nursing.
  • Cool compresses for up to 20 minutes before nursing.
  • Moist warmth for a few minutes before nursing may help the milk begin to flow (but will not help with the edema/swelling of engorgement). Some suggest standing in a warm shower right before nursing (with shower hitting back rather than breasts) and hand expressing some milk, or immersing the breasts in a bowl or sink filled with warm water. Avoid using warmth for more than a few minutes as the warmth can increase swelling and inflammation.
  • If baby is having difficulty latching due to engorgement, the following things can soften the areola to aid latching:
  • Reverse pressure softening (directions in the link)
  • Hand expression
  • If the above two things are not effective, try pumping for a few minutes with a hand, electric (low setting) or “juice-jar” breast pump.
  • While nursing
  • Gentle breast compressions and massage during the nursing session can reduce engorgement.
  • After nursing for a few minutes to soften the breast, it may be possible to obtain a better latch by removing baby from the breast and re-latching.
  • Between feedings
  • If your breast is uncomfortably full at the end of a feeding or between feedings, then express milk to comfort so that the breasts do not become overfull.
  • Hand expression may be most helpful (though obviously second to breastfeeding) as this drains the milk ducts better.
  • Mom might also use a hand pump or a quality electric pump on a low setting for no more than 10 minutes (engorged breast tissue is more susceptible to damage). A “juice-jar” pump may also be used.
  • Massaging the breast (from the chest wall toward the nipple area) is helpful prior to and during milk expression.
  • It’s not good to let the breasts get too full, but you also don’t want to overdo the pumping, as too much pumping will encourage overproduction. If you do need to express milk for comfort, your need to express will likely decrease gradually over time; if it does not, then try gradually decreasing the amount you express.
  • Use cold compresses (ice packs over a layer of cloth) between feedings; 20 minutes on, 20 minutes off; repeat as needed.
  • Cabbage leaf compresses can also be helpful.
  • Many moms are most comfortable wearing a well fitting, supportive bra. Avoid tight/ill-fitting bras, as they can lead to plugged ducts and mastitis.
  • Talk to your health care provider about using a non-steroidal anti-inflammatory such as ibuprofen (approved by the American Academy of Pediatrics for use in breastfeeding mothers) to relieve pain and inflammation.
  • AVOID:
  • Excess stimulation (for example, don’t direct a shower spray directly on the breasts).
  • Application of heat to the breasts between feedings. This can increase swelling and inflammation. If you must use heat to help with milk flow, limit to a few minutes only.
  • Restricting fluids. This does not reduce engorgement. Drink to thirst.
Other treatments for engorgement

Cabbage
Applying cabbage leaf compresses to the breast can be helpful for moderate to severe engorgement. 

There is little research on this treatment thus far, but there is some evidence that cabbage may work more quickly than ice packs or other treatments, and moms tend to prefer cabbage to ice packs.

What are cabbage compresses used for?
Engorgement.

Extreme cases of oversupply, when the usual measures for decreasing supply (adjusting nursing pattern, nursing “uphill,” etc.) are not working
During weaning, to reduce mom’s discomfort and decrease milk supply.

Sprains or broken bones, to reduce swelling.
To use cabbage leaves:

  1. Green cabbage leaves may be used chilled or at room temperature.
  2. Wash cabbage leaves and apply to breasts between feedings.
  3. For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for 20 minutes, no more than 3 times per day; discontinue use as soon as engorgement/oversupply begins to subside.
  4. During the weaning process: Leave the leaves on the breast until they wilt, then apply new leaves as often as needed for comfort.
  5. For further information on how to use cabbage leaves:
  6. Cabbage? Why Use It and How Does It Work? Instructions for Use by Paula Yount
  7. Cabbage Leaves for Engorgement by Jack Newman, MD, FRCPC
  8. Cabbage Leaves for Prevention and Treatment of Breast Engorgement by Sandra Smith, MPH CHES

“Juice Jar” breast pump

  • This simple pump can be useful to help with engorgement, and to draw the nipple out when baby is having a difficult time latching on.
  • Find an empty glass jar or bottle at least 1 liter in size with a 5 cm or larger opening. The type of bottle that cranberry juice comes in is often a good size.
  • Fill the jar nearly full with very hot water. The glass will get very hot and you will need to hold it with a towel.
  • Pour all the water out of the jar.
  • Use a cool washcloth to cool down the rim and upper part of the jar so you can touch it without burning yourself (test it with your inner arm).
  • Place your breast gently into the mouth of the jar so that it makes an airtight seal. Some moms lean over a table to do this, others put the jar in their lap on a pillow and lean forward. Expect this to take a few minutes, so make yourself comfortable.
  • As the air slowly cools inside the jar, it creates a vacuum inside the jar and this gentle suction expresses milk from the breast. Break the suction immediately if you feel discomfort – if the jar cools too quickly it may create excessive suction which can damage breast tissue.
  • Repeat for the other breast.
  • Some moms need to repeat this, others find it works sufficiently with only one try.

How do I stop getting engorged at night?

Your baby’s sound asleep, possibly for the first night ever.

 You’re lying in bed, desperately for some shut eye yourself.

 But instead, your breasts are engorged and swollen, throbbing and aching. 

Milk starts to leak from your nipples.

 What to do? There’s nothing worse than being kept awake at night with engorgement, but luckily, you don’t have to suffer.

 Relieving painful engorgement in the middle of the night isn’t as hard as you think.

