Pregnancy encyclopedia: Breast engorgement to Breastfeeding positions

Breast engorgement

Normal breast fullness sometimes develops into overfullness (engorgement) from the second to fifth day after birth. Engorgement is simply the fullness you feel in your breasts when your baby does not suckle all the milk you are producing at a feeding. Your breasts can feel hard and warm to the touch. They can become so full that it becomes a challenge for your baby to latch on and nurse comfortably.

Your body will naturally adjust your milk supply for your baby if you feed often during the second to fifth day after birth. Breastfeed for as long as possible at each session. Even with frequent nursing, you can still become over full. This is due to increased fluid in your breasts' lymph glands and increased blood circulation in your body that occurs naturally after birth. Engorgement can also occur as your baby grows and changes his feeding patterns or if weaning occurs too abruptly.

How to minimize or prevent engorgement:

• Make sure your baby is positioned and latched on well to your breast. Remember that your baby's nose and cheeks should touch your breast and her body should face you.
• Allow your baby to nurse often, without keeping to any schedule, especially during the first weeks after birth. Nursing 8 to 12 times or more every 24 hours is good. Nursing often during the first 48 hours after birth delivers rich first milk (colostrum) to your baby, providing strength and energy. Removing the colostrum from your breasts provides more space for your mature milk and reduces engorgement. Feeding often will help prevent engorgement during this time.
• If your baby is sleepy during the first week after birth, wake him often for feedings (at least two to three hours during the day and three to four hours at night). Try to keep him feeding for at least 10 minutes each time. Remember, being asleep does not mean he isn't hungry! He needs your help to eat and grow stronger in order to begin waking himself for feedings.
• Avoid feeding formula to your baby during the first 3 to 4 weeks (unless medically needed). This will encourage frequent feedings, strong weight gain and a plentiful milk supply. Your breast milk always has all the nutrients your baby needs. You do not need to give your baby water. This will not promote weight gain, can make engorgement worse, and can reduce your milk supply.
• If you miss a feeding or have a challenge with latch-on because your breasts are over-full, gently hand express or pump your milk until your breast feels less full and the areola tissue is soft enough to squeeze between your fingers.
• When weaning your baby, do so slowly and gradually, expressing your milk as needed for comfort.

If you become engorged:

• Before trying to feed your baby, take a warm shower or apply warm, moist towels to your breasts for a few minutes -- then, gently massage your breasts from the chest wall toward the nipple, using circular motions, until they begin to soften and milk begins to drip.
• Express a little milk before nursing to soften the areola and make it easier for your baby to latch on.
• If your baby still can't latch on, use a hospital-type pump or manual expression (see "Expressing breast milk") every 2 hours, or as needed, 10 minutes per side, until your baby can nurse and you hear swallows during the feeding.
• If your nipples remain flat, wear a plastic, multiple-holed breast shell for half an hour before feeding (this will help draw out your nipples).
• Feed often, at least every 90 minutes to 2 hours (time from the beginning of one feeding to the beginning of the next feeding).
• Each feeding should last until your breasts soften.
• Try holding your baby in different nursing positions.
• Help yourself relax by sitting back with your feet up, listening to soothing music, and taking deep breaths.
• If you notice hard areas in your breasts even after frequent nursings, try taking your bra off when you breastfeed to be sure it is not restricting milk flow.
• After feeding, if you have breast discomfort (including warmth and swelling), place a hand towel on your breast to protect your skin and apply ice packs for about 20 minutes. Frozen packaged vegetables (such as peas or corn) placed right on the breast will also reduce swelling.
• Avoid letting your baby use a pacifier or bottle when you are engorged. This can reduce feedings and encourage your baby to prefer a bottle nipple instead of your nipple. Your baby is learning to breastfeed in the first few weeks after birth by understanding repeated motions using her tongue and lips. To successfully breastfeed, allow you and your baby lots of time to learn and practice before introducing anything else into her mouth. Once breastfeeding is working, she can begin to experiment with other items like pacifiers and bottle nipples.

