As you begin to build your breast milk volume, you will feel changes in
your breasts. Between day two and day three, you will notice that your
breasts feel warmer to the touch and the breast tissue feels denser when
squeezed (compressed). Between day three and five, your breasts will
feel fuller as your breast milk volume builds. As your baby requires
more milk and demands more nursings, your breasts will produce more
milk. Breastfeeding works on the principle of demand and supply. The
more milk your baby demands, the more breast milk your breasts will
supply for feedings.
During the first week of breastfeeding, some women notice engorgement
or edema. Engorgement/edema is swelling of the breast tissue
along with the milk volume building. This breast tissue swelling can
cause the breast to be hard and firm. At times, this hard firm swelling
can result in difficulty with latching the baby due to the swelling and
firmness of the areola and the resulting flattening of the nipple. In
the past, warm compresses prior to latching were recommended, but some
women found that the warmth actually increased the tissue's swelling.
The current recommendation is the use of ice. The engorgement/edema will
usually reabsorb within about 48 hours if you follow the suggestions
If your nipple is not available for your baby to grasp, gently
pump your breast just long enough to form a nipple and soften
the areola, then swiftly latch the baby to your breast. During
the feeding, gently massage the entire surface of your breast
with long soft feather-like strokes towards baby's mouth or use
gentle breast compressions during baby's active suckling to help
your milk flow through the swollen breast tissues. Discontinue
breast massage or compressions if uncomfortable. After nursing,
you may still feel firm breast tissue due to the unabsorbed
tissue swelling. Ice bags or cool cabbage leaf compresses will
help relieve this swelling.
Place 4 to 6 large bags of frozen peas or ice bags over and
around both breasts including your armpits. Place the ice over a
layer of clothing not directly on your skin (avoid freezer
burn). Leave ice bags in place for 10 minutes, remove for 10
minutes, reapply for 10 minutes, remove for 10 minutes—repeat on
and off the breasts until the next breastfeeding. If the tissue
swelling is still present—repeat use of ice bags on and off your
breasts until the next breastfeeding. Continue applying the ice
bags and evaluating your breasts response until the breast
tissue is comfortable after nursing. Then discontinue the use of
Cool green cabbage leaf compresses are also used to relieve
engorgement/edema. Use enough fresh cool leaves to cover the
skin of both breasts and armpits. Hold the leaves in place with
your bra and wear the leaves continuously until the next
breastfeeding. Remove leaves and discard before breastfeeding.
Reapply the leaves after each nursing and evaluate how your
breasts feel after breastfeeding. As soon as your breasts feel
relieved/comfortable after breastfeeding, discontinue the use of
cool green cabbage leaf compresses to avoid decreasing your milk
supply. Use the cool green cabbage leaves only to relieve
engorgement/edema not to decrease milk volume.
Fullness is due to the breasts filling with milk between breastfeedings.
As the lobules in the breast fill with milk, the breasts feel full and
lumpy. Some mothers notice certain areas of their breasts not draining
well after nursing, especially the top and outer portions of their
breasts. Massaging with soft gentle feather-like strokes from your neck
towards the baby's face and from your armpit towards the baby's face
while baby is suckling may help to drain these overfull areas. Gentle
breast compressions (squeezing while baby actively suckles) during the
nursings may also be helpful As your baby drinks your milk and your
breasts empty, the production of more breast milk is stimulated. If you
baby does not drink enough to make your breasts comfortable, please take
care of your uncomfortable breasts. Avoid a breast infection by use of
ice bags/cool green cabbage leaf compresses (see engorgement/edema) or
pump your breasts just until comfortable and store pumped breast milk
for later use.
Mastitis is a bacterial infection in your breast tissue, not in your
breast milk. By continuing to breast feed, you will pass on antibodies
to you baby in your breast milk. Symptoms are a very sore angry breast
plus either a fever of 100 degrees or higher and/or flu-like symptoms.
Call your physician and a lactation consultant immediately for advice.
Remind your physician that you are a breastfeeding mother and prefer
treatment that is safe while breastfeeding.
Antibiotics are usually prescribed to treat this infection. Follow the
directions carefully and take all the medication prescribed, even if you
feel better fast. The usual course of treatment is 10–14 days. If you
are not beginning to feel much better after taking the medication for
two days, recall your physician and discuss the possibility of needing a
different and more effective antibiotic. If you have any concerns about
taking a medication while breastfeeding, call your baby's physician, you
own physician, and/or lactation consultant for updated information on
the medication. Ibuprofen or acetaminophen may help relieve
discomfort—follow directions on label for dosage.
Rest is essential during mastitis, especially for the first two days.
Ask family and friends to help with toddlers, older children, errands,
and preparing meals. Ignore everyday chores, if possible. Rest in bed
with your baby in the cradle within easy reach. Keep very well hydrated.
Allow your body time to heal.
Some mothers find that soaking the affected breast in a extra large bowl
of very warm water for five minutes prior to breastfeeding, is very
soothing. Some mothers find that the warm soaks actually increases the
breast discomfort. Experiment. If soothing, then soak; if not soothing,
do not soak. Gentle breast compressions (squeezing while baby actively
suckles—TMJ movement, slight pause noted between wide jaw opening and
closing) may help the milk flow through the ducts surrounded by the
infected breast tissue.
After nursing, place ice bags/bags of frozen peas, over a layer of
clothing covering the affected area of your breast for 10 minutes, then
remove for 10 minutes. If the cool is soothing, repeat on and off in 10
minute periods until the next breastfeeding. If possible, continue
between breastfeedings until the infected breast tissue is no longer
"angry". When your breast is comfortable, discontinue the use of warm
soaks and/or ice bags/peas.
Breast milk during a breast infection may have a salty taste and have
the odor and taste of the antibiotic. Some babies need to become
accustomed to the change in flavor and smell of their breast milk.
Keeping yourself well hydrated will dilute this new flavor and make
baby's acceptance of the change easier.
For more information, call 1.866.CALL.MLH.