Engorgement: Newborn can't latch on

I gave birth three days ago and I have been having problems getting my son to nurse. It wasn't a problem for the first day and a half, but since then my milk has come in, I am engorged and he cannot latch on. He has not had a bowel movement in 24 hours. 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 a baby has been nursing well during the first few days and then begins to have difficulty around day three or four, it is often due to engorgement. Frequent nursings in the early days can help to keep engorgement to a minimum. While it is normal to have transient breast fullness as your milk supply is increasing, severe engorgement is not the norm.

How do you tell if you have passing breast fullness or full-blown engorgement? When you are experiencing breast fullness in the early days following your baby's birth, your breasts will still be compressible, meaning that there still is a softness and flexibility to them. This fullness rarely lasts longer than one day, and usually does not cause your baby much difficulty. On the other hand, when engorgement is severe, your breasts may feel rock-hard, and even your areola will seem firm. This makes it very difficulty for your baby to latch-on to your breast, and even if latched on, may find it difficult to "extract" any of your milk. This can be frustrating to both you and your baby. All this milk, and now what?

When a baby is not nursing effectively it is important to remove the milk from your breasts. I would recommend short-term use of a hospital-grade electric breastpump. To protect your milk supply, it is necessary for your baby to nurse, or for you to express your milk, at least 10 to 12 times a day. If your baby is not at your breast, your expressed milk can be fed to your baby. Express your milk starting on the lowest setting. Be very careful. When your breasts are severely engorged, rough handling can damage your delicate breast tissue. I would not advise the use of a manual or small electric pump at this time. You need the most effective (and gentle pump) when you are suffering from severe engorgement. Not any pump will do!

Apply warm, moist compresses and do very gentle breast massage. Expressing your milk prior to a feed will help soften your areola and get your milk flowing.

Once your areola softens, put your baby to your breast. He should have a much easier time now that your breasts are more easily graspable and your milk is flowing. Remember that most babies are very efficient at removing milk from your breasts -- much better than even the best pump. Time at your breast is very important for your baby, your milk supply and your comfort!

Use icy compresses. In between feeds apply a cold compress (you can use a bag of frozen peas) to help relieve pain and reduce the inflammation. Cold cabbage compresses can also be used, but use only for a very short time, because this has the possibility of severely decreasing your milk supply. To prepare cabbage compresses, pull off cabbage leaves and wash. Place in zip-lock bag and store in refrigerator. When ready to use, remove leaves and crumple in hands. Place inside your bra, covering all areas of your breast. Leave on until wilted, or about two hours. If your breasts are still very firm, change leaves and repeat until breasts begin to soften.

Consider the use of a pain reliever/ anti-inflammatory, such as Ibuprofen. Discuss options with your health care provider.

Work with an IBCLC. Since your baby has not had a bowel movement in 24 hours, it is important to make sure he is properly nourished. This is a red flag that he may not be taking in enough calories, and needs to be immediately investigated. I would highly advise working with an IBCLC in conjunction with your baby's health care provider, so that you can work on breastfeeding, making sure your baby is well-fed in this time of crisis. My very best wishes for a quick return to breastfeeding!

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