Breastfeeding is tough, and there’s a lot you don’t know about it until you’re actually doing it. 

I didn’t quite understand that my body would be ready to feed my baby all the time — even if my kid was sound asleep. 

There were many nights I’d wake up in puddles of milk after my baby had slept a longer-than-normal stretch. 

Breast pads were my best friends in the early months, as they kept me from having to change clothes (and sheets) several times a night.

And since sleep is such a precious commodity when you have an infant in the house, maximizing every minute you can get is crucial. 

Being kept awake by throbbing engorgement or leaking milk is the last thing you want when you could be sleeping. 

Here are a few tricks to relieve nighttime engorgement so you can long a few hours of sound sleep and sweet dreams.

1. Don’t Be Afraid To Nurse Your Baby

Since breastmilk digests in less than 2 hours, your baby will wake to feed throughout the night. 

This is completely normal, and there’s nothing wrong with nursing your baby on demand for as long as they need it. 

Especially since nursing is the quickest way to reduce engorgement at night. Just gently massaging your breast as your baby nurses to help milk flow and relieve some of the tightness.

As an added benefit, night nursing also promotes bonding between parent and child. I know firsthand how helpful this can be. 

We co-slept with my little one for the first few months to make the night nursing easier on both of us. 

I grew to love our time together at night when the rest of the house was asleep. 

It was special to both of us, a time when we could be together without interruption or worry.

2. If Nursing Isn’t An Option, Grab The Pump

But what happens if you wake up engorged and your baby is fast asleep? Well, don’t you dare wake a sleeping baby. 

Instead, pull out your breast pump. 

Middle-of-the-night pumps are great for building a freezer stash for times you need to leave your baby with someone else.

 This way, you relieve engorgement, keep your supply up, and store milk for later.

3. When It’s Time To Sleep Through The Night, Use You Hand

There comes a point in every baby’s life when they start sleeping longer and you don’t need to be producing as much milk during the night. 

Of course, i will take a little bit of time for your body to learn that it can minimize the nighttime supply.

 If you wake up feeling engorged, use the hand express method to get a little relief without wasting the milk you made.

Should you pump when your milk comes in?

We recommend breastfeeding as much as possible.

 It is the best way to feed your baby. However we understand that not every mom can feed on demand and be with their baby 24 hours a day. 

If you want to continue to provide your baby with breastmilk , a breast pump is an effective way to establish and maintain a good milk supply. 

There are many reasons to pump breast milk.

You may want to store milk for when you’re away from your baby. 

Maybe you’re going back to work, leaving your baby with family, friends, or a babysitter, or running errands.

  • Your baby is unable to latch or feed directly from the breast.
  • You want to give your baby breastmilk but don’t want to feed directly from the breast.
  • You’re interested in donating milk to a milk bank or milk exchange program.
  • You’re trying to increase your milk supply, are weaning and need to alleviate pressure, or are suffering from mastitis or need to drain your breast to help healing
  • Many other reasons!
  • Things You Need to Know before Breast Pumping
  • Once you’re ready to start breast pumping, there are a few things you need to know. If you have a full-term, healthy, breastfeeding baby, you can wait a few weeks to start pumping and storing breast milk. If your baby is preterm or ill and cannot breastfeed yet, or if you have chosen to exclusively pump, pump as soon as you can after birth, preferably within one to six hours of delivery.

If you’re primarily breastfeeding:

Pump in the morning.

 Many moms get the most milk first thing in the morning.

Pump between breastfeeding, either 30-60 minutes after nursing or at least one hour before breastfeeding.

 This should leave plenty of milk for your baby at your next feeding.

If your baby wants to breastfeed right after breast pumping, let them! Some babies are patient and will just feed longer to get the milk they need.

Free Breast Pump

If you’re exclusively breast pumping:

Plan to pump 8-10 times in a 24 hour period. Full milk production is typically 25-35 oz. (750-1,035 mL) per 24 hours.

Once you have reached full milk production, maintain a schedule that continues producing about 25-35oz of breastmilk in a 24 hour period.

Each mom and baby are different, plan your pumping sessions around what works best for the two of you.

Remember, a quality, electric breast pump is essential to breast pumping success.

Learning to Pump

Learning to pump can be a daunting process. These steps will set you and your baby up for success.

  1. Do a little homework. Read up on the basics of breast pumping, and be sure to review your breast pump instructions.
  2. Find a quiet, comfortable place to sit.
  3. Bring a drink and a snack.
  4. Plug in your pump or make sure it has working batteries.
  5. Wash your hands with soap and water.
  6. Assemble the pump kit.
  7. Center the flanges over your breast(s) and center the nipple in the flange opening, making an air seal. Flange fit is important!
  8. If you’re double pumping, cup each flange to the breast with fingers below the flange and thumb on the top. When adjusting your dials, switch to using one arm across both breasts, keeping an airtight seal.
  9. Turn your pump on.
  10. Similar to a baby nursing at the breast, start out with high speed and low suction until you see milk flow (let-down), then adjust speed to medium and increase suction based on comfort level.
  11. Once milk flow decreases, increase speed to high until the next let-down, then decrease to medium speed.
  12. Keep going! You’ll find pumping gets quicker and easier with practice.

How Much to Pump

How much milk you should expect to pump will vary depending on factors such as your baby’s age, time since last feeding or pumping, time of day, pump type, how much practice you’ve had with your pump, and whether you’re relaxed or stressed.

