Breastfeeding: Unable to nurse with engorged breasts

I recently gave birth and my milk is just "coming in." The problem is that it seems as though my left breast is clogged. It's engorged, swollen and nothing I do helps to relieve the pressure. When I try to feed my baby, nothing comes out. A breast pump doesn't even help to eliminate this problem. I've tried warm compresses and hot showers and nothing seems to help. What should I do?


Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

When engorgement is severe and your breasts (and even your areola) feel hard, it can be very difficult to get your milk flowing. This is both painful and very frustrating. All that milk, and yet, it seems impossible to get out!

Your breasts may be so full that the swelling extends under your armpit, and the skin of your breast may be stretched tight. You may experience extreme tenderness, warmth and throbbing -- and even run a low-grade fever. The breast congestion and slowing of circulation results when milk is not effectively emptied from your breasts.

Because your breasts make milk independently of each other, it sounds like your baby is able to nurse at the right breast. Continue nursing at least 10 to 12 times a day from that side, as you work on softening the affected breast and encouraging your baby to nurse on both sides.

Since you are having problems removing the milk in your left breast, even when using a breast pump, you will need to try some other measures. Many nursing mothers have reported that use of cold cabbage compresses has helped to relieve their engorgement. Wash leaves ahead of time, dry, and store in a zip-lock style bag in the refrigerator. When needed they will be cold and ready to use. Remove cabbage leaves and crumple the veins slightly before applying. Place inside your bra, being sure to cover all areas of your breast -- extending under your arm if there is swelling present. Change the leaves when wilted, or about every two hours. Repeat this process until breasts begin to soften, but then stop--continued use may decrease your milk supply.

After allowing the cold cabbage compresses to soften your breast, use a warm, wet compress along with some gentle breast massage toward the nipple to help soften your breast/areola and get your milk flowing. Or you might want to try a saline soak, using one-half teaspoon of salt to one cup of very warm water - along with gentle massage. Hand-expression, before you use a pump, or put your baby to your breast, may be just what you need at this time.

Until your baby accepts the affected breast, you will need to continue trying gently to express your milk as often as your baby would nurse. What type of breastpump are you using? I would not recommend using a manual or small electric pump when your engorgement is severe. You need a gentle and very effective pump, such as the Medela Classic or Lactina. When expressing your milk, begin by using the lowest setting.

As your breast and areola begins to soften, encourage your baby to nurse on the affected breast. He should find it much easier now that your breasts are more easily graspable and your milk is flowing. A baby who is nursing well is much more effective at removing milk from your breasts than the best pump available. Encouraging frequent feeds will help to keep you comfortable, and will help to rebuild your milk supply in the affected breast.

Wear a comfortable, yet supportive bra (such as a sports bra, one without an underwire) in between feeds, and remove when nursing or expressing your milk to allow your milk to freely flow. In between feeds, for comfort and relief of swelling, you can use icy compresses (a bag of frozen peas works well). Speak with your doctor if you would like to use a medication, such as Ibuprofen for relief of pain and inflammation (it's safe to take when nursing). The American Academy of Pediatrics considers Ibuprofen to be compatible with breastfeeding.

If you begin to develop a fever and/or flu-like symptoms, and your breast is red, hot and swollen, it is very important to contact your doctor. You may be developing mastitis.


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