Engorgement can occur when a mother’s milk first comes in, between two to five days after the baby is born. Engorgement happens when the amount of milk and blood supply to the breast increases. This causes swelling of the breast tissue. Engorgement can also occur when you decrease regular breastfeeding significantly or stop breastfeeding altogether.
If you experience breast engorgement as your milk first comes in, your breast normally stays compressible. Your baby continues to latch on comfortably and effectively without problems. Extreme breast fullness rarely lasts more than 24 hours, and breastfeeding can continue without much discomfort.
Severe engorgement, however, is painful. Your breasts can become hard, tense and warm, and you may experience throbbing, aching pain. If your baby were able to latch and milk could be transferred, your breast would soften, but because your breast's areola becomes tight and less compressible, it can be difficult for baby to latch. It is normal for the breast to feel lumpy, after it softens, until the engorgement is gone in one to three days.
With severe engorgement, a method called reverse pressure softening may help (linking page information provided by permission of K. Jean Cotterman RNC-E, IBCLC). If reverse pressure softening doesn’t work and baby can’t latch on to soften the breast, you need to remove the milk in another way. Consider expressing the milk by hand or pumping. Hand expressing requires patience and practice, and it can be difficult learn, especially while you are experiencing engorgement. In this case, pumping is the only other option.
When the breast is engorged and baby is able to latch, you should breastfeed every two hours to keep your breasts soft. Make sure that you feel a softening in the breast after baby has latched on. Watch to see that baby is swallowing the milk. If the breast remains firm and uncomfortable after feeding, express the milk by hand until you are comfortable.
When the breast is engorged, do not apply heat. After feeding apply ice or a cold compress to the breast. For pain, take an anti-inflammatory. If the breast is engorged and you are not planning to breastfeed, follow these same steps. Apply ice, take a pain reliever, wear a well supportive bra and do not draw milk off.
In the first 24 hours, when your milk is coming in, your body temperature may elevate, to as high as 100.5 degrees. If it goes higher than that, notify your doctor.