If you’re primarily breastfeeding, on average, you can expect:

More milk production in the morning hours .

Volumes gradually decreasing during the day into the evening.

Breast milk volumes are dependent on many variables and each breast may produce different volumes.

If you’re exclusively pumping, on average, you should try maintain full milk production of about 25-35 oz. (750-1,035 mL) per 24 hours. 

It may take some time to achieve this target, do not worry about hitting this on day one!

Babies may take more milk from the bottle than when breastfeeding. 

The faster, steadier flow of the bottle causes some babies to take more than they need. 

A slow-flow bottle may help prevent overfeeding.

How to Reach and Maintain Full Milk Production

If you’re pumping because your baby is preterm or too sick to breastfeed, or because you have chosen to exclusively pump, follow these tips to reach and maintain full milk production. 

Pumping often to drain the breast completely sends a signal to the body to produce more milk. 

The more often you drain your breasts the more milk they will make.

From Birth to Day 4

If you can, start pumping within six hours after birth.

Use a multi-user pump to initiate and maintain milk supply.

Expect to pump just a little colostrum (the first milk) at first.

As soon as possible, pump 8-10 times every 24 hours. 

This is how many times each day your baby would typically feed from the breast.

 In most cases, the more times each day you pump, the more milk you make. 

The reverse is true, too. Pumping fewer times will produce less milk.

Double pump (pump both breasts at once); this saves time and may boost production more quickly.

Pump at least 10-20 minutes, until your milk comes in on Day 3 or 4. 

Then, hand express any remaining milk. 

Remove and place the breast flange under your breast to collect the milk you hand express. 

(The hand expression helps to better drain your breast, and drained breasts make milk faster.)

To help establish milk supply, pump at least twice between 1 to 6am. 

In early morning hours milk- making hormone levels increase and taking advantage of this will increase your milk production.

From Day 4 to Full Production

When your milk increases from drops to ounces on about day 4, make these changes:

Pump longer, two minutes after the last drop of milk or until your breasts are softened/no longer feel full.

Focus on the total number of pumpings each day (8-10 times per 24 hours) rather than the time between pumpings (every 2-3 hours).

Don’t allow more than one five-hour period to pass without pumping during your baby’s first two weeks of life.

Many moms find it easier to focus on their daily total rather than pumping at a set time each day. 

This daily total also seems to be most important to your milk production.

Maintaining Full Milk Production

When you reach 25-35 oz. (750-1,050 mL) per baby per 24 hour period, you’ve met your goal.

 Most moms can then pump fewer times each day and maintain production. At this stage:

Maintain a schedule that continues producing approximately 25-35oz of breastmilk in a 24 hour period.

While maintaining your optimal production of milk, you can try and sleep more. 

Once full production is developed, many moms pump right before bed and first thing in the morning. 

See if you can do this without too much breast fullness or a decrease in milk production.

Pump for a shorter period of time. For many moms, 10-15 minutes of pumping is long enough.
Once a week, add up the milk you pump in a 24-hour period. 

Write it down and compare your totals each week. You’ll know right away if your production drops.

Increasing Milk Production

If you need to boost milk production, the sooner you work on it, the faster you’ll see results. 

Some ideas to try are:

Pump more. 8-12 pumpings per a 24 hour period boosts milk production for most moms.

Pump longer, two minutes after the last drop of milk or until your breasts are softened/no longer feel full

Only Cleared FDA Closed System

  • Check your breast flange size; it can change with time.
  • Use breast massage before or during pumping.
  • Hand express after pumping.
  • Ask your lactation consultant or healthcare provider for additional information on increasing milk supply.
  • Weaning From the Pump

When you decide to wean from the pump, remember the safest and most comfortable weaning is almost always a gradual one.

 There are a couple of ways to wean from the pump:

Drop one daily pumping. Give your body two to three days to adjust. 

Then drop another daily pumping.

 Leave your first and last daily pumpings until the end.

 Repeat until you’re fully weaned from the pump.

Keep the number of pumpings the same but pump for a shorter period of time. For example, if you were getting 4 oz. (120 mL) at each pumping, stop after 3 oz. (90 mL). 

Give your body two to three days to adjust and then do it again. 

Repeat until you no longer feel the need to pump.

While weaning, if your breasts ever feel full, pump just long enough to make yourself comfortable. 

Letting your breasts stay too full puts you at risk for pain and infection.

Is heat or cold better for engorged breasts?

What is Normal? It is normal and expected for your breasts to become larger and to feel heavy, warm, and tender between the third and fifth day after your baby is born. 

These breast changes are due to an increase in milk volume as well as an increase in blood and lymph fluids flowing to the breast. 

The changes signal the “incoming” of your more mature milk, and are a positive sign of good breast function. 

If your baby is nursing well, this condition resolves in about 24-48 hrs. 

Frequent nursing from birth (every 2-3 hours or 8-12 x or more in 24 hours) helps reduce the tenderness and fullness of your breast.

What is Engorgement? Normal breast fullness can lead to engorgement if your baby is not nursing often enough and/or not removing milk effectively. 

Engorged breasts become very full, firm, hard, and the skin can be red, taut and shiny. Some mothers have a low-grade fever.

 The breast may become so swollen that the nipples flatten making it difficult for your baby to latch.

