Engorgement 101: What It Is and How to Get Relief, STAT!
- Christine Salvucci
- Jun 19
- 5 min read
The amount of text messages and panic voxers I get from my mamas with plugged ducts, engorgement and fear of mastitis was enough to make this blog post my number one priority! Engorgement is one of the most common breastfeeding challenges in the early days postpartum but it can also pop up here in there around times of rapid growth and when babies start sleeping longer stretches. So let's talk about it so we are adequately informed with up to date research from a registered nurse and board certified lactation consultant.
What does it mean to be engorged? What is engorgement? Am I going to get mastitis? How do I relieve this ASAP?!
What Is Breast Engorgement:
Breast engorgement is a temporary and often uncomfortable symptom that occurs when the breasts become overly full of milk, fluid and/or blood. Most mamas will experience engorgement when their milk is transitioning from lactogenesis I to lactogenesis II once baby is born and placenta is delivered. For a vaginal delivery this can happen between days 2-4 and for a c-section can occur between days 2-5 (although, sometimes longer depending on labor, delivery and if any complications occured).
The most common sign of breast engorgement is uncomfortable breast tightness when your breasts feel so full and painful with lots of tenderness.
If your boobs are as firm as your forehead, you're engorged.
Engorgement is not just milk. In the first few days when milk is coming in, this is physiologic engorgement....meaning milk is coming! Engorgement causes a lot of inflammation and fluid shifts in the breast tissue as milk transitions from colostrum to transitional and mature milk. My mamas that hired me prenatally will text me and say they feel the urge to pump because their boobs are so engorged.
My recommendation -- if your baby is latching, keep feeding through it! Ice, take tylenol/motrin (If you can) to help with inflammation.
Engorgement is not necessarily a bad thing as it's often a sign of a healthy and abundant milk supply, your body getting the hint to bring in more milk for your baby to support their nutritional demands. However, it can make the start of breastfeeding a challenge and latching a little more difficult.
Why Does Engorgement Happen?
As milk production ramps up after baby is born, the body has gotten clear signals to open the flood gates. Your milk is coming, its here, and it feels like a ton of bricks on your chest and it happened so fast. The result of engorgement?
Swelling
Firmness / hardness in your breast but also can travel under your armpit or up to your clavicle
Warmth
Shiny, tight skin
Flattened nipples from the swelling
Sometimes, a low grade fever
Body aches and chills - some of my mamas are more sensitive to this big inflammatory response. This does NOT mean you have mastitis
Redness - this can be a common inflammatory response. It also does NOT mean you have mastitis.
Engorgement can happen if baby is not effective at the breast (sleepy baby, preterm infant, oral restrictions) or if flange size is not appropriate.
One of my favorite breastfeeding medicine physician, Katrina Mitchell, emphasizes that this stage is a mix of inflammatory changes and lymphatic congestion, not just excess milk. This inflammation leads to ductal narrowing, NOT a "blockage" or a "clog". That is why approaches geared toward decreasing inflammation are more effective than aggressive massage, pumping or feeding more and the haakaa/epsom salt "hack" that went around for a while. These just cause MORE inflammation in the breast only perpetuating the inflammation and make things worse.
Types of Engorgement:
Primary Engorgement: happens within the first week postpartum when milk Is "coming in." It's typically bilateral and diffuse -- meaning it happens on both sides and both breasts feel firm.
Secondary Engorgement: Can happen any time due to infrequent or ineffective milk removal -- like if baby sleeps longer than usual, missed or rushed feedings or has a shallow/weak latch from any oral ties or prematurity. This can feel more localized or unilateral.
Why Engorgement Matters?
Engorgement is more than just uncomfortable -- it can interfere with breastfeeding and pumping. Flattened nipples from the swelling and engorgement can make breast/nipple shaping and latching for your baby more difficult. Inflammation can slow the milk flow for the baby and the pump leading to a frustrated mom & baby! If unmanaged (or mismanaged) can lead to milk supply issues and infectious mastitis.
How to Best Relieve Engorgement
Relieving engorgement is relatively straight forward but there is no quick and easy fix. Inflammation from the engorgement can stick around for a few days but we can get relief! If baby is latching, keep breastfeeding! If you are pumping, its best to keep pumping on your routine and not over pump. If you are making an excess of milk, I recommend talking to an IBCLC to help down-regulate for a multitude of reasons. Following the right treatment typically leads to relief in 1-2 days.
Steps for Engorgement:
Breastfeed or pump regularly on routine every 2-3hrs during the day and every 3-4 hours overnight. If baby is sleeping longer stretches, try not to go longer than 5-6hrs between expressing milk.
Before and after feeding or pumping - ICE ICE BABY! This can help decrease inflammation and allow milk to flow from the breast easier. When you are engorged - NEVER APPLY HEAT! Heat vasodilates and brings more blood and fluid to the breast making the inflammation and engorgement worse.
Take Tylenol or Motrin around the clock - alternating administration adequately covers anti-inflammation and the discomfort from the engorgement.
Gentle reverse pressure softening - engorged breasts can make it more difficult for baby to latch. Reverse pressure softening moves the swelling away from the nipple so baby can get a deeper latch.
AVOID
Aggressive massage
Over pumping or feeding
Haakaa and epsom salt "trick"
Heat in the setting of acute engorgement
Rushing to antibiotics - this comes with risk if we can manage without them!
Engorgement can be normal and temporary stage as your body calibrates to match your baby's needs. Once milk production becomes demand-driven, engorgement usually subsides within a few days -- with the right support.
When To Get Help
Call your lactation consultant if engorgement does not improve within 24-48hrs. It is always recommended to touch base with an IBCLC to discuss possible reasons if this is reoccuring and to make sure management is under control. If a big supply dip was suspected, it would be nice to touch base to make sure baby is still transferring enough milk and supply is protected.
***Disclaimer: I am not a physician, I cannot prescribe medications. This blog post is educational***
If you are experiencing engorgement and would like to chat more or book a call - I'd be happy to help you!
Hope you found this helpful!
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