Engorgement and Sore Nipples
Around day three or four, most women experience what’s known as “engorgement,” when the breasts fill – or should we say overfill – with milk, often leaving them double or even triple in size (seemingly in a matter of minutes) and rock hard. Your body has no idea how many babies you’ll have to feed and how much they will eat, so it takes a better safe than sorry approach, giving you enough milk to feed an army. Then as your baby (or babies) start to eat, your body can better judge exactly how much is needed, leveling off the amount of milk produced. That’s why it’s so important to continue to nurse throughout engorgement – no matter how uncomfortable – otherwise your body will think your baby doesn’t need to eat, stopping milk production altogether. The same goes for relieving engorgement pain by pumping more than the baby is eating, because your body will continue to replace that milk. It will take a good six weeks for the supply-and-demand to settle in.
While we can tell you that it lasts no more than 48 hours, the pain can be so excruciating and breastfeeding can be so frustrating that it might rank up there with the pain of labor. However, there are some very, very lucky women (especially second-timers) that don’t experience much engorgement at all. If you do, however:
- Soothe the pain with cold pads designed to fit in your bra or put chilled green cabbage leaves on your breasts.
- Wear a supportive nursing bra around the clock.
- Nurse every two to three hours, and let your baby stay on the breast as long as he or she wants. As uncomfortable as this sounds, because engorgement will subside when a milk supply-and-demand is established.
- Before you nurse, you may have to soften the areola if your breasts are too firm. You can either pump (only until the area softens and the baby can latch on) or manually express in a warm shower. You might only be able to stand in the shower (avoid spraying water directly on your nipples) because the warmth can cause milk to leak out.
- Don’t pump to relieve the pain because the more milk your body expels, the more milk your body will produce. That’s why continuing to feed your baby throughout engorgement is so important, because it establishes the amount of milk needed.
- If you’re in too much pain to bear and/or running a fever, talk to your doctor about taking a mild pain reliever.
Even those who choose not to breastfeed will have to suffer through engorgement. Again, take the above measures to relieve your pain, but the only difference is you don’t want to encourage any milk production because as long as your body is releasing milk, it will continue to make milk. This means don’t pump and avoid nipple stimulation and hot showers. Milk might leak out for the next week or so, but it will eventually dry up.
5 Tips to Reduce Milk Production:
If you’re opting out of breastfeeding, your breasts will still fill with milk – making your engorgement more prolonged than it would be otherwise. To reduce your milk production:
- Apply cold compresses, either with cold cabbage leaves or a cold gel pack.
- Do not pump. The more milk your body releases, the more it will make.
- Do not bind your breasts. Keep circulation flowing with a well-fitting, supportive bra (most likely in a much bigger size than normal.) Binding your breasts could lead to a painful breast infection or clogged milk ducts.
- Reduce swelling with ice for 15 minutes, 3-4 times a day. Check with your doctor about taking ibuprofen or another pain reliever.
Sore, cracked, tender nipples are par for the breastfeeding course – though breastfeeding advocates would rather you not know. Breastfeeding does become a painless, convenient, bonding experience fairly quickly – but not quite yet. Some women’s nipples toughen up faster than others, and it’s smooth sailing in a matter of days. Yet all it takes is one time that the baby latches or unlatches incorrectly to cause painful cracks and scabs (only made worse by subsequent feeding sessions), so it might be rough while you’re still getting the hang of breastfeeding. This is all extremely normal, and all we can say is to contact a local lactation consultant if you need help positioning the baby correctly. Beyond that, just fight through it. Once the rocky beginning is over, you’ll be glad you stuck it out. In the meantime:
- Have medical-grade, natural lanolin (we recommend Lansinoh) on hand to prevent or heal cracked nipples. Dab a little on your nipples after a feeding for some much-needed relief.
- Use the healing power of breast milk to heal sore nipples. Use some lingering left-over milk or simply express a little to rub on yourself.
- Make sure your nipples are dry at all times – meaning changing your nursing pads as soon as they’re wet and letting them breathe (at home, of course.) Don’t immediately cover up when you’re done with a feeding – the air is good for you.
- Buy breast shells if even the touch of fabric on your nipples is irritating. The shells are designed to give your nipples some breathing room.
- Try switching your breastfeeding positions (see breastfeeding) so that different parts of your nipple are being used. This is also helpful in preventing clogged milk ducts.
One of the most important things to remember when dealing with sore nipples is to keep nursing on both sides, even if one is painful and the other isn’t. If you favor one side over the other, not only can you do damage to your milk production, but you’ll most likely wake up to find one breast two times the size of the other. It’s also important to know that most breastfeeding woes are temporary and most likely normal. Before you know it, your nipples will take to nursing as if they were designed for it.