Menu Close

Tips for Prevention and Treatment for Engorgement

Brunette mother breastfeeding small infant.

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.

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.

Share this


  1. Barbara Q Nutrition

    How can you remove milk when painfully pathologically engorged, right when milk comes in (days 3 – 6 pp)… with a fully scabbed and thus blocked nipple?

    (Yes, This is possible as it happened to me 3 months ago)

    • Marie Biancuzzo

      Hi Barbara, good question! And I’d love to tell you that there’s some solid, evidence-based practice for this, but no, that’s not the case! Even the experts don’t agree on a “clinical” answer. I have a few hacks that sometimes work, and sometimes don’t. I did a post on therapeutic breast massage so try that. Sometimes, any of all of these will work, sometimes they help, but don’t fully alleviate the condition.

  2. Donna Blythe

    Hi Marie,
    I have received a scholarship for birth workers of color to study to become an IBCLC and to pay for the exam.
    I am interested in your course. Can I ask a few questions

    • Marie Biancuzzo

      Terrific! This is great news! Of course, I would encourage you or anyone to talk directly with us. But I’d also encourage you to first look at our 95-hour course. When you arrive on that page be sure to read the FAQ and also, download the goals and objectives for the course (scroll down on the FAQ). Then, I would encourage you to read a few of the posts that I have here on this blog. After that, if you still need help, please tell us the best time to reach you (and what your time zone is) and include your phone number. Send email to at your earliest convenience. Thank you for the question.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.