Tips for Prevention and Treatment for Engorgement

By definition, engorgement is about congestion and distension. There’s vascular and lymphatic congestion, and milk. Remember, this is all about the fluid getting stuck, like having too much water in a dam. Prevention and treatment for engorgement creates a successful release. To do that, keep these principles in mind.

• Physiologic engorgement is normal, and therefore “prevention” isn’t the aim.
• Associated discomfort or prolongation of physiologic engorgement can be minimized.
• Pathologic engorgement can almost always be prevented.

Whether it’s physiologic (normal) engorgement or pathologic engorgement, the aim of treatment is similar: Remove the milk and minimize the discomfort. 

When should milk be removed?

• Remove the milk as soon as possible after the baby is born.
• Treatment for engorgement means stimulating the breasts and removing milk at short, regular intervals. In situations where there’s a severe situation, that would be every 1 to 1 ½ hours. In no case should milk removal sessions be more than 3 hours apart.

How can milk be removed?

The short answer? Any way that works! And, if one way doesn’t work (or work well), try something different.

• Hand expression often works best. In my later years, this has become my go-to strategy. Why so? Because I’ve heard one too many mothers say that the pump hurts worse than the engorgement, especially if it is severe. 
• Offer the breast to the baby. But this might not work if the breast is so engorged that latching is difficult. In that situation, I suggest that the mother hand express just enough milk to get the baby to latch on. Sometimes, that works like a charm. (Other times, it doesn’t.) 
• Consider the pump as the third-best option during episodes of severe engorgement. The pump works only by exerting negative pressure. That’s unlikely to be as helpful as the mechanical pressure (yes, that’s a real word for what hands do). 
• Get into a warm shower and bend forward. The water must run on the BACK, not on the breasts.   

What about hot or cold treatments?

Oh yikes. If I had to name the 10 biggest controversies related to breastfeeding management, this would be near the top!

For one of the most comprehensive studies you’ll ever find about treatment for engorgement, check out an 85-page exhaustive Cochrane review by Mangesi and colleagues. Wondering what they concluded for clinical practice implications? Here’s the verbatim quote:

There is insufficient evidence from trials to support the widespread implementation of a particular treatment for breast engorgement.

One of the first things I picked up on in this study was the fact that some of the “evidence” was from self-reports, and that researchers didn’t differentiate between physiologic and pathologic engorgement. So, I’m back to … what do I know from clinical practice?

Experts I know have ended up going on what we presume to be a best practice for the population of clients we’ve seen.

So, here’s what I read from the World Health Organization decades ago, and to my knowledge, they have not changed their tune on it. Warm treatments help to get the milk flowing before nursing, and cold treatments help after the baby has nursed.

I’ve had good results with my clients from using this technique for treatment for engorgement.

What about cabbage leaves?

Again, tough to tell. There are only a few old, small studies. So, we’re back to … what do we know from clinical experience?

Here’s what I know: Cabbage leaves have been used for decades, perhaps centuries, to successfully reduce swelling and distention in other body parts. (For example, arthritic knees.)

I also know that if you leave the cabbage leaves on too long, the milk can dry up completely. So, would it be helpful for reducing engorgement?

What about reverse pressure softening?

Reverse pressure softening is the brainchild of late expert clinician Jean Cotterman, RN IBCLC. There are no studies whatsoever to address the efficacy of this technique. But I know of many clinical experts who assert that this works. And I knew Jean well enough to know that she knew what she was doing.

What about restricting fluids?

That’s about the dumbest idea for treatment for engorgement I’ve ever heard! It just plain doesn’t work.

What about prescription oral pain relievers?

There’s some common sense here. First, it’s really tough to focus on a new baby when pain starts taking over your life.

Second, most times, an over-the-counter analgesic like ibuprofen will alleviate the pain.

Third, it’s not like engorgement lasts a lifetime.

That’s a longwinded way of saying, I’m all for adequate pain management.

Anything else for treatment for engorgement?

Yes. The one thing that the textbooks don’t mention: Remember, this isn’t trivial, but it is temporary.

And remember that when the engorgement goes away, it just means that the swelling has gone away.

What methods have worked for you in treating engorgement? Share in the comments below.