Other causes of engorgement:

Mother and baby are separated and mother is not pumping often enough

Mother received IV fluids causing excessive edema

Supplementation of baby without replacement pumping

Baby’s latch is not deep enough to enable adequate milk removal

Tips for relieving engorgement:

Nurse very frequently–a minimum of 8 times in 24 hours, waking the baby by the third hour if necessary.

 Nursing even more often, every 1-2 hours, is helpful.

Apply heat to the breast for 5-10 minutes before nursing. 

Using warm, moist compresses or taking a warm-hot shower with gentle breast massage can help the milk flow.

Apply cold compresses to your breasts after feedings for 15-20 minutes. 

Cold can reduce swelling and inflammation. 

A bag of frozen peas or corn wrapped in a cloth molds easily to the breast and can be reused. 

Do not apply ice bags directly to your skin.

Massage firm, lumpy areas of your breasts with your fingertips while the baby is nursing.

 Gentle massage or breast compressions can help with milk drainage.

A well-fitted, supportive nursing bra may make you feel more comfortable.

 Avoid underwire bras during this time.

Ibuprofen (Motrin or Advil) can help alleviate both pain and swelling. 

Discuss with your healthcare provider before taking any medication.

Some mothers find cold cabbage leaves can be helpful to reduce moderate to severe engorgement. 

It is not clear if there is a substance in the leaves that reduces swelling or if it is simply the cool temperature of the leaves that provides relief.

Wash and core a head of raw green cabbage and place in the refrigerator.

Just before using, crush the veins of the leaf with a rolling pin.

Place several leaves over your breasts leaving the nipple exposed. Your bra will hold them in place.

Leave cabbage leaves in place for at least 20 minutes.

Discontinue leaves when engorgement has improved.

What if my breasts are so hard that my baby has trouble latching?
Soften the areola with reverse pressure softening (RPS). 

This process can move the excess fluid from the areola back into the breast. 

The technique is described below but you may find the video below helpful.

With your hands slightly curved, place the fingertips of your middle three fingers on either side of the base of your nipple where it touches the areola.

Gently push inward toward the chest wall and hold for 30-50 seconds. 

During RPS your areola softens, the nipple protrudes more, and milk will often start to drip.

Once the areola is softer and pliable, latch your baby deeply onto your breast.
Soften the areola by removing some milk using hand expression. 

Dr. Jane Morton, clinical professor at Stanford University School of Medicine, has developed a video demonstrating how to hand express your milk.

Use a manual or electric breast pump on a low, comfortable setting to remove a small amount of milk, soften the areola, and lengthen the nipple before latching.

How often and how long should I be pumping?

A well nursing baby is better than a pump for effectively removing milk from the breast. Allow/encourage your baby to nurse frequently.

If your baby takes only one breast and does not want to nurse from the other tight, firm breast, you can hand express or pump to relieve the pressure. 

Removing enough milk to just soften the breast tissue, can provide relief without resulting in overproduction.

Unrelieved prolonged engorgement can decrease your milk supply. 

If breasts are firm and not softened after nursing, use your electric pump and remove the milk that flows quickly and easily. 

A hospital grade, rental pump is usually the best choice for this situation.

If you find that you are relying on pumping to manage your engorgement, and/or your baby continues to have difficulty latching, please contact a lactation consultant.

 A consultant can help you to develop a strategy that will work for you and your baby during this engorgement phase.

What is breast engorgement?

Engorgement is when the breast tissue overfills with milk, blood and other fluids. 

This causes your breasts to feel very full, to become hard and painful and your nipples to appear flattened and tight.

Breast engorgement can be severe. It usually occurs if the baby is not feeding properly, so the milk builds up.

Breast engorgement can also occur at any time you are breastfeeding, especially when your baby’s feeding pattern changes and they feed less.

Engorgement is usually temporary – eventually you will produce just as much milk as your baby needs.

How to prevent breast engorgement
To reduce the chance of breast engorgement, you should feed your baby often and on demand (not by the clock) from birth, with at least 8 to 12 feeds in the first 24 hours. 

It will help to sleep in the same room as your baby to keep up these feeds. 

Also, avoid giving your baby any fluids other than breastmilk unless needed for a specific medical reason, and don’t limit your baby’s time at the breast.

How to relieve breast engorgement
If your breasts become engorged, there are things you can do to relieve the discomfort.

The best way to is to empty the breast, either by feeding your baby at the breast, or by expressing your milk. 

It’s okay to wake your baby and offer a breastfeed day or night if your breasts become full and uncomfortable between feeds.

The following tips might also help:

Apply a warm washer to the breast, or have a warm shower before a feed, for comfort and to help the milk flow.

Remove your bra before breastfeeding (and leave it off).

Hand-express a little milk before feeding your baby, or try ‘reverse pressure softening’ (applying pressure around the nipples to push fluid back into the breasts).

Gently massage the breast in a downward motion from the chest wall toward the nipple while your baby is feeding.

Use a cold compress, like a cool gel pack from the fridge, or a chilled washed cabbage leaf over the breast to relieve inflammation.

Express milk after a feed, either by hand or with a breast pump, if your breasts still feel full

Sometimes, if the engorgement does not improve, a complete ‘pump out’ with an electric pump may be necessary to relieve the milk pressure that is causing increased blood and fluid within the breast tissue (ask your lactation consultant or doctor for help).

Information and Tips for Sudden Weaning - Very well Family

Sudden weaning, also called abrupt weaning, is the quick end of breastfeeding.

Sometimes weaning has to happen quickly because of an unexpected situation that arises or a medical emergency. 

