Breast Fullness Versus Breast Engorgement

GENERAL INFORMATION:

What is breast fullness?

• Breast fullness is a condition where your breasts feel heavy and swollen. Breast fullness is caused by an increase in the amount of colostrum (early milk) stored inside them. This normally happens during the later part of your pregnancy. This prepares your body for breastfeeding your baby. Increased blood and lymph flowing inside your breast also add to the fullness. Lymph is a liquid that contains antibodies and is your body's defense against infections.
  
  
• Breast fullness is normal. You will usually feel this up to one and a half days after giving birth. With breast fullness, you do not have pain and your breasts stay soft. Your nipples and areola (dark circle around your nipple) do not swell and stay the same size. When breastfeeding, your baby can easily take in a mouthful of your nipple and areola. He should be able to suckle on your breast easily.

What is breast engorgement? Breast engorgement is a condition where your breasts get very swollen and painful from having too much milk inside. This may happen in your breasts, your areolas, or both places. Your breasts may also feel lumpy, hard, and warm, and you may have a fever. Mothers who gave birth for the first time have an increased risk for having this condition. Breast engorgement usually happens 3 to 7 days after giving birth when your regular milk comes in. You can also get engorged if you are not breastfeeding often enough or your baby does not suckle well. Your breasts do not completely empty and milk may build up inside causing engorgement. Breast engorgement also happens when milk does not come out of your breasts well enough. Plugged milk ducts can block the flow of milk out to your nipples and cause your breasts to swell.

How do breasts make milk?

• Your breasts change during pregnancy to prepare for making milk. Your breasts contain milk glands and milk ducts that increase in number, causing your breasts to get larger and fuller. Milk is made in small sacs called milk glands or mammary glands. The milk glands are arranged side by side in small grape-like clusters. The milk glands connect to milk ducts, which are pathways for milk to travel through before reaching your nipples. These small ducts join other ducts and form bigger ducts as they get closer to the nipple. Breast milk flows from the ducts into the sinus (collection area) behind the nipple. It then comes out through 15 to 20 small openings on your nipples.
  
  
• During the later part of your pregnancy, your breasts start to make and store colostrum. Colostrum (KO-lah-strum) is a substance made by the breasts before they start making milk. It contains protein, vitamins and minerals, and sugar. Your baby will receive colostrum during breastfeeding before your breasts start making milk. This yellow, creamy substance may be in your milk for up to two weeks after your baby is born. Your breasts start making milk 2 to 4 days after your baby's birth. The milk glands will make milk continuously while you are breastfeeding. The amount of milk made depends on how much milk is removed from the breast, such as during feeding or pumping.

Can breast fullness or breast engorgement affect breastfeeding?

• Breast fullness does not cause pain when you breastfeed or change your ability to breastfeed. Breast engorgement can cause breast pain and make it hard for your baby to latch-on well for breastfeeding. To latch-on means that your baby has taken all of your nipple and part of your areola (dark circle around your nipple) far into his mouth. Latch-on is important for your baby to get enough breast milk. When your baby does not get enough breast milk, he may not gain weight as he should.
  
  
• When you are engorged, your areolas may swell and cause your nipples to flatten. Your baby cannot take a mouthful of your breast in his mouth to latch-on well and can only suckle on your nipple. He may not get enough milk and may suck harder, which can cause nipple pain. Your breasts will not empty completely and a lot of milk may be left inside. Having painful breasts can make you not want to breastfeed as often as you should. If breast engorgement is not treated, the amount of milk your breasts make may decrease or even stop. You may also get plugged ducts (clogged milk paths in your breast) or mastitis (breast infection). These may damage milk ducts and milk glands, and decrease your milk supply even more.

What can increase my risk for having breast engorgement?