Breast milk

-- expressing (see "Expressing breast milk")

Breast milk storage

• If you are away from your baby for a feeding or if you become engorged, pump your milk and save it for a future bottle-feeding. There are several styles of containers available for storing breast milk. These include specially designed plastic bags, bottles and glass containers.
• If you wash your hands carefully before pumping or expressing and the containers you're using are clean, your breast milk will be safe for 6 to 8 hours at room temperature. Immediate refrigeration, however, is recommended.
• Use refrigerated milk within 3 days. Gently shake the milk to remix the creamy portion, which separates during storage.
• If you are going to freeze your breast milk, leave some space at the top of the container. Breast milk, like most liquids, expands as it freezes.
• When using plastic bags, use only those designed specifically for breast milk collection. Before storing, fold the top several times and seal with freezer or masking tape. Place smaller bags in a larger bag to help prevent punctures. Some bags come with twist ties for easy sealing and don't need to be double-bagged (check the instructions).
• Freeze your milk in 2- to 4-ounce portions. Smaller amounts thaw more quickly, and you will waste less milk.
• You may continue to add small amounts of breast milk to the same container throughout the day. Chill in the refrigerator for 2 to 3 hours. Then freeze in appropriate amounts.
• You can add fresh milk to already frozen milk. First, refrigerate all freshly expressed milk until it is cold. Then add it to the frozen milk. There must be less fresh milk than frozen milk.
• Frozen milk may be stored at 0 degrees Fahrenheit in a home freezer for 6 months or at minus 20 degrees Fahrenheit in a deep freezer for up to 12 months.
• Thawed milk may be kept for up to 24 hours in the refrigerator.
• Never refreeze thawed milk.

Breast milk thawing

• Place milk in the refrigerator the night before you're going to use it. Refrigerator thawing takes 12 hours.
• Or place the milk under warm running water or in a pan of warm water.
• Throw away any breast milk you don't use during a feeding.
• The color, consistency and odor of your breast milk may vary, depending on your diet and the time since giving birth.

Breast pumps

Consult a lactation consultant or a La Leche League group about types of breast pumps and their advantages and disadvantages. Many do not express milk very well and may cause pain during use. A breast pump that causes pain while pumping should not be used.

Breastfeeding after returning to work

With a little planning, you can return to work and continue to breastfeed with success.

1. Talk to your employer. Some companies have programs in place to support breastfeeding mothers in the workplace. Other organizations informally allow women to take the time they need during the day to pump their breast milk. Your employer must provide you with a private area other than a rest room to express milk.
   
   You may also have the options of extending your maternity leave, working part-time for a period, job sharing, or working at home part of each day or week. Because breastfeeding babies are healthier, breastfeeding mothers miss less work, so cost-conscious employers support breastfeeding.
   
2. Choose a supportive daycare provider. Share information about how to store and thaw breast milk with your daycare provider. Ask that your baby not be fed for the last hour or two before your return so your baby will be ready to breastfeed. If your baby is hungry, a snack-size portion of breast milk can be given until you arrive.
   
3. Introduce a bottle at 3 weeks or when you are preparing to return to work. Once your milk is well established and your baby is nursing well, introduce your baby to drinking breast milk from a bottle. This will prepare your baby for the time when you are at work and will need to use a bottle. You may find that your baby is more receptive to receiving a bottle from Dad, your partner or a babysitter. Continue to occasionally offer a bottle to keep reminding your baby that it's an acceptable meal option.
   
4. Purchase or rent a high-quality, automatic breast pump. Breast pumps are available with a variety of options. Depending on your work situation and where you will be pumping your milk, choose an electric or a battery-operated pump. (If possible, have car adapter options to use the pump.) Use a double pumping kit with your breast pump (to express milk from both breasts at the same time) for fast pumping time that fits into a coffee or lunch break. Expressing milk from both breasts will help maintain a strong milk supply.
   
   Manual expression or a smaller, handheld pump may work for infrequent expression of milk, but to maintain successful nursing while you're at work and regularly missing feedings, an investment in a pump will pay off in good results. Look for a pump that will cycle on its own rather than require you to release the pressure. A breast pump should never feel painful when it is used.
   
