Two to four days after birth, your ‘milk will come in’, it will come in a dramatic fashion. You may wake up to find that you have rock hard breasts that are two bra sizes bigger than they were the last time you were awake.

This dramatic increase in breast size and fullness is called physiologic engorgement. It is caused by the changes in hormone levels after the birth of your baby. These hormone changes begin the process of milk production and also increase blood circulation to the breasts.

Physiologic engorgement is usually more dramatic and uncomfortable in first-time mothers and lessens in intensity the more times you go through the process.

The fullness and tightness can be quite uncomfortable. Many mothers find that their breasts fill up faster than baby can empty them. Some mothers can even develop a slight fever when their breasts are engorged. This has more to do with the increase in blood flow rather than an infection.

Frequent breastfeeding is the best way to prevent and treat engorgement. Relief comes when baby gets the milk flowing and empties the breast. Once you and your baby find the delicate balance between supply and demand, the discomfort will pass. The swelling will subside, you’ll stop feeling like you will pop right out of your skin and your breasts won’t look like they belong to a porn star. Rest assured, once all this passes, your breasts are still making enough milk for your baby.

Preventing and coping with engorgement

Engorgement can lead to other problems, so it’s important to treat it quickly. When the breasts swell with fluid and milk, the nipple may flatten out, making it more difficult for your baby to get a good mouthful of breast. The baby can suck on only the end of the nipple and often can’t get enough of the areola tissue into the mouth to compress the milk sinuses and empty the breast. This causes further engorgement and a hungry baby. As the hungry baby sucks harder but incorrectly, the nipple gets damaged and painfully sore. Eventually, your breasts make less milk because to match the amount of milk that the baby has been taking from breast. This will put a stop to the engorgement, but may lead to problems with milk supply if your baby is still not attaching properly and sucking well.

You can keep normal physiologic engorgement from becoming a problem. Here are some suggestions for coping with breast fullness:

Teach your baby good attachment technique in the first days after birth. It’s easier for a baby to learn to latch on correctly on the first and second day after the birth when your breasts are softer, before your milk comes in. Check out our tips for correct attachment.

Keep your baby with you immediately after birth and breastfeed frequently . This will minimize problems with engorgement and get your milk supply meeting your baby’s needs more quickly. Don’t let the well meaning nurses take your baby to the nursery so that you can get some rest. Keep your baby close and start off as you intend to continue. Feed according to your baby’s need.

Breastfeed often during the night as well as during the day. In the first month or two, a baby who sleeps for four or five hours at a time is a mixed blessing. Mum gets a chance to rest, but she may suffer from frequent bouts of engorgement. If you find yourself in this situation you might need to wake your baby up if you feel too uncomfortable. This is preferable to expressing the excess milk because eventually supply and demand will even out. If you are tipping breast milk down the sink or putting it in the freezer, your breasts will start to make enough for your baby and enough to tip down the sink.

Do not limit the length of breastfeeds to protect your nipples. Protect your nipples by being sure that your baby has good technique. Limiting the length of breastfeeds will increase engorgement. In the beginning most babies can not adequately empty the breasts in five or ten minutes.

Express a little milk. If you are becoming uncomfortably engorged and your baby is not breastfeeding well or often enough, you may need to express a little milk for your own comfort and to allow good feeding technique from your baby. Express only enough milk to make you feel more comfortable. Expressing too much milk may stimulate the production of more milk. Remember, the delicate balance of supply and demand.

Soak your breasts in a warm shower just before expressing your milk or feeding your baby. Direct the shower spray from the top of your breast toward your nipple as you massage your breasts. This warmth can help trigger a let down, which gets the milk flowing more quickly when you begin to express or your baby begins to feed. Other ways to apply warmth and moisture to your breasts include leaning over a sink or bowel of warm water (gravity will help you express milk in this position) or applying a warm towels or cloth nappies.

If baby is unable to breastfeed well, you may need to express your milk with an electric pump every 2 to 3 hours, to prevent problems with engorgement. Basically, do whatever you need to do to get the milk out of your breasts. Frequent emptying of the breasts in the early stages of breastfeeding will help you have a good milk supply in the weeks and months to come. And if expressing too much leads to over supply, that is a problem that is easier to fix than the other problems that can come from engorgement.

Don’t stop breastfeeding . Unrelieved engorgement can lead to a breast infection, and a baby who breastfeeds well can empty the breasts more efficiently than any pump.

Between breastfeeds, apply cold compresses to your breasts to relieve the pain and reduce swelling. Wrap small plastic bags filled with crushed ice in a tea towel or a cloth nappy. Frozen peas are good too.

Wear a loose fitting bra. Avoid bras that are too tight or those with seams that compress the lower part of your breast against your body. This traps milk and sets you up for engorgement and possible mastitis.

Get plenty of rest. Lie down with your baby and snooze and breastfeed together.

Cabbage leaves can be helpful . If engorgement is particularly bad, cabbage leaves can be a real help if you can put up with the smell of cabbage cooking on your breasts. Keep the leaves in the refrigerator and take the big veins out before putting the leaves on the breasts, you can use your bra to keep them in place. Change the leaves once they lose the coolness. Just the cool feeling alone can be relieving for engorgement. Don’t use these for any longer than you need to. There is some concern that they may work too well and reduce supply beyond what is required although controlled studies have not confirmed any special benefits or problems with this treatment.

Engorgement after the early weeks

If you have enjoyed weeks of trouble-free breastfeeding and then suddenly begin to suffer from engorgement, take this as a sign that something is interfering with the delicate balance between your milk supply and your baby’s needs: Is your baby going too long between breast feeds, has you baby changed it’s feeding pattern, has something changed about the way your baby is sucking (sometimes teething can do this), has your baby been sick or are you feeling stressed. These things can all throw a good breastfeeding relationship out of wack for a short time. Often the only thing required to help you though this is take a few days off from other responsibilities to reconnect with your baby. Many mothers find it helpful to go back to the early rules of breastfeeding. Feed you baby according to its unique needs and get plenty of rest. Don’t use dummies or bottles, avoid stress, eat well and keep your self hydrated. And if possible, get some extra help for a few days.