Lorna C. Aliperti, APRN, IBCLC
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Breast Engorgement

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.

Treatment

Most practitioners agree on the following measures to help relieve engorgement.

  1. Milk removal–ideally by your baby– is the best treatment. The challenge is to help make this possible.
  2. Cold compresses, applied to the breasts for approximately twenty minutes at a time will help reduce the swelling and make milk removal easier.
  3. 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.
  4. 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.
  5. 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.
  6. 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.

Amy Mora

Lorna, you are wonderful. You saved my child from having to go on formula. I was able to continue breastfeeding. (I had yeast and it was horrible!)

Amy Mora

Marlene Ferguson

Lorna was a godsend. Michael was losing weight and no one at the hospital was able to help him to latch on. She got him started breastfeeding and then showed me how to do it myself. He’s now gaining an ounce a day.

Marlene Ferguson

Jonathan Sollinger, M.D., Willows Pediatric

I have frequently referred patients to Lorna and been very pleased with the results. She responds quickly, the moms like her, and she is flexible and knowledgeable in her treatment of both mother and baby.

Jonathan Sollinger, M.D., Willows Pediatric

Henry M. Rascoff, MD, Riverside Pediatrics

There are extremely few specialists to whom I refer patients that I hear 100 percent glowing remarks about. You are at the very top of that short list, and the one and only lactation consultant whose name crosses my lips when a private referral is needed. Thank you so much for the superb care you provide.

Henry M. Rascoff, MD, Riverside Pediatrics

Eliza Miller

Lorna’s help was invaluable in breastfeeding my twins. She helped me through the early days of dealing with tiny, sleepy babies, sore nipples, engorgement, and oversupply, and I found myself calling on her again in later months as I had recurring plugged ducts and milk blebs. Her advice was always practical, easy to follow and yielded immediate postiive results. Today I’m still nursing my fourteen-month-olds–thank you Lorna!

Eliza Miller

Susan Kunin

Lorna, I sincerely thank you. You made what was a difficult beginning, one of the most wonderful things I have ever done. You are caring, knowledgeable and always there for moral support. I have recommended you to many new moms, and they all have similar success stories. I truly appreciate everything you have done for us.

Susan Kunin

Elizabeth Gallo

Lorna is professional, knowledgeable and caring. She saw me and my baby through some of the toughest weeks of breastfeeding. I felt comfortable calling her whenever I needed help and she was always there. Without her expertise and support I highly doubt we would be nursing as happily as we are today. She was an indispensable asset to me.

Elizabeth Gallo

Cathy Grammon

The service and products were great. Lorna was especially helpful during that first difficult week. She gave me the moral support I needed to keep going.

Cathy Grammon

Abbey Fox

I can’t thank you enough for everything–your encouragement, patience and enthusiasm–without you this would have been over LONG ago. Harrison thanks you as well!

Abbey Fox

Kathryn Laird

I really appreciate your help, Lorna. Things started turning around after your visit. Although I had already reduced my milk intake, eliminating all remaining dairy had an enormous impact on Avery’s issues, and really solved our colic problems pretty much right off the bat. One thing that was very telling is that about a month later, I had about 24 hours where I decided I’d try milk again, and we had sour cream, cheese and whatnot…We had a miserable 24 hours and I actually threw away three bottles that I had pumped because it was just so bad. I immediately went back on soy milk. Thanks again.

Kathryn Laird