What is the most therapeutic intervention for breast engorgement in a breastfeeding mother?

This page gives information on breast engorgement and breast oedema: their predisposing factors, signs and symptoms, and treatment.

Breast engorgement

Predisposing factors

• Poor attachment at the breast.
• Restricting breastfeeds.
• Limiting the time at the breast.
• Missing baby early feeding cues.
• Giving formula supplements to the baby.
• Using a breast pump without a clinical indication and causing oversupply.
• Breast implants.

Signs and symptoms

• Typically appears around the late third to the fifth day post-birth.
• Breast may be hard with tightly stretched skin that may appear shiny.
• Areola full and hard which makes latching difficult.
• Warmth and tenderness may be present.
• Breasts may throb.
• Engorgement may extend into the axilla with painful lumps.

Treatment

• Advise gentle breast massage prior to a breastfeed.
• Apply cool cloths to the breasts up to twenty minutes before offering the baby the breast.
• Advise to avoid heat as this increases inflammation.
• If the breast remains uncomfortable after a feed enough breast milk to achieve comfort may be expressed.
• Ibuprofen may be useful to alleviate discomfort.
• Ultrasound treatment.

Read more about Engorgement from Kelly Bonyata on the KellyMom website.

Breast oedema

Predisposing factor

Women who receive excessive intravenous fluids during labour may develop breast oedema. This is different to the physiological engorgement of the breasts and generally it appears before lactogenesis 2 is expected to occur around days 3 and 4. If a mother comments that her breasts are feeling full on days 1 or 2 post-birth this may be a sign of breast oedema.

Signs

• If a ‘pressure test’ is carried out with the finger and thumb indentations remain on the breast.
• If a mother has been using a breast pump due to either the wrong diagnosis and treatment for engorgement or to remove breast milk for a baby unable to latch at the breast, the breast pump will also leave an indentation and exacerbate the lack of milk flow by drawing interstitial fluid towards the areola.
• A baby is unable to latch at the breast during the first or second day due to breasts being too full and tight.
• It is unusual for a mother to have breast oedema without leg oedema so check out the legs.

Treatment

• Assisting the baby to achieve a good latch can help milk move forward in the breast and get the milk flow going.
• Assistance is needed to avoid nipple damage because of full breasts.
• Avoid manual or electric breast pumps without using a reverse pressure softening technique first as this pumping action exacerbates the problem. The negative pressure of the pump draws excess interstitial fluid towards the areola.
• Hand expressing using reverse pressure softening is necessary to push the oedema back manually. This helps the baby to latch and assists in reducing breastfeeding problems due to oedema.

Reverse pressure softening

A technique developed by Cotterman. Reverse pressure softening:

• moves excess interstitial fluid inward in the direction of natural lymphatic drainage
• relieves overdistention of the milk ducts
• reduces the pain and discomfort when the baby latches
• facilitates a latch so that the baby can effectively remove milk from the breast.

How to perform reverse pressure softening

• Apply gentle but firm pressure on either side of the areolar using the finger and thumb and pressing towards the chest wall.
• Keep the pressure constant for up to 60 seconds – the oedema will feel like it is shifting backwards.
• Apply pressure again to the softened area and then again to the area behind the softened area.
• Rotate around the areola and rotate finger pressure until the areola is soft and the nipple is pliable.
• When this occurs the mother may latch the baby on the breast.

Read more in K Jean Cotterman’s article about Reverse pressure softening on the KellyMom website or Reverse pressure softening: A simple tool to prepare areola for easier latching during engorgement in the Journal of Human Lactation.