What is happening
During the first four days postpartum, a new mother’s milk “comes in”. This change from colostrum to mature milk is a process which usually lasts until day ten. Milk production is initiated by the rapid decline in progesterone due to the removal of the placenta (which produces this hormone) during birth.
Average milk production changes from less than 1½ ounces per day to about 20 ounces a day during the first three days after birth. There are, of course, wide individual variations. This increased milk volume can exceed the storage capacity of the breast and cause fluid leakage into the surrounding tissue, which results in swelling and pain. The swelling, in turn, can slow the removal of milk from the milk ducts and contribute to increased pressure. Ultimately, this can cause reduced milk volume, since a substance in milk tells your body to slow down production. If milk is not removed for long periods, this substance accumulates and your body will make less milk.
Most practitioners agree on the following measures to help relieve engorgement.
- Milk removal--ideally by your baby-- is the best treatment. The challenge is to help make this possible.
- Cold compresses, applied to the breasts for approximately twenty minutes at a time will help reduce the swelling and make milk removal easier.
- Chilled cabbage leaves, applied to engorged breasts and changed every two hours, can also reduce engorgement and help milk flow. The leaves are usually rinsed and pressed flat with a rolling pin (or similar object) before application.
- Warmth in the form of a hot shower or warm compresses immediately prior to milk removal seems to help the milk ejection or “let down” reflex in some women.
- Even if the baby is unable to nurse, expressing or pumping milk at frequent intervals—every 1½ to 2 hours--will help promote flow and prevent a slowing of milk production.
- Ibuprofen taken three to four times a day will help reduce inflammation and pain. If this bothers your stomach, take it with food.
Continue the above measures until milk removal becomes easier and the pain and swelling subside. Until this engorgement period is over, don’t worry about lots of pumping or nursing causing you to make more milk. One thing at a time.
Reverse Pressure Softening
If your baby is willing but your nipples have all but disappeared because of the swelling and engorgement, a treatment called “Reverse Pressure Softening” developed by Jean Cotterman, RNC, IBCLC may help. It is best performed before each attempt to latch.
Mom (or a helper) should apply steady, gentle pressure with fingertips circling the nipple--nails nearly touching the nipple--toward the chest wall for a minute or so. The goal is to press some of the fluid away from the areola and help trigger the milk ejection reflex. This may make it easier for your baby to grasp your nipple.