Thursday, December 12, 2013

Engorgement 911!

Image from gynaeonline
by Glenni Lorick, IBCLC
I frequently get calls from moms who are experiencing engorgement, the painful over-fullness of the breasts that sometimes happens when a mom's milk first comes in, usually around day 4 or 5 of baby's life. I have a 3 step protocol that I offer these moms, and it has been VERY effective. Of course, an ounce of prevention is worth a pound of cure, so first, let's look at how to prevent it!

Prevention

The best way to prevent engorgement is to nurse frequently during the first week of your baby's life. By frequently I mean 10-12 times a day. If your breasts don't have the chance to get overfull, you won't get engorged. But once engorgement begins, it can be a downhill spiral because baby is unable to latch on to the engorged nipple and areola, the milk doesn't flow readily, and there are so many other fluids, not just milk that are contributing to the painful swelling of your breasts. It is very important not to let more than a 3 hour stretch of time pass from the beginning of a feed to the beginning of the next feed. 

Often a mother may sleep a longer stretch at night, and when she awakens, she is miserably engorged. Your baby needs to sleep in your room, ideally right next to your bed, and you need to be sure to feed at least every 3 hours (or more frequently) during the night. If baby isn't willing or able to nurse, then you need a good pump (ideally hospital grade) for that first week. All of our Madison county hospitals will give you a breastpump rental kit if you ask for it.  Be sure NOT to leave the hospital without it! Your insurance pays for it, and having that kit just might be a lifesaver. You can rent a hospital grade pump for just $5.00 a day or $25.00 a week. If baby isn't nursing well, you NEED to make that investment!

Glenni's 3 Easy Steps to Relieving Engorgement

As a lactation consultant, I do see a lot of engorgement. Over the years I have developed an easy 3 step protocol to help mothers relieve the discomfort. 

1. Soften the Areola
If you try to nurse on an engorged breast, your nipples will take a beating! Often a baby who was nursing great in the hospital ends up mangling mom's nipples when she get gets engorged. The solution is NOT TO NURSE until you have softened the nipple and areola.

Softening the areala requires two things: moist heat and milk extraction. The ideal moist heat is a comfortably hot shower. While you are in the shower, you will manually express enough milk to soften the areola. If you can't take a shower you can actually put your breast in a basin of warm water and express, or you can use a moist hot washcloth on your breasts before expressing or pumping. Sometimes it actually requires a hospital grade pump to really get the milk flowing.  Once you have softened the areola, it's time for step 2.

2. Nurse Baby
You want to make certain you get a good deep latch. Lead with baby's chin, be sure his mouth is wide open, and come up and on. This is important because without a good deep latch baby can't effectively nurse and drain the breast. If the latch isn't as deep as you'd like it to be, slide a finger between baby's chin and your breast, and pull it down while you pull baby's head in closer. The latch should NOT hurt. If it hurts, you need to see a lactation consultant to figure out what is wrong!

If baby only nurses on one side, or for some reason doesn't nurse well, then use a breast pump. The goal is simply to relieve fullness, not necessarily drain the breast. If you need to pump instead of nursing baby, continue applying moist heat to the breast as you pump. You may find that pumping each breast individually and massaging as you pump will help you better empty the milk.
Once you have nursed or pumped, you may find that your breasts still feel a little hard. That's why we use step 3.

3. Apply Cold Cabbage Leaves
Cabbage contains sinigrin (allylisothiocyanate) rapine, mustard oil, magnesium, oxylate and sulphur
heterosides. The theory behind the use of cabbage leaves to reduce swelling is that they open the capillaries to allow improved blood flow. They also seem to help the body reabsorb excess fluids. You need to use common green cabbage. Wash it and remove the core, then peel off the leaves. Place them in a container of water in the refrigerator.  After nursing, if your breasts still feel full, crush their veins and apply the cold cabbage leaves for about 20 minutes. If they get hot from the heat in your breast, you can switch out and apply fresh leaves.


How Long Until Engorgement is Gone?

It truly varies from mother to mother, but I have seen some women get past engorgement using these three steps in just 3 or 4 feedings. Other women require several days of treatment following this protocol. If you begin the treatment at the first sign of engorgement, you will probably find that it works more quickly for you. 

A final word of caution is in order. If you have symptoms of engorgement, but you also have red streaks on your breasts and flu-like symptoms, then you probably have mastitis. You need to call your doctor immediately for antibiotics, keep the breast as empty as possible, and rest, rest, rest, rest!!

Please leave your feedback about how this protocol has worked for you!

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