Other times, a mother may decide to stop breastfeeding on a particular date and wean cold turkey. 

But, whether it’s chosen or something that can’t be helped, sudden weaning can have more of an effect on you, your body, and your baby than you might realize.

Sudden Versus Gradual

With sudden weaning, you may not have the time to prepare yourself and your child for the physical and emotional changes that you’re likely to experience. 

When your body doesn’t have a chance to adjust to the quick changes, weaning can be more difficult, even painful.

Sudden weaning is the opposite of gradual weaning. 

When a child stops breastfeeding gradually, there is a slow transition from breastfeeding to another source of nutrition.

 If you have the option, it’s recommended to wean in a gradual way.

 The slower tapering off of breastfeeding is easier on your body, so you may not experience some of the breast problems or other weaning related issues that can develop.

Plus, gradual weaning is often less traumatic for children. 

Breastfeeding provides nutrition, but more than that it’s a source of comfort and security. 

So, while some children can give up breastfeeding without a fuss, others will have a much harder time especially when it happens too quickly.

Why Do Some Women Wean Suddenly?

There are definitely circumstances that require sudden weaning, such as medical emergencies. 

However, in many situations, sudden weaning can be avoided. 

If you have to wean, but you don’t want to, talk to your doctor or a lactation consultant to find out if it’s really necessary or if there’s another option.

 Here are some of the reasons why women stop breastfeeding suddenly:

The start of a new medication: 

There are certain prescription drugs that you cannot take while you’re breastfeeding. 

But, many medications are safe for breastfeeding women. 

If your doctor prescribes a new drug that’s not compatible with breastfeeding, ask if there’s an alternative that is safe. 

Of course, if your health depends on taking something that is not compatible with breastfeeding such as chemotherapy drugs to fight cancer, then you will have no choice but to wean during your treatment.

Illness, hospitalization, or surgery:

 If you get sick with common illness, you should still be able to breastfeed. You don’t have to stop breastfeeding if you have a cold or diarrhea. 

But, if you have a serious illness, you have to be hospitalized, or you need to have surgery, you may have to stop breastfeeding without any notice. 

On the other hand, if it’s your baby who is sick or needs to be in the hospital, breast milk can be very helpful to your child. 

If possible, continue to breastfeed or pump for your baby.

Separation from a child: 

When you have to be away from your baby for an extended period of time, perhaps for a military deployment or a long trip, you won’t be able to breastfeed.

 If you plan to start breastfeeding again when you return home, you can pump to maintain your breast milk supply.

 You can even send your breast milk home to your baby while you’re away. 

Of course, this can be a challenging and time-consuming activity, so many moms choose to stop breastfeeding instead.

Pressure from others: 

The criticism and pressure from a partner, family, friends, or even a health care provider who doesn’t support or understand breastfeeding can cause a mom to make the decision to wean suddenly especially if the child is a little older.

A new pregnancy: 

It is not always necessary to stop breastfeeding because of a new pregnancy. 

But, since breastfeeding can cause uterine contractions if you are at a high risk of miscarriage or premature birth, weaning is the safer option.

How Sudden Weaning Affects Mothers

Weaning has physical, hormonal, and emotional effects on mothers. When you wean gradually, you have more control over the situation, so you can prepare and adjust to the changes over time. 

But, when weaning is sudden it can have a greater impact on you and your body.

The abrupt end of breastfeeding can lead to painful breast engorgement.

Hard, swollen breasts full of breast milk can cause a breast infection, plugged milk ducts, or a breast abscess.

Breast engorgement can also cause milk fever. Milk fever can seem like the flu with symptoms such as fever, chills, and muscle weakness. 

It usually lasts a few days.
Your breasts will continue to make and leak breast milk for a while. It could take many months to dry up completely.

With the end of breastfeeding and the changes in the balance of hormones, your period and your fertility will return. 

With this, there will be a greater chance of becoming pregnant again.

Sudden Weaning and Depression

When weaning is sudden or unexpected, it can be disappointing. 

If weaning was not something that you wanted, it can make you feel like a failure and bring about a sense of sadness, anger, or guilt. 

Even if you felt tied down and you were looking forward to the end of breastfeeding, you may be surprised to find yourself feeling a little down when it all ends so abruptly.

 The sadness may be even greater in women who have suffered from depression or psychiatric issues in the past.

Tips to Get You Through Sudden Weaning

While sudden weaning can be uncomfortable and sad, there are some things you can do to help you get through it:

Remove a little breast milk to feel more comfortable.

 If your breasts become engorged, you can hand express or pump some breast milk to relieve the pressure and ease the pain. 

But, you should only pump enough to feel better.

 If you remove your breast milk too much or too often, your body will continue to make even more.

Wear a bra that’s supportive but not too tight. Gentle, even pressure on your breasts can feel good. 

But, choosing a bra that’s too restrictive or trying to bind your breasts to stop the production of breast milk could lead to plugged milk ducts or a breast infection.

Use a cold compress on your breasts. 

Cold cabbage leaves or ice packs can relieve the inflammation and pain of swollen engorged breasts.

 With continued use, cold compresses can also help to decrease milk production.

Keep breast pads handy. 

The engorgement from sudden weaning can build up the pressure in your breasts.

 That pressure can cause leaking at random times, especially when you hear your baby cry.

 Be prepared and prevent embarrassing stains by wearing breast pads in your bra to soak up any breast milk that leaks out.

