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 below:
- Pump your breast – 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.
- Ice your breast – Place four to six 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. 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 ice.
- Use cabbage compress – 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. Within hours, 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 your 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, so we encourage you to continue to breastfeed. By doing so, you will pass on important antibodies to your baby via your breast milk.
Symptoms of mastitis are a very sore, “angry” breast, plus 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 to 14 days. If you are not beginning to feel much better after taking the medication for two days, call your physician again 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, your 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 within easy reach in a bassinet. Keep very well hydrated. Allow your body time to heal.
Some mothers find that a hot shower or soaking the affected breast in an extra large bowl of very warm water for five minutes prior to breastfeeding, is very soothing. Some mothers, on the other hand, 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) may help the milk flow through the ducts surrounded by the infected breast tissue.
With edema, fullness or mastitis, the goal is to “keep them flowing to keep them going.”