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Engorgement. Just the sound of the word can be off putting. This may be, for many moms, the most dreaded part of the postpartum experience. Whether or not you choose to breastfeed, you're likely going to have some breast engorgement. How can a breastfeeding mother handle this engorgement? What kind of challenges can it cause? Is there a way to prevent engorgement? Lets start by defining engorgement: Engorgement is the swelling of breasts caused by the influx of milk, lymphatic fluid, and "third spacing".
Can engorgement be prevented? The answer to this question isn't crystal clear. Not all moms will experience engorgement and will go on to successfully reach their breastfeeding goals. Most moms will experience some degree of engorgement. What can we do to reduce the intensity? Have you ever heard of third spacing? Third spacing is the increase of interstitial fluid increasing swelling of the breasts. This third spacing is highly influenced by how much IV fluid mom receives in labor. This means women with high intervention pregnancies are likely to experience more intense degrees of engorgement. Women who are able to avoid IV fluids, are likely to experience a lesser degree of engorgement.
Okay, you're milk is coming in. Great! That's wonderful! You're excited but thinking "Damn, this hurts!". The pressure from engorgement is not comfortable. That's for sure. You suddenly become frantic trying to figure out how to relieve this pressure. So what do you do first? You try to get baby to feed. But he won't. WHY WON'T YOU LATCH?! Suddenly, a baby who was doing just fine latching, can't figure this out. So then you grab your pump. Maybe it helps, maybe it doesn't. Oh! Hot shower! That's a good idea. You stand in the shower, milk pouring out, but still no relief from the pressure. You just know you're doomed for a life of misery because the first few weeks postpartum feel like ten years and this pressure is too intense to deal with. Good Lord, I'm bound to get mastitis. That's it. You've decided. You shall chop your breasts off.... Does any of that sound familiar? Okay maybe the last part was a bit dramatic... but I know that's what I thought the first time I dealt with engorgement.
Over or under supply if mismanaged
Let's go back over this approach. Feeding baby is the best way to remove milk efficiently, but it's proving challenging. What can you do? This is where Reverse Pressure Softening comes in handy. RPS will soften the breast around the nipple and areola, so that baby can latch more easily. Babies can not latch on to a hard basketball, but they can latch on to a flexible balloon. You can perform RPS by applying gentle, but firm pressure around the nipple/areola. You can use two fingers to apply pressure to one spot for a few seconds, and work your way around the circumference of the nipple repeating this technique. (Don't worry! I have a demo video to come!)
Massage, moist heat, milk removal, cold compress
Let's talk about pumping. Pumping in the first few weeks of breastfeeding is generally recommended against for the average dyad (there are scenarios where pumping is an important tool to supporting breastfeeding, but we are talking about the average healthy dyad). Hand expression is a much better alternative. Hand expression is gentle, does not put as much demand on the body (therefore it does not risk the creation of an oversupply as much as pumping does), and women are often more responsive to hand expression than they are to pumping. In fact, some studies now show that early hand expression in lieu of pumping is associated with longer breastfeeding durations (more moms who hand express over early pumping are likely to reach their goals).
Massage, moist heat, milk removal, and cold compresses are all effective ways to manage engorgement. In fact, with my second child, I experienced engorgement much differently. For one, I didn't receive as many fluids in the hospital, therefore I didn't have as dramatic swelling. Second, I used this method to ensure efficient milk removal: Massage, moist heat, reverse pressure softening, latch baby (or hand express), cold compress for 15 minutes. The reverse pressure softening and cold compresses seemed to be the biggest differences in my relief approaches between my two children.
Personally, I did use a hand pump now and again, if baby went for a long stretch without nursing and I just didn't have the patience to hand express. However, as someone with oversupply challenges, I only pumped briefly to take off the edge, and avoid pumping myself into an oversupply. I pumped way less in the early days after my second child's birth, and my issues with oversupply were not nearly as dramatic as they were after my first son's birth. Please remember, each mother baby dyad is unique with their own challenges and circumstances. This advice is generalized for the average, low risk family. If you have a more complex situation, it is always suggested to work with a lactation professional to develop a personalized plan for you to find success in reaching your individual goals.
Share your engorgement experiences and tips for relief below!
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