FAQ 16: Why do I get engorged frequently? 


One of the common challenges faced by many breastfeeding mothers is engorgement. Engorgement essentially contains the following symptoms.

Your breasts seem tight, full, and uncomfortable.

- There can be mild to excruciating pain when you touch your breasts.
- The fullness and pain don't go away upon nursing.
- Breasts are hard and shiny.

Even though engorgement is most likely to happen in the first few days when the milk comes in, a breastfeeding woman can face engorgement at any point in her breastfeeding journey. The reasons for engorgement vary according to the stage of breastfeeding journey. Here are some likely causes.

1. While nursing a newborn :

Many new moms go through engorgement when the mature milk comes in. One of the possibilities is oversupply in which case hand expressing the excess milk works the best. But in many other cases, it can be due to a poor latch. When the latch is not good, milk transfer is compromised and as a result, mother feels engorged. Also, it's difficult for the baby to latch on an engorged breast. So, it's a cycle that needs to be broken by achieving a deep and correct latch. Engorgement also happens if the mother is not allowing the baby to nurse as they wish. Sometimes excess IV fluids given to the mother during labour causes edema and often it is misunderstood as engorgement.


2. While nursing a baby less than 6 months old :

At this stage, there can be various causes -

- Baby has missed a feed, nursing strike or baby refusing to feed from a particular breast
- You missed a feed, overslept or were away from the baby
- Wore a tight bra and ended up feeling tight and full

- If there has been a latch issue which went undetected initially


3. While nursing an infant from 6 to 12 months of age :

At this stage, the most likely reason is that nursing sessions are being replaced by solids. Considering breast milk is the main source of nutrition till 1 year of age, mother should cut back on solids and nurse as frequently as she used to when the baby was less than 6 months ago. This will prevent engorgement.


4. While nursing a baby from 1 to 2 years of age :

When babies are teething, their latch changes, and this can cause inefficient milk transfer. This is a temporary situation and hand expressing to get relief can be enough to tackle engorgement.


5. While weaning the baby off (2 yrs and above aged child as per WHO recommendation) :

Any weaning method which is not gradual will cause discomfort and engorgement for the mother. So, it's recommended to wean the baby gradually over a period of a few months to let your body constantly adjust to the decreasing need for milk and finally stop producing any.



In short, any woman who is breastfeeding can experience this. If your body is making milk, but the milk isn’t being emptied efficiently and/or regularly; you are likely to experience engorgement. It is important to note that, if some women don't experience engorgement, it doesn't mean that their supply is less.



There are different techniques to tackle engorgement.

-Massage and Hand Expression :

Mild engorgement can be taken care of by warm compress, gentle massage and hand expression.

Warm shower helps. Massage while showering can release the milk.

Start with a hot shower + comb or electric toothbrush. Use this in the shower and gently brush/ massage from under your armpits towards the nipples. Again, do this gently but firmly. Allow any milk to flow out. When you are engorged - the focus is on finding relief. So, don’t worry too much about saving any milk while you do this in the shower. *note* If you don’t have access to electric toothbrush, your knuckles or even a fat tooth comb works.

Alternatively, take a hot water bucket, put some Epsom salt, or any salt. Dunk your breast in the water. If you have access to a bathtub, even better. While your breasts are submerged in water, using some coconut or olive oil - gently massage your breasts from your underarms, and upper back towards your nipples. And allow the milk to flow into the water. *note* if you feel a lump, please massage the lump in the direction of the areola.

While massaging, gently move the lump towards the nipple while the baby nurses.

It's important to *Express* even after nursing to empty the breast completely. The more efficiently you empty, the sooner you will find relief.

If you still feel heavy, and hand expression is painful, take a really big towel, dip it in hot water and compress using this. Allow the warmth and the wetness to soothe you. The wet-warm compress is very important because it helps melt the fat that clogs up under your skin.

Breast tissue during engorgement is very sensitive. So, it is important to use either wet warm compress or oil for gentle massage. For the same reason mentioned above, avoid dry massage. And dry heat - like hot water bottle.

Reverse pressure softening can help too.



Things to remember while massaging -

Use a couple of drops of coconut/olive oil. And massage until the oils soak into your skin. No need to lather with oil. Just a couple of drops is all you need.

Massage from your upper back underarms towards your areolas. This is because breast tissue is spread all over the chest, back and under arms. Some women can even feel lumps under their under arms.

The areolas have a distinct smell the same as your womb. Which allows the baby to crawl and nurse. If you are a new mother, do consider wiping your areolas with water before feeding just so there’s no residue smell of the oil that may confuse your baby. You may have to consider doing this only if the baby seems bothered by the smell of the oil. Washing nipples with soap is neither required nor recommended.

If you feel a lump, please massage the lump and stroke it in the direction of the areola.


-Variation in nursing positions :

Use the football hold and nurse the baby from the engorged side.

Dangle feeding/cow position - this is very important, as you are using gravity to help you dislodge the clog and allow the milk to empty fully and move freely out of the breast.

You can nurse the baby in such a position so that his/her chin is pointed towards the lump/clogged duct. That way, the suck will be stronger in that area to drain the duct.


-Variation in nursing pattern :

Always express some milk, before offering the breast, especially if you are a new mother. It's hard for a newborn to latch and suckle from an engorged breast. So, it’s best to hand express some milk and then allow the baby to latch.

Nurse from the affected side *first* in each session. (Until the lump dissolves) and heaviness and redness reduces. This is because, when a baby is hungry, they sucks more vigorously, leading to more efficient drainage of that breast.


-Changes in the diet :

It helps to remove any galactagogues from the diet.

Consumption of Garlic, if raw, can work as an antibiotic and probiotic which helps in the case of mastitis.

Saturated fats can be avoided.


-What to avoid :

Avoid tight bras or and clothes that are extremely restrictive.

Avoid cold cabbage leaves. Cold cabbage leaves are for mothers who are at the end of their breastfeeding journey as they are known to dry your milk drastically.


For a pumping mother, it helps to keep the following things in mind:
1. It's important to always empty the breast. Sometimes pumps can't drain the breast completely, it's recommended to hand express to drain the breast completely.
2. Pump in dangle position. This helps use gravity to dislodge the clog.
3. Pump every 2-3 hours. Use the letdown mode/massage mode of your pump for 12-15 mins while you massage your breasts. 
4. Use a few drops of coconut oil to massage. Also apply some on the flange if necessary.
5. When breasts are making more milk than needed, and you are feeling engorged, pumping to empty may sound like it's the problem. However, know that when you are going through this, it's important to first find relief. And relief comes only when you fully and efficiently empty the breast. Over time, slowly, you can teach your body to make less milk. It takes time, and patience.


What happens if engorgement is ignored?

Mastitis usually happens when the mother ignores all the signs for a long time, and has fever and shivers along with pain. In a few cases, mastitis can happen without fever as well. But the redness is very very evident. Usually accompanied with redness of the breast tissue. In case you have done all the above and the fever doesn’t subside, or the size of lump doesn't change, and other symptoms of engorgement don't decrease, please consult a doctor or your gynaecologist. Don't ignore this. Try the above remedies but be vigilant as well.




References :

https://kellymom.com/bf/concerns/mother/engorgement/

https://www.llli.org/breastfeeding-info/engorgement/

Easy Breastfeeding by Camilla Contiproblem, you could modify your feeding pattern so that you spend more time on the left.