Stay on top of the pain. The build-up of breast milk can be painful. 

Talk to your doctor about taking Motrin or Tylenol to help relieve the pain.

Try some milk reducing herbs. 

Some mothers use sage, parsley, and peppermint to decrease the supply of breast milk and dry up more quickly.

Seek support.

 Talk to your partner, your family, and your friends and let them know how you’re feeling. 

You can also join a local breastfeeding group or reach out to other breastfeeding moms in an online support community.

If you’ve experienced depression or a psychiatric issue in the past, talk to your doctor.

 Since the hormone changes can affect you in many ways, you may need to be followed more closely during this time.

How Sudden Weaning Affects Children

Gradual weaning allows a child to slowly adjust to a new source of food and the loss of the comfort and security that breastfeeding provides. 

So, when breastfeeding ends quickly, it can affect your little one in many ways.

She may refuse the bottle, especially if you’re the one trying to give it to her.

She may have a difficult time giving up breastfeeding and understanding that breastfeeding has to end. 

She may be fussy, sad, or even angry at you for not letting her breastfeed.

She may be more likely to get sick.

 Breastfeeding helps to prevent some of the common childhood illnesses so the sudden weaning of a newborn or young infant can put a child at a greater risk for ear infections and respiratory infections.

Tips for Helping Your Child

If you aren’t against using a pacifier, you can offer it to your baby to satisfy her natural need for sucking.

See if your child would like a security item such a special blanket, or a teddy bear.

If your child refuses to take the bottle from you, let someone else try to give it to him especially if he’s never had a feeding in a bottle before.

 If your baby is closer to 6 months old, you can skip the bottle and transition him straight to a cup instead.

Distract older children during the times you would normally be breastfeeding and start a new routine.

 Take a walk, play a game, or offer a big kid snack and drink.
Give your child extra attention in other ways.

 You can replace those breastfeeding moments that you both miss with other tender moments of cuddling, singing, reading, and just being together.

What to Feed Your Child When You Have to Wean Suddenly

When you quickly and abruptly wean your baby from breastfeeding, you’ll have to consider another form of nutrition.

 If you have stored breast milk in your freezer, you can continue to give your child breast milk.

 But if you don’t have breast milk available, what you feed your baby will depend on your child’s age.

 If you have a newborn or a young infant, your child’s doctor will recommend an infant formula.

 A child between the age of 4 and 6 months can begin to eat solid baby food along with the infant formula. 

You can continue solid foods along with infant formula for one year.

After your child’s first birthday, more of her nutrition should be coming from foods, so you can usually transition from infant formula to cow’s milk. 

However, some children use toddler formula instead of cow’s milk.

 Talk to your child’s healthcare provider about your feeding options and your child’s needs.

How do you unblock a milk duct?

The glands that make milk in your breasts are divided into segments. 

A bit like an orange, in fact. 

Your milk ducts are the narrow tubes that carry milk to your nipple from each ‘segment’.

You can get a blocked milk duct when any one of your breast segments doesn’t drain properly during a feed.

 You might get this if your baby has a tongue-tie.

 It might also happen if your baby is not taking your breast into their mouth deeply enough to feed effectively – a ‘shallow latch’.

Sometimes a blocked milk duct can happen if your breast tissue is irritated for other reasons. 

This might be due to wearing a bra that’s too tight or a seatbelt across your breast on a very long car journey, or an awkward sleeping position when you’re putting weight onto your breast.

“Make sure you get your blocked milk duct sorted as soon as you can, you don’t want it to turn into mastitis.”

Signs and symptoms of a blocked milk duct

When you have a blocked milk duct, the area around your breast will feel hard and painful. 

It might also be red, warm to the touch and slightly tender. 

When your baby feeds on the side of the blocked duct, they might fuss because they’re getting your milk more slowly than usual.

It’s important to relieve a blocked milk duct as soon as possible or it will lead to mastitis (an inflammation of the breast).

Blocked milk duct treatment

Here are some ways to try to clear a blocked duct (they also work well for engorgement and mastitis):

Carry on breastfeeding

While women sometimes get the advice to stop breastfeeding, it’s actually important to deal with the blocked duct first and carry on breastfeeding. 

This lowers the risk of the blockage developing into mastitis. 

If you were thinking of stopping breastfeeding anyway at this point, you’ll need to clear the blockage first and then stop gradually after that.

If you’re finding breastfeeding painful because of sore nipples, you might want to express milk instead for a while.

 But it’s also important to get skilled support so that you resolve the cause of the sore nipples.

Get your baby’s positioning and attachment checked by someone who is skilled at offering breastfeeding suppor

Other things to try include the following.

Before feeding:

Gently massage the breast focussing on any lumps or sore areas with your fingertips or palm of your hands (Mohrbacher, 2010).
When feeding:

It can be helpful to start feeding from the fuller side first, so your baby can soften the breast and clear the blocked duct.

Women often find it helpful to try a different feeding position. One where the baby’s chin is near the blocked duct can be helpful.

After feeding:

If your baby falls asleep quickly, or is not feeding effectively, try breast compressions and/or express after a feed.

Apply a cold cloth or cool gel pack after feeds.
In general:

Breastfeed or express more frequently if your breasts are uncomfortably full. Long gaps between feeds can also make a blocked duct more likely to come back.

Although there are no studies about this, many women find it helpful to try to break up the blockage by using an electric toothbrush. 

The vibrations are said to be helpful.