5. Give the pump a trial at home. To make yourself familiar with the pump and to help yourself relax during pumping, try the process out at home. Get comfortable with how it works before you try to do it at work.
   
6. Remember the law of supply and demand. The more your breasts are stimulated by your baby or a pump, the more milk you will produce. Don't skip a pumping session at work; it's important to your successful breastfeeding.
   
7. Try not to go back to work on a Monday. If you can, return to work midweek so you will only have a few days before you're home for the weekend. This can make the transition easier.
   
8. Work feedings into your schedule. Plan ahead for how you can work feedings into your workday.
   - Nurse just before you leave in the morning
   - If you can, go home or to your daycare provider's for lunch or have your baby brought to you
   - Pump two to three times during the day for 10 to 15 minutes each session using a double pumping kit (that's only about 45 minutes out of your work day).
   
9. Be patient. During the first few attempts at pumping you may feel anxious or nervous, which can inhibit your milk let-down reflex. Be creative in finding ways to relax while pumping. Can you listen to music on headphones? Find a more private spot than the women's restroom? Try looking at a picture of your baby or imagine nursing your baby.
   
10. Refrigerate the milk. If you don't have a refrigerator at work, use a cooler case. Breast milk can be kept in the refrigerator for up to 3 days. After that, label the bottle with the date and store it in a home freezer. (See Breast milk storage)

Yes, you can return to work and continue breastfeeding. Many new mothers feel fatigued, and you may experience a sense of loss over leaving your new baby in someone else's care. You may also feel loss over losing the feedings during the day that you are replacing with pumped breast milk fed from a bottle. If you need help or advice, talk to other new mothers and to mothers who have experienced what you are going through. Talk to your partner and your health care provider and your lactation consultant.

Breastfeeding positions

Positioning your baby properly during nursing is very important to prevent sore nipples and to help your baby feed efficiently and gain weight well. You and your baby can use a variety of positions or the same position throughout your breastfeeding experience. You and your baby will learn together what is best for you.

Cradle hold

• Place a pillow or two in your lap to support your baby and lift your baby to breast level.
• Place your baby's head on the crook of your arm, at breast level.
• Turn your baby's tummy and hips to face yours (don't let your baby rest on his back and turn only his head to nurse).

Cross-cradle hold

• Position your baby so you two are tummy-to-tummy, and your baby is lying across your lap.
• Hold your baby with your elbow and forearm behind your baby's back, and your hand supporting the back of your baby's head.
• Hold your breast with your free hand. When your baby's mouth opens, you can firmly pull in your baby's head for nursing.
• After your baby has latched on, you may want to switch your arms back to the cradle hold position.

Clutch hold

• Place a pillow or two at your side to support your arm and your baby and lift your baby to breast level.
• Support your baby's neck and lower head in your hand, with your forearm supporting her tummy against your side.
• Place your baby on his side, facing you.

Lying-down hold

• Lie on your side with pillows supporting your back and your top leg, which is bent forward.

Recline hold

• Lie on your back, supported by pillows.
• Your baby lies across your chest, tummy-to-tummy.

Dancer hold

If your baby's cheeks become hollow during sucking, this is an attempt to hold her jaw steady while she nurses. Jaw and chin support from you can help. Here's how:

• Support your breast with the "C" hold, thumb on top, four fingers underneath.
• Slide your hand forward, supporting your breast with three, rather than four, fingers. Your index finger and thumb should now be free in front of your nipple.
• Bend your index finger slightly so it gently holds your baby's cheek on one side while your thumb holds the other cheek. You are cradling your baby's head in a "U" of your index finger and thumb, with your baby's chin resting at the bottom of the "U."

For any position, make sure your baby's nose and cheeks touch your breast. This will help prevent sore nipples and help your baby get the most milk possible during each feeding.

Copyright: (c)2002 Allina Health System

First published: 10/04/2002
Last updated: 10/04/2002

Reviewed by: Allina Patient Education experts