I was lucky to have relatively easy births, but nothing at all prepared me for my boobs on day 4. The pain! My breasts were suddenly ENORMOUS, super-hot, heavy, stretch marked, they literally felt like they were going to burst. I ran towels under the cold tap and draped them across the melon sized lumps of molten lava on my chest, crying to myself and demanding that my husband sterilise the expressing machine. Eventually, in desperation, I expressed about 200 mls from each side (my baby needed about 40mls in total), which felt gorgeous for a while until the whole supply and demand thing kicked in again and my body thought I had triplets. If this sounds familiar, you are not alone. Primary engorgement is pretty common when the milk comes in between day 2 and day 5, and can be really painful for a few days.
Having just reviewed the research again, there really isn’t much evidence based material out there. Obviously the key thing is to get the milk out by feeding the baby – waking the baby to do so if necessary. Many mums find that warm compresses help if they are about to feed or express, presumably by increasing oxytocin and helping the milk to flow. Cold things tend to reduce the pain of inflammation. Mothers use cool gel pads for this purpose, or smooth cabbage leaves from the fridge. Some mums take ibuprofen or paracetamol to ease the pain. If the breasts are too tight for a baby to latch on, some expressing or massage just before a feed can help. There is a technique called reverse pressure softening advocated by many feeding specialists, follow this link for more information https://kellymom.com/bf/concerns/mother/rev_pressure_soft_cotterman/
If the boobs are absolutely impossible to live with, and making it increasingly unlikely that anyone or anything will be able to get milk out (like mine) then more expressing might be necessary. I wouldn’t advocate doing this frequently, as the body might get the message to make masses of milk. It is a “weigh it up and see” sort of equation on the pain and gain stakes. If you have lots of spare milk you can freeze it in meal sized portions in special breast milk freezer bags. Please don’t dump this precious stuff if you can help it!
The good news is that frequent feeding and getting into sync with your baby should help everything to calm down within a couple of days. In the unlikely event that you become feverish and/or develop angry red patches on your breast, please consult your healthcare provider in case you are developing mastitis.
Engorgement when reducing or stopping breastfeeding
If you or your baby start skipping breastfeeds or extending the time between them, then you might notice some engorgement until your breasts get the supply and demand messages sorted out again. This can take a few days.
If you want to stop breastfeeding all together, replacing a regular breastfeed (say your usual 10.30 pm feed) with formula, then waiting a few days and replacing another feed (say 10.30 am) often results in less discomfort than going “cold turkey.” Other mums do half a breastfeed and then offer formula each time to reduce the supply and demand signals to their breasts.
If stopping all breastfeeding immediately, it is recommended to express the minimum possible in order to remain comfortable and avoid engorgement and mastitis.
If you are concerned about any of this, please call your healthcare provider, go along to a local breastfeeding support group, or give me a ring.