 If you haven’t got one, a wide tooth comb can work too – gently rub towards the nipple.

 Doing this in a warm bath or shower has been found to be effective by some women.
Rest as much as possible.

You can take paracetamol or ibuprofen while breastfeeding. 

If you’re taking other medicines, do check with a pharmacist. Aspirin should not be taken by women who are breastfeeding.

If the lump has not cleared after a day or two, or symptoms worsen (e.g. a fever and flu-like symptoms), do go and see your GP.

How to prevent blocked milk or breast ducts

Blocked milk ducts can be prevented by doing the following:

Wear a well-fitted bra. 

Tight clothes or ill-fitting bras might restrict the milk ducts within the breast.
Make sure your baby is in an effective position with a deep latch.

 If it’s already been checked but you’re still having difficulties, do seek more support. Often, even a good latch can be improved.

 Your midwife or health visitor should watch a whole feed or visit your local breastfeeding support group where a skilled breastfeeding peer supporter can do this.

Avoid long gaps between breastfeeds or expressing.

Milk blisters or blebs

Sometimes, a blocked duct is associated with a bleb or blister on the end of the nipple.

These blisters look like the kind of friction blisters from wearing new shoes, or they’re filled with a bit of blood. 

They’re likely to have been caused by your baby rubbing or compressing the nipple against their hard palate. 

If you have these kind of blisters, do get support to improve positioning and attachment.

Milk blisters or blebs look like a flat patch of white on the nipple and are often really painful – although not always.

 Nobody really knows what causes them. 

It’s rare for blebs to occur in the first few days of breastfeeding but if your baby doesn’t attach well, they can appear early on.

Milk blisters that look like a slightly hardened plug can sometimes be removed by gently rubbing them with a flannel in the shower, or with a little bit of oil.

 Sometimes women say that the milk that had accumulated behind the blockage can flow and look a bit thickened.

If the bleb is caused by a thin layer of skin blocking one of the nipple openings, then opening it up can ease it. 

Don’t try this at home though as it could increase the chance of infection. Talk to your GP who might try using a sterilised needle to pierce the side or top of the blister and squeeze. 

This should unblock the duct and allow the milk to flow again. 

Make sure you keep the area clean while it’s healing.

If you are dealing with a recurring milk blister, although there is little scientific evidence behind it, many women find it helpful to soak the affected nipple in a cup or container of Epsom Salts solution. 

There is also some research suggesting reducing saturated fats and taking the food supplement lecithin might be helpful.

Mastitis symptoms

If a blocked milk duct is not cleared, it can lead to mastitis. 

Mastitis is a common condition that makes your breast tissue painful and inflamed.

 It’s most common in mums who are breastfeeding during the three months after their baby is born but it can happen anytime.

Symptoms of mastitis may include:

A red, swollen area on one breast (usually not both) that can feel hot and painful when you touch it.

  • A breast lump or a hard area.
  • Flu-like symptoms, such as aches, a fever, chills or tiredness.
  • A burning or radiating pain in your breast.
  • Nipple discharge, either white or with streaks of blood.
  • As well as trying the above suggestions, your GP might prescribe antibiotics. For more information on continuing to breastfeed with, and treating, mastitis, take a look at this article.

How do you clear a blocked duct?

During a let-down breast milk is ejected from the milk producing glands (alveoli) and flows through a network of milk ducts out the nipple.

 If one of these ducts becomes clogged, milk builds up behind the blockage, a lump forms and the area feels sore.

What causes this?

A blocked duct is caused by inadequate drainage of the milk ducts or as a result of something obstructing the flow of milk.

If you’re troubled by plugged ducts assess the following as potential causes:

  1. A poorly attached baby
  2. Incorrect sucking by baby
  3. Giving your baby bottles in place of breastfeeds or not emptying your breasts when separated from him
  4. A sudden change in feeding pattern – for example, baby skipped feeds because he started sleeping through the night, he become unwell or he discovered he loves eating solids
  5. A tight or ill-fitting bra; particularly under-wire bras
  6. A baby carrier or seat belt that digs into your breast
  7. Using your fingertips to compress your breast tissue away from your baby’s nose
  8. Holding your breast too tightly while feeding
  9. Sleeping on your stomach
  10. Trauma to your breast
  11. Blocked ducts are more likely to occur in the early months of breastfeeding, a time when many mothers have an abundant supply of breast milk.

What are the signs and symptoms to look out for?

Generally only one breast is affected, but it’s possible for blocked ducts to occur in both breasts at the same time.

 Here are some things to look out for:

  1. A tender lump or knotty area developing within the breast
  2. A hot and reddened area on your breast
  3. Tenderness around the affected area which is more pronounced before feeding compared to after
  4. If left untreated
  5. While it can be painful, a blocked duct is not a serious problem. However, if left untreated it could lead to mastitis (inflammation of the breast) which can become serious.

What to do?

A blocked duct can usually be cleared within a day or two by taking steps to enhance milk drainage.

Before feeding: 

Take your bra off while breastfeeding to ensure it does not restrict milk flow. 

Warm your breast by taking a warm shower or bath, or by placing a warm compress on the affected area, or by leaning over a bowl or sink of warm water for a few minutes. 

Massage your breast from the chest wall to the nipple while it’s warm.

During feeding: 

Feed your baby as often as she’s willing to feed, starting with the affected breast. 

If possible position your baby so that her chin points toward the affected area.

 Check that she’s properly attached. 

