Milk Coming In

Milk-coming-in is part of the changes you experience after the delivery of your progeny. Your body has been making all the necessary preparations since egg and sperm met. Possibly you’ve even seen a discharge from the nipple occasionally during pregnancy. Remember you’ve spent 40 weeks creating life and now you need to sustain that life. At first, women worry whether milk will come in but after a few days, they realize how bountiful their yield is. Engorgement is when the breast tissue overfills with milk, blood, and other fluids. It may cause your breasts to feel very full, to become hard and painful, and your nipples to flatten and tighten. Engorgement is a temporary stage to the milk-coming-in part of breastfeeding. Milk-coming-in is part of the changes you experience after the delivery of your progeny. Your body has been making all the necessary preparations since egg and sperm met. Possibly you’ve even seen a discharge from the nipple occasionally during pregnancy. Remember you’ve spent 40 weeks creating life and now you need to sustain that life. At first, women worry whether milk will come in but after a few days, they realize how bountiful their yield is.

This phenomenon is called engorgement. “Engorgement is when the breast tissue overfills with milk, blood, and other fluids. It may cause your breasts to feel very full, to become hard and painful, and your nipples to flatten and tighten. Engorgement is a temporary stage to the milk-coming-in part of breastfeeding.

Most women have heard the stories of nipple pain, but some may not have anticipated “breast” pain. To wake up one morning about 2-5 days after delivery, and find you have “rocks” as breasts can be quite overwhelming. You’ve likely just left the hospital or birth center and have yet to settle in at home when you feel such intense changes to your breast. If you’re lucky you experience these changes while still in hospital and you get as much help as possible to navigate milk-coming-in.

My memory of milk-coming-in the first go-around was quite pronounced. Baby and I took a much-needed nap after being discharged from the hospital on day 3. I woke up 5 hours later with “Dolly Parton” breasts and a screaming newborn. In truth, I couldn’t get her to latch due to their enormous size and flattened nipples. My husband and I spent hours trying to console and feed my baby to no avail. We thought she was ill and returned to the hospital. The nurse in the emergency room put us in a dark, quiet room and latched her right away. It had been 12 hours since she had eaten and my breasts were emptied. What a relief it was to have more comfortable breasts and a content baby!

I hope the information you learn from this blog, prevents you from experiencing the extreme situation I was in.

Engorgement Expectations & Treatments

1. Lactogenisis is the period when the breasts start to produce transitional milk. At the start of this phase, the breasts may feel warm to the touch, lumpy, and you may have a low-grade fever (under 101).
2. The more medication and fluids you have in labor, the more engorged your breasts will be. Your nipples are an extremity, and fluid builds up in all extremities. Think of how tight your hands and feet feel and imagine the same thing happening to your nipple area. You can use reverse pressure softening to reduce the discomfort in your breast. 
3. Most healthy, normal, uncomplicated births of healthy mothers should notice a change to their breasts within 48-72 hours — the more complicated the delivery, the slower the transition from colostrum to transitional milk to mature milk. If you do not notice any changes to your breasts by day five, please call your lactation consultant.
4. Your breasts can feel like they will burst at times when you’ve gone too long between feeds. This feeling can also be felt up in the armpit and be uncomfortable to put your arms down. Use warm compresses before feeding and ice after feeding on those sore areas.
5. You should feel relief or softening after feeding. If you don’t think there is any change to your breast after the feeding (and baby is not content), use a warm compress and massage before trying another feeding. If baby transferred milk (and is content), but you are still uncomfortable use warm compresses and hand-expression to help soften. Pumping is a last resort.
6. The more you feed on demand from birth (minimum of 8-15 times per day in the first week), the less uncomfortable this phase is. When you feed on a schedule, the more painful and long-lasting the changeover will be and the less milk you will make.
7. If the baby is unable to go directly to the breast to feed or is not emptying well due to health concerns, you must pump both breasts 8-15 times per day for 15 minutes by electric pump. If you are not getting relief with the pump, consider troubleshooting pump pieces and or a new, improved pump. 
8. Your breasts will feel sore to the touch, and you will not want to touch them, but this will give you relief the fastest. If you can spend a few minutes massaging the breasts in the shower and feed quickly after exiting, you can remedy the pressure build-up in the breast. Don’t be shy, use gentle pressure in a circular, top to bottom motion as often as possible to keep engorgement from intensifying. 
9. Wear a supportive but not compression bra. Sports bras and underwires are generally too restrictive! Make sure the fit is appropriately-sized for your changing body. You may need a new one, get yourself sized by a professional. Along the same lines, do not put any undue pressure on breasts-sleeping on them or holding the breast too tight, like a vice grip. This pressure may impede overall milk supply and or “dry up” your milk. 
10. Use buoyancy when all else fails. Float your breasts as you sit in a bathtub or jacuzzi or put your breasts in bowls of warm water; this can make all that stagnant milk and fluid start to move freely. Be sure to massage those firmer lumps while breasts are soaking.
11. Cold, raw green cabbage leaves can feel marvelous. Use this tip only when all of the above has failed. First, crack the leaf stalk then apply inside bra for 10-15 minutes. Don’t use longer than 20 minutes or more than twice per day for no more than two days. You don’t want to dry up your milk completely. Throw away wilted leaves.
12. The last resort is to use your electric breast pump. If you’d like to use a hand or silicone pump just to soften the breast, that is fine. However, using the motorized pump can create more problems. If you must use the electric pump, only pump to comfort. You will feel your breast soften in just a few short minutes and stop pumping. You are not trying to store milk or build up your supply; unless you are returning to work at two weeks postpartum. 

Your hormones and body are going through significant transitions at this time. Be patient with how you feel physically and mentally. The engorgement phase only lasts a day or two if you follow these tips. Those women who’ve had breast implants may have a more extended conversion, but relief will come. Get help if you are not finding an approach that helps you get comfortable.

Normal Engorgement When Milk is Coming In

Don’t be too concerned if you feel much larger then anticipated. Sometimes your breasts are 2-3 sizes more significant for a short time. Your bra size will only be this big for 4-6 weeks. Use this checklist to be sure you are experiencing normal engorgement:

• the baby is transferring milk well
• you hear swallowing
• the output is adequate
• the baby is somewhat content
• You have been feeding at least eight times per 24 hours (consistently sucking well for 10+ minutes)

If you find yourself unable to get relief after you’ve used these suggestions, speak with a professional, and learn more about the breast pain. If your fever is 101 or more, call your obstetrician and your lactation consultant ASAP.

Engorgement is manageable and may come at other times throughout your nursing career; for a missed feeding, oversleeping or out and about. As long as you take care of it as soon as you notice the issue, there shouldn’t be lasting problems. The more you do skin to skin, feed on demand, and relax, the easier you will adapt to your ever-changing breasts and make adequate milk.