Engorgement

Amber

Updated September 24, 2025 18:51

What is causing my engorgement and what can I do to relieve the pain?

Engorgement can make the breasts feel very full, tight, heavy, hard and uncomfortable. There are two types of engorgement that occur for different reasons: physiological (a normal part of the milk “coming in”) and pathological (an excessive or problematic engorgement that signals an adjustment is needed).

Physiological Engorgement (Normal)

Physiological engorgement occurs in every mother who’s given birth, whether or not she breastfeeds. It’s the body’s natural response to birthing. This process is normal, and preventing it is not the goal. Physiological engorgement begins within the first few days after delivery and usually resolves within 10–14 days or less.

During pregnancy, the breasts prepare to make milk. Once the baby is born and the placenta has been delivered, the pregnancy hormones “holding back” the milk release. Don’t worry—while you may not feel much change in your breasts right away, you are already producing colostrum, which is all your baby needs for the first few days.

Around 2–4 days after giving birth, the breasts begin to fill up with mature milk. Baby’s frequent nursing has signaled your body to bring in a plentiful milk supply. Sometimes the body goes into overdrive and makes more milk than baby needs. Extra blood flow to the breast tissue also causes swelling. The engorgement a mother feels when her milk “comes in” is a good sign that her body is doing what it’s supposed to do. By steadily feeding on demand during the first 2–4 weeks, milk supply regulates to match the baby’s needs.

Pathological Engorgement (Problematic)

This type of engorgement does not occur in all breastfeeding mothers. It is a sign that something needs to be adjusted and is almost always preventable. It happens when milk has not been removed from the breast in a timely manner and can occur at any point in the breastfeeding journey, especially when feedings or pumping sessions are missed.

Comparing Signs and Symptoms

The symptoms of physiological and pathological engorgement are similar, but pathological engorgement is more severe.

Physiological	Pathological
Firm breasts	Very hard breasts (breasts may project at a right angle to the chest)
Skin looks stretched or reddened	Skin is so tight that it appears shiny
Nipple flattens, making latching more difficult	Nipple is significantly altered and more severely flattened
Swelling, enlargement, and tenderness are limited to the breast	Swelling, enlargement, and tenderness are more widespread, extending to tissue beyond the breast

Risk Factors

- Delaying the first breastfeeding sessions after delivery
- Going more than 3 hours between effective latching or milk expression, leaving the breasts poorly drained
- Supplementing with formula or using a pacifier to delay or replace breastfeeding sessions, causing milk to build up in the breasts
- Abruptly stopping breastfeeding, such as when baby is sick and nursing less, during nursing strikes, or with sudden weaning

Minimizing Risks

- Breastfeed within the first hour after delivery
- Breastfeed every 2–3 hours, ensuring baby has a deep latch
- Hand express in the early days, or pump using the correct flange size if baby isn’t effectively removing milk
- Wake baby to nurse in the early weeks, even at night
- If able, avoid supplementing with formula
- If formula is given, pump to replace the missed feeding
- Avoid using pacifiers to delay or replace breastfeeding sessions
- Plan for gradual weaning when ending your breastfeeding journey

Complications of Unresolved Engorgement

It’s important to take steps to resolve pathological engorgement. Many of the comfort measures below can also ease the discomfort of normal physiological engorgement. Frequently removing milk is key. Over time, if milk is not removed effectively and the breasts are not being thoroughly drained, milk supply can decrease. Engorgement can also lead to sore, cracked nipples from a poor latch, plugged ducts, or mastitis (a breast infection).

Solutions & Comfort Measures

Nurse at the breast - This is the first choice. Hand express just enough to soften the nipple before latching. Try different breastfeeding positions to drain the breasts more thoroughly.

Hand expression - This is the second choice, if baby will not latch to empty the breasts. It often works better than pumping and may be less painful. Pumping can sometimes worsen soreness or irritate sensitive breast tissue.

Reverse pressure softening: Place your five fingertips around the base of your nipple and apply gentle, steady pressure for about one minute. This helps move fluid away from the nipple, making latching easier.

Pumping - A helpful third option, if needed.

Ice packs - Apply between feedings to reduce swelling. Always place a barrier between ice and skin. Use it for 10–20 minutes at a time, then take a break for an hour.

Heat - (Use with caution.) Heat can feel soothing, but may also increase swelling. Consider taking a warm shower, bending forward at the waist to let gravity help move the milk down. Make sure the water runs over your back, not directly on your breasts.

Medication - Ask your doctor about using an over-the-counter anti-inflammatory, such as ibuprofen, to reduce pain and swelling.

Cabbage leaves - Chilled, clean cabbage leaves have long been used to reduce pain in breast engorgement. Studies show varied effectiveness of this method. Use should be limited to 10 minutes at a time to avoid reducing milk supply too drastically.

Final Thoughts

Engorgement can happen for different reasons and cause temporary discomfort. Reach out to your peer counselor for support, and contact your doctor if symptoms don’t improve or worsen. With the right methods, engorgement is usually a short-term challenge in your breastfeeding journey that can be managed with simple strategies.

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