• Being in an uncomfortable position during breastfeeding: How you position your baby and breast for feeding can affect how well he is able to latch-on. Your baby may have a hard time suckling when he is uncomfortable. Being uncomfortable can also make you anxious and decrease or stop your milk flow. Your breasts may not empty completely and a lot of milk may still be left inside. Ask your caregiver for more information about how to hold and breastfeed your baby.
  
  
• Leaving milk in your breasts when you breastfeed: Any of the following may cause you to not completely empty your breasts of milk:
  
  
  • Cracked, bleeding, or painful nipples can make you want to breastfeed less often.
    
    
  • Feeding problems or medical conditions may make your baby not want to breastfeed as often.
    
    
  • Feeling tired or stressed, and doing too many things can lead to less breastfeeding.
    
    
  • Hurrying through breastfeeding sessions with your baby may not let your breasts empty all of the way.
    
    
  • When your baby gets older, he gets distracted easily and may stop suckling sooner than usual. He may look around more instead of feeding, or want to sleep more. Your breasts may still have milk in them after your baby is done feeding.
  
  
• Mastitis, painful nipples, or plugged ducts: These conditions can cause your breast to swell. The swelling can pinch off your milk ducts and decrease or stop your milk flow. When milk cannot drain out of your breasts, it will build up inside your breasts. Too much milk that has built up inside your breast will trap even more milk. Your breasts will swell and get even more painful . Ask your caregiver for more information about nipple soreness, plugged ducts or mastitis.
  
  
• Your baby has trouble feeding or has medical problems:
  
  
  • Cleft lip or palate: This is a condition that affects your child's upper lip and the hard palate (roof of his mouth). A cleft happens when his lip or hard palate did not grow together normally before he was born. A baby with a cleft lip or palate, or both, may have not be able to make enough suction. This can interfere with his ability to effectively latch-on and empty your breast. Ask your caregiver for a referral to a lactation consultant to help you learn how to breastfeed your baby with this condition.
    
    
  • Premature or sick baby: If your baby is born prematurely (too early) or is sick, he may not be strong enough to suckle effectively. When you are able to put him to your breast to feed him, he may not empty it of milk. You may also need to hand express or pump your breasts to empty them after feeding your baby. Ask your caregiver for more information about expressing, collecting and storing your breast milk.
    
    
  • Tongue tie: Your baby may not be able to latch-on well if he has ankyloglossia (tongue tie). This is something he is born with where his tongue is attached tightly and cannot move as freely as it should. When he has this condition, he may not be able to empty your breasts completely during breastfeeding. Ask your caregiver for more information about ankyloglossia.

How is breast engorgement treated?

• Remove excess milk. Breast engorgement can go away right after you remove the excess milk in your breasts. You can do this by breastfeeding or expressing milk from your breast.
  
  
  • Breastfeed often. Frequent breastfeeding is the very best thing you can do when you are engorged. Put your baby to breast every two hours or anytime he shows signs of being hungry. Signs include looking more awake, being more active, mouthing, or rooting. Mouthing is when your baby puts his hands in his mouth or acts like he is sucking. Rooting is when your baby opens his mouth and turns his head to where his cheek is touched. Fussing and crying are later signs of hunger.
    
    
  • Express or pump milk from your breasts. You may also need to do this right before you put your baby to breast. Expressing or pumping out some milk can make your areola less swollen and your nipple a better shape for latching-on. If your baby is not emptying your breasts fully when he feeds, expressing or pumping afterwards can also help. Ask your caregiver for more information about expressing, collecting and storing breast milk.
  
  
• Decrease swelling and pain.
  
  
  • Apply a cold compress after breastfeeding. This decreases swelling and pain in your engorged breasts. Put ice in an ice bag or use a package of frozen vegetables. Wrap the bag in a thin towel before putting it on your engorged breasts. This will help make sure that it is not be too cold on your breast. You may also use chilled cabbage leaves in place of ice.
    
    
  • Apply warmth to your breasts before breastfeeding. Put a warm wet cloth on your breasts or take a warm shower to increase milk flow. Turn your back to the spray when taking a shower. The water can be painful when it hits your engorged breasts or nipples.
    