Gently massage the area in a circular motion starting behind the lump, working toward the nipple.

After feeding:

 If the duct has not cleared during the feed, hand express or pump after your baby has finished feeding to ensure your breast is adequately drained. 

It may take several feeds to clear the blockage.

How do you get rid of armpit lumps?

An armpit lump may refer to the enlargement of at least one of the lymph nodes under your arm.

Lymph nodes are small, oval-shaped structures that are located throughout the body’s lymphatic system.

 They play an important role in your body’s immune system.

An armpit lump may feel small. In other cases, it may be extremely noticeable. 

Armpit lumps may be caused by cysts, infection, or irritation due to shaving or antiperspirant use. 

However, these lumps may also indicate a serious underlying health condition.

Seek medical attention if you have an armpit lump that gradually becomes enlarged, is or isn’t painful, or doesn’t go away.

Causes of armpit lumps

Most lumps are harmless and are usually the result of abnormal tissue growth. 

However, armpit lumps can be related to a more serious underlying health problem. 

You should have your doctor evaluate any unusual lumps you have.

The most common causes of armpit lumps are:

  1. bacterial or viral infections
  2. lipomas (typically harmless, benign fat tissue growths)
  3. a fibroadenoma (noncancerous fibrous tissue growth)
  4. hidradenitis suppurativa
  5. allergic reactions
  6. adverse reactions to vaccinations
  7. fungal infections
  8. breast cancer
  9. lymphoma (cancer of the lymphatic system)
  10. leukemia (cancer of the blood cells)
  11. systemic lupus erythematosus (an autoimmune disease that targets your joints and organs)

Armpit lumps in women

Armpit lumps can occur in men and women of all ages. However, a lump under the arm could indicate breast cancer. 

Women should perform monthly breast self-exams and report any breast lumps to a doctor right away.

Note that breasts undergo hormonal changes during the menstrual cycle and may tend to feel more tender or lumpy during this time.

 This is considered to be completely normal.

 For the most accurate results, perform breast self-exams about one to three days after your period ends.

Another potential cause of armpit lumps in women, which tend to also occur near the breast and groin regions, is hidradenitis suppurativa. 

This chronic condition involves clogging and inflammation near apocrine glands of hair follicles in the skin, commonly causing painful boil-like lumps that fill with pus, leak, and possibly even become infected.

Risks for having this condition include tobacco smoking, family history, and obesity. 

Although the exact cause is not known, it is thought that possibly hormonal changes of puberty and/or the immune system responding too strongly to the hair follicles becoming clogged and irritated.

 Men can also have hidradenitis suppurativa, but it is much more common in women.

Diagnosing armpit lumps

A thorough physical examination is the first step in diagnosing an armpit lump. 

Your doctor will ask you questions about any changes in the lump, as well any pain you have in the area.

Palpation, which is examining by feel, is used to determine the consistency and texture of the lump. 

This method is done exclusively by hand as the doctor gently examines the lymph nodes and surrounding tissues.

In some cases, a physical exam may support the conclusion that the lump probably isn’t harmful. 

For example, benign lumps, such as lipomas, usually don’t require additional treatment.

 If a lump is bothersome, however, a doctor can recommend treatment options to remove it.

Based on the results of your physical examination, your doctor may order further testing to rule out infection, allergic reaction, or cancerous changes. 

Your doctor may order a combination of the following diagnostic tests:

complete blood count to measure the number of platelets, red blood cells, and white blood cells in your system

breast X-ray (mammogram), which is an imaging test that may allow your doctor to see the lump better

MRI or CT scan imaging

biopsy, which involves removing a small piece of tissue or the entire lump for testing
allergy testing

a culture of fluid from the lump to look for infection

Treating armpit lumps

The course of treatment your doctor recommends depends on the underlying cause of the lump. 

Bacterial infections can be treated with oral antibiotics. 

After several days, the armpit lump should start to disappear as your body and the antibiotic fight the infection.

 If the lump doesn’t respond to oral antibiotics, you may have to be hospitalized for intravenous (IV) antibiotics.

If your lump is associated with allergies, it should subside once you start medication and learn to avoid your allergy triggers.

In most cases, armpit lumps don’t require any treatment, just simple observation. 

If your doctor determines this is the case, you can use home remedies such as warm compresses and over-the-counter pain relievers to ease any discomfort. 

Lumps that don’t require treatment include those associated with:

  • lipomas
  • viral infections
  • fibroadenoma (noncancerous breast lumps)

Hidradenitis suppurativa treatment options may include some of the following:

  • antibiotic therapy
  • bleach bath
  • biologic therapy
  • wound dressings
  • anti-acne therapy
  • surgical treatment
  • lifestyle changes

If your armpit lumps are cancerous, your doctor may refer you to a specialist for further care. 

Treatment will depend on the type of cancer and what stage you’re in, and it may involve a combination of:

  • chemotherapy
  • radiation therapy
  • surgery

Outlook for armpit lumps

The outlook for an armpit lump depends on its cause. 

For example, a lump that stems from a self-limited viral infection will likely eventually go away on its own. 

However, a lipoma, while harmless, usually does not go away on its own. A dermatologist can help you remove it.

The outlook for an armpit lump caused by cancer depends on a variety of factors, including the stage of cancer and whether the tumors have spread to other parts of the body. 

For the best chance of recovery, it’s important you go to your doctor early on for diagnosis and treatment.

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ismael

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