Breastfeeding for Beginners

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Engorgement

Breast engorgement is a preventable condition of early lactation and is the result of inadequate breast milk removal prior to and at secretory activation. Hence, it usually occurs on about the third or fourth day when your supply changes from colostrum to mature milk. Milk removal above the baby's needs at this time will not continue to cause oversupply so expressing for comfort and to make latching easier is acceptable.

Increased blood supply to the breasts can also have an impact by causing engorgement of the breast tissue. This form of severe engorgement often causes the mother to progress from painful engorgement with apparently excessive milk to an inadequate milk supply. It is characterised by stasis of milk in the alveoli and increased interstitial fluid (lymph system).

Prevention:

  • Early initiation of breastfeeding
  • Ensuring that the baby is well latched to the breast
  • Frequent feeds day and night (express frequently if baby is not feeding)


 Warning signs:

  • Heat
  • Hardness
  • Redness
  • Pain
  • Swollen blood vessels


Management of engorgement:

  • Always wear supportive underwear
  • Hand express for comfort and to soften the breast a little prior to feeding, if necessary
  • Do not use a breast pump
  • Avoid excessive stimulation i.e. massage under a hot shower
  • Remove milk from the breasts frequently and effectively (hand express if baby can’t suckle)
  • Allow baby to drain one breast before offering the second
  • Alternate the starting side at each feed
  • Apply warm packs prior to feeding to stimulate the letdown reflex
  • Apply cold compresses after feeding for comfort (for about 20 minutes)


Management of breast tissue engorgement:

  • Gentle arm rotation and massage assist in facilitating the drainage of lymph but be aware that it drains primarily to the nodes in the axilla so any hand massage must be towards the axilla.
  • To reduce tissue engorgement prior to feeding, lie on your back and massage the breast away from the nipple, towards the axilla. Have baby ready to feed immediately massage is completed because the fluid will return very quickly making attachment difficult.
  • Reverse pressure softening (see article on this site)
  • DO NOT use a breast pump as it will increase breast oedema
  • Avoid excessive stimulation i.e. massage under a hot shower
  • Hand express regularly if baby is not available to suckle
  • Apply warm packs prior to feeding to stimulate the letdown reflex
  • Apply cold compresses after feeding for comfort (for about 20 minutes)
  • Routine analgesia should help to provide some degree of comfort