    
  • Massage your breasts. Breast massage helps empty your engorged breasts and decrease pain. Gently massage your breasts before and during breastfeeding to help increase your milk flow. Gently stroke your breast starting from the outer areas and work your way towards the nipple. Breast massage can also prevent and treat plugged ducts.
    
    
  • Take pain medicine. Ask your caregiver about what medicines you can take for breast or nipple pain. You may be able to take over-the-counter (OTC) medicine such as acetaminophen. Follow your caregiver's advice on how to take them.
    
    
  • Wear a comfortable cotton support bra. Your breast size will likely change after your milk comes in. Ask for help at the store for finding a bra that fits you well. You can wear a regular bra that you take off when breastfeeding or a nursing bra with breast flaps. Cotton bras are best as they will not trap moisture that can irritate your nipples. Avoid wearing underwire bras. Your milk ducts extend up towards your armpits. Underwire bras can squeeze your breasts and pinch on milk ducts, and cause plugged ducts or mastitis.

How can I prevent breast engorgement?

• Avoid giving supplemental bottle feedings or using pacifiers. You want your baby to suckle your breasts frequently, not other objects.
  
  
• Avoid wearing tight fitting clothes and underwire bras. Avoid carrying heavy objects, such as big purses, baby carriers, and diaper bags, that can squeeze your breast.
  
  
• Breastfeed or pump at least eight times a day, and breastfeed as often as your baby wants. Your baby can feed 8 to 12 times a day, or even more. Make sure your baby is well latched-on so he can suckle easily. Your baby will get the right milk flow when he has a mouthful of your breast. Offer both breasts when breastfeeding. Be sure the first breast is completely emptied before you offer the second breast. Use a breast pump to remove and store left over milk after your baby has finished a feeding. You may also use it to remove excess milk if you miss a breastfeeding session, or any time your breasts feel very full. Ask your caregiver for more information on how to use a breast pump.
  
  
• Find a comfortable breastfeeding position for you and your baby. Hold your baby in a position where he can suckle at your breast easily and comfortably. When you are relaxed, your milk flows easily. Make sure your baby is relaxed during breastfeeding. This lets him empty your breasts completely. Ask your caregiver for more information about how to hold and breastfeed your baby.
  
  
• Rest and relax. Rest and relax as much as possible. Ask family members and friends for help doing your usual activities at work or in your house.
  
  
• Visit your caregiver. Have your breasts checked if you see or feel anything different with your breasts. Painful, red, or swollen areas may tell you that you have a breast problem.

When should I call my caregiver? Call your caregiver if:

• Your breast is very swollen or painful and keeps you from breastfeeding.
  
  
• You feel a lump in your breast.
  
  
• You feel that your baby is not suckling properly or getting enough milk.
  
  
• You feel sick and you cannot breastfeed your child.
  
  
• You have bleeding from your nipple and you cannot breastfeed.
  
  
• You have engorgement that lasts more than two days.
  
  
• You have redness and pain in your breast or at the nipple and areola area.

Where can I get more information? Ask your caregivers for more information about breastfeeding. Join a breastfeeding class, or a support group with other breastfeeding mothers. Ask your caregiver for the name of a Lactation Consultant. This person is specially trained to help women breastfeed their babies. Contact any of the following:

• La Leche League International
  1400 N. Meacham Rd
  Schaumburg, IL 60173-4808
  Phone: 1-847-519-7730
  Web Address: http://www.lalecheleague.org
  

• The National Women's Health Information Center
  Phone: 1-800-994-9662
  Web Address: http://www.4woman.gov
  

CARE AGREEMENT:

You have the right to choose how you are going to feed your baby. To help with this plan, you must learn as much as you can about breastfeeding. You may ask your caregiver for more information or join a group with other breastfeeding mothers. You and your caregiver can work together to plan the best way to feed your baby.

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