It is important to distinguish between engorgement and clogged milk ducts, two completely different conditions.
Engorgement
Milk production in your breasts increases during days 3 to 5 after baby’s birth. As the milk comes in, a condition called engorgement occurs. The lymph nodes and lymph tissues swell, and both blood supply and the amount of milk increases, causing your breasts to tighten. They may become hard and lumpy. When the milk comes in, you can feel the milk ducts all the way up to your armpits. This is a normal condition—a good normal condition—that occurs when mature milk comes in. Not all women experience engorgement, and it is possible for milk to come in without feeling any tightness in your breasts. Engorgement means that you feel a tightness in both breasts which become hard, sensitive and reddish. It is difficult for baby to latch on your breast. You may also develop a fever.
What to do To help baby latch on correctly, try a technique called reverse pressure softening (RPS) or gently hand express before your baby nurses in order to relieve some of the pressure.
How to alleviate the symptoms
- Use heat or cold on your breasts (in the shower, for instance)—whichever feels best.
- Rest, crawl into bed.
- Drink plenty of fluids, ideally juice, warm beverages and nutritious smoothies.
- Take Ipren (ibuprofen) for the pain, or Alvedon (paracetamol). Follow the instructions on the package.
Breastfeed often during these days. Frequently hold your baby skin-to-skin with his or her airways free. This helps to increase oxytocin levels in your blood, which stimulates the let-down reflex (milk ejection reflex). Gently hand express standing in a warm shower. You cannot pump out engorgement, but pumping can alleviate some of the pressure.
Hormones that make you weepy
Hormones are raging in your body when your milk comes in, which might make you weepy and emotional. This is because oxytocin and prolactin (the two breastfeeding hormones) are at their highest levels. Baby wants to nurse often. Breastfeed as often as baby wants. Imagine that by nursing, baby is placing an order for more milk within a few days. Take extra good care of yourself at this time. Take one day at a time.
This will pass
It will not be like this the entire time. Engorgement usually passes after one or two days. Your breasts will get soft again, indicating that you have only breastmilk in your breasts.
Rule out infections
Infections such as urinary tract infections, uterus infections and other such infections should be ruled out. If you feel that your general wellbeing is affected or you feel ill, contact your healthcare provider.
Clogged milk ducts
Clogged milk ducts can be divided into bacterial and inflammatory clogged milk ducts.
Clogged milk ducts caused by bacteria start with a wound on the nipple, thereby enabling bacteria to sneak into the milk ducts (where they should not be). A bacterial infection develops in the breast.
Inflammation of the clogged milk duct is an inflammation that occurs when one or more of the milk ducts are obstructed due to swelling around the ducts, preventing the flow of milk. It usually feels like a lump in the breast. Sometimes, these are the only symptoms and the lump will disappear on its own if you continue to breastfeed.
At other times, the mother will have painful breasts, the area around the inflammation will be red and swollen, and breastfeeding is painful. A high fever is also a possibility. The symptoms typically occur suddenly. We will focus on inflammation of the clogged milk duct, which is most common.
Inflammation of the milk duct can occur for various reasons
- Baby does not have a large portion of the breast in his or her mouth when sucking.
- Baby has, for some reason, not nursed as actively or strongly on the breast as before—either because the baby is ill or because it takes a long time between feeding sessions.
- You remove baby from the breast before he or she has finished feeding.
- Tight bras or tight-fitting clothes.
- Feedings are suddenly spaced farther apart because baby is sleeping longer.
- Stress, fatigue, pain and anxiety can cause mastitis since stress hormones can inhibit oxytocin and thereby also the let-down reflex.
What to do
- The first thing you need to do is determine the cause of the clogged duct in order to treat the underlying problem. It usually passes on its own, but you may need medical attention.
- The treatment involves breastfeeding frequently from the breast with the clogged ducts. Try to hold the baby so that baby’s chin is touching the area where the clogged duct is located. Gently stroke the area that is red or affected. Drum your fingertips, play the piano or move your fingers gently over the red area and down toward the nipple, ideally while your baby nurses.
- If breastfeeding is too painful, hand express or pump your milk. It’s good to know that your baby can always extract more milk than you can by hand expressing or with a pump.
- Remember to nurse from the healthy breast as well.
- If heat feels good, place a warm wheat bag or warm towel on your breast before breastfeeding to alleviate the pain.
- Shower while hand expressing as a form of treatment.
- Rest a lot.
- Drink plenty of fluids.
- Try to find a quiet place.
- Use pain medication when necessary.
Other infections and when you need medical attention It’s important to rule out other infections. Make sure that you do not have a urinary tract infection, a uterus infection or some other infection. Get medical attention immediately if you suspect you have an infection. If your general wellbeing is affected, call your healthcare provider for advice.
If you are pregnant and develop clogged milk ducts that do not go away after two days, call your child health clinic, breastfeeding clinic or healthcare provider. If you have stopped breastfeeding and develop clogged ducts, always contact your healthcare provider.
If a lump does not go away within two months, always contact your healthcare provider.