Engorgement

What is engorgement? – Engorgement is a swelling of the breasts caused by expanding veins and the pressure of new milk. Many, but not all women experience engorgement usually two to six days after delivery. Immediately after birth, the mother produces colostrum, a yellow, sticky fluid secreted by the breasts that provides nutrition and protection against infections. Colostrum contains more protein, less sugar and much less fat than mature breast milk.

Engorgement usually happens when the breasts switch from colostrum to mature milk (often referred to as when the milk "comes in"). However, engorgement can also happen later if lactating women miss several nursings and not enough milk is expressed from the breasts.

The degree of engorgement usually lessens with each child. First-time mothers often suffer more from engorgement than women who are nursing their second or third child, because the time it takes for the mature milk to "come in" seems to shorten with each child.

When the breasts switch from colostrum to mature milk, some feeling of fullness, swelling, and discomfort are normal. However, when breasts become engorged, they are more prone to infections, and therefore, preventative measures should be taken to avoid and reduce engorgement.

Preventative measures and remedies for engorgement: Many doctors and lactation consultants agree that the best way to prevent engorgement is to nurse often. Some suggest not going more than three hours without nursing and not skipping night feedings.

When breasts are severely engorged, the baby often cannot latch on property. Pumping or manually expressing some breast milk can help reduce engorgement, allowing the baby to suckle, which will help alleviate the swelling and prevent future episodes. Also, some women find a warm shower just before a feeding helps relieve some discomfort and facilitate let down. Massaging the breasts as the baby nurses can help get out as much milk as possible.

In her book, "Breastfeeding - A Guide for the Medical Profession" Dr. Ruth Lawrence recommends applying cold packs to the breasts after a feeding to help reduce swelling, warmth and pain. The mother may take acetaminophen (Tylenol) or ibuprofen (Advil) to relieve the pain. Neither drug should affect the baby.

Cabbage leaves: Women have been using cabbage leaves to relieve engorgement symptoms for years. But does this natural remedy actually work? Some women swear by it, but few research studies have been able to medically prove if cabbage leaves actually alleviate engorgement.

Cabbage leaves are usually rinsed off (and sometimes chilled) and the veins of the leaves crushed or removed. The leaves are then placed on the breast, leaving the nipple exposed. Some women place the leaves right in their bra, which helps keep them in place.

In 1993, a group of researchers evaluated 120 breastfeeding women who were split into two groups. One group used cabbage leaves on their breasts to relieve engorgement and the other group received "routine care." The cabbage leaf group tended to report less engorgement, but the trend was not statistically significant. The researchers did find that the women who used cabbage leaves were more likely to be exclusively breastfeeding at six weeks than those who did not.

In 1994, British researchers set out to determine the effects of using cabbage leaves for breast engorgement. They concluded that the use of cabbage leaves resulted in fewer women giving up breastfeeding but that more research is needed to determine if cabbage leaves actually treat engorgement.

A study was published in the Journal of Human Lactation in 1995 that compared the effectiveness of chilled and room temperature cabbage leaves. Twenty-eight lactating women with breast engorgement used chilled cabbage leaves on one breast and room temperature leaves on the other. After a two-hour period, the women reported significantly less pain with both treatments. The researchers concluded that it is not necessary to chill cabbage leaves before use.

An Australian research study in 1998 compared the effectiveness of cabbage leaf extract and a placebo in treating lactating women for engorgement. Twenty-one women received a cream containing cabbage leaf extract and 18 women received a cream with no extract. Both groups reported the creams supplied equal relief from engorgement. The researchers did discover that breastfeeding itself had a greater effect than the cream on relieving discomfort and decreasing tissue hardness. They concluded that, "It is recommended that lactation consultants encourage mothers to breastfeed if possible to relieve the discomfort of breast engorgement."