Engorgement and mastitis
Breast feeding, like parenting, is not always uncomplicated, especially in the first few weeks after birth. It can be easy to forget at this time that, like all new skills, breast feeding can take a while to learn and become really good at. Not all women experience true engorgement or mastitis; however, if you do it may really test your commitment to breast feeding. At times you may feel that it is not worth it, and that breast feeding is just not for you. This information has been compiled to assist women who are experiencing problems with engorgement and/or mastitis. It is strongly advised if you are experiencing difficulties with breast feeding to seek the advice of a midwife, lactation consultant, community child health nurse, the Australian Breastfeeding Association or your doctor.
What is engorgement?
Breast engorgement means breasts that are hard, swollen and painful because their blood vessels are congested (too full). This can mean that your nipples don’t protrude and your baby cannot latch on properly. Breast engorgement is different from the normal breast fullness that happens a few days after the birth when the milk supply comes in.
What to do for engorgement
- Feed your baby on demand until they have had enough.
- Let your baby finish the first breast before starting on the second.
- If you have a strong ‘let down’ and milk pours from the breast during the feed, take your bra off and let it run out freely. You can catch it in a towel or cup, or a sterilised container for freezing and using later.
- Put your baby to the more painful breast first. Try using one side for each feed rather than offering both breasts. If your baby is still hungry offer the other breast.
- Stand in a warm shower for 5 minutes before feeding. It is soothing and comfortable. Although is it generally not a good idea to express excess milk by hand, expressing a little in the shower can make it easier for a very new baby to ‘latch on’ correctly.
- Apply a cold pack after feeding. Cabbage leaves that have been washed and stored in the refrigerator applied over the whole breast can be very soothing!
- Massage your breast lumps gently towards the nipple while feeding.
- If necessary, express after feeds.
- Avoid giving your baby any other fluids.
- If your breasts are very painful, ask your doctor or breast feeding advisor about pain relief. You may feel reluctant to take pain-relievers, however, remember that being in pain makes establishing a healthy, satisfying breast feeding pattern much more difficult.
Remember, there is no greater relief for engorged breasts than an enthusiastically feeding baby.
What is mastitis?
Mastitis is inflammation of the breast tissue, particularly the milk ducts and glands in a breast feeding woman. It is caused by blocked milk ducts when the breasts are too full and the milk is not draining properly. It can also be due to a cracked nipple. Bacteria (germs) may get into the breast tissue and grow in the blocked milk ducts. You will have a sore breast and will notice a lump that is usually red and tender. You may also have a temperature and feel unwell with 'flu-like symptoms. Most cases of mastitis are caused because the baby is not latched on or positioned on the breast correctly.
What to do for mastitis
- See your doctor or midwife immediately if you have a fever. You may require antibiotics to cure the infection. Untreated, severe mastitis can lead to a breast abscess.
- It is very important that you have time to rest and spend time feeding your baby properly. Seek help and support from your partner and family.
- Breast feed on demand, starting with the sore breast. Make sure the baby is latched on correctly (mouth covering not just the nipple but also almost the entire areola, the dark circle of skin around the nipple) and drains the breast well. It is quite safe to feed your baby from the affected breast.
- Wear loose fitting clothes and a bra that is well fitting and does not dig in anywhere (obstructing the flow of milk).
- Change breast pads or bras frequently if you are leaking milk.
- Apply warmth to the sore area just before feeding, by taking a shower or applying a warm hot water bottle wrapped in a towel or a wheat bag.
- Drink plenty of fluid (especially if you have a fever).
- Paracetamol can be taken every 4 hours if necessary for the pain and fever.
Last Reviewed: 20 May 2009