Right after you give birth, your hormones undergo a major shift — say bye-bye to estrogen and progesterone, and hello to prolactin, the milk-producing hormone. This change causes your postpartum breasts to grow even bigger (is this possible?) and more tender (more tender?!!) than they were during pregnancy. Welcome to the world of engorgement, which begins around two to five days after delivery whether you're planning to nurse or not. The sinister side effects: rock-hard breasts that are swollen and wickedly uncomfortable. This is pain with a gain, though, since engorgement is a sign that your breasts are filling up with the milk your baby needs. The increased blood flow to your breasts (necessary to get the milk-producing factory up and running) is also adding to the pain and swelling.
Will engorgement ever end?
Fortunately, engorgement is temporary, and assuming you get started breastfeeding right away (the earlier the better for relief), the pain and hardness should diminish within two to three days. By the time your baby and your breasts devise a good supply-and-demand relationship (usually within a few weeks), the engorgement will have diminished completely. If you're not nursing, it'll decrease within a few days.
What to do about breast engorgement if you're nursing.
Until your milk supply-and-demand cycle is well established, take these steps to minimize discomfort:
- Feed your baby frequently (every two to three hours) to encourage the demand to keep up with the supply. The less your baby feeds, the more engorged your breasts will become. The more your baby feeds, the quicker engorgement will pass (pretty strong motivation, right?).
- Place warm compresses on your breasts (i.e., a washcloth dipped in warm water) before feedings to help get the milk flowing and ease the pain.
- After feedings, use cold compresses (a washcloth dipped in ice water will do) or cooling bra-inserts to soothe those beasts…er, breasts.
- Between feedings, place a chilled cabbage leaf on each breast. Don't ask why, but it does work!
- Express a little milk with a pump or by hand to relieve pressure, but don't express too much or your breasts will produce even more milk than necessary, exacerbating the problem.
- Massage your breasts gently while nursing to help keep the milk flowing.
- Change your baby's position (try the cradle hold one time, the football hold at the next feeding) to ensure all milk ducts are being emptied.
- Wear a well-fitting (but not tight) nursing bra at all times — even to sleep — so your (huge) tender breasts don't flop around (ouch).
- If you're in severe pain, acetaminophen or another mild pain reliever (ask your practitioner for a recommendation) taken after a feeding can help.
What to do about breast engorgement if you're not breastfeeding.
Happily, your painful engorged breasts will return to their normal size and feel within a few days. Until then, you want to discourage any future milk production, so:
- Wear a snug-fitting bra.
- Avoid any kind of nipple stimulation or milk expression.
- Use ice packs to ease discomfort.