Week 1

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 nipples:

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.

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12 thoughts on “Caring for Your Newborn: A complete guide to the first week with your new baby

  1. says:

    If you plan on breast feeding, having formula in the house is an invitation to failure. Pleas consider NOT having “back up” formula. Instead have good breast feeding books (like The Womanly Art of Breastfeeding) & the number of a good lactation consultant.

  2. says:

    I agree entirely on not keeping formula in your house. Breastfeeding can take awhile to get a hang of, and that’s okay for the baby. That first week is such a vulnerable time, it’s easy to give in. If you need formula, your doctor will tell you at your one week appointment, or you can see a lactation consultant, and pick it up on the way home. It’s not that hard to stop by a drug store or get someone to stop for you if it’s needed.

  3. says:

    If you’ve decided to cloth diaper, I’d still use disposables for the first month or so. For one thing, it’s not particularly cost effective over disposables to buy that tiny size in addition to the bigger sizes or one size diapers. Also, figuring out a laundry routine for cloth diapers can take some experimentation and troubleshooting, which I think is better left for a little later on.

  4. says:

    This is a really well thought-out and written piece. Week one is so overwhelming, I’m glad it’s acknowledged and supported.

  5. says:

    I completely agree with the cloth diaper comment – and I’m glad this article pointed that out as well. While I’m a big fan of cloth diapers LATER, trying to use them in the beginning is a set-up for failure and a HUGE waste of what should have been an investment. I’d try them in a few months.

  6. says:

    Give yourself complete permission to do nothing that isn’t crucial to your infant’s (and your) survival in those early weeks. This probably means feeding the baby and yourself, changing the baby, and getting as much rest as possible. I am one of those people who can’t easily fall asleep, no matter how exhausted I am, so napping while my newborn took 30-minute “naps” just was not possible (and the people who cheerfully told me “just sleep when the baby sleeps!” became very irritating). Between that and breastfeeding every 90-120 minutes, exhaustion got me quickly and probably set me up for a few very rough months. So rest if you can, even if you can’t sleep, and ignore the guilt that might come along with seeing the laundry stack up.

  7. says:

    I breastfed my infant for over a year, but those early weeks were tougher than I ever expected. As much as I agree with not “caving in” by giving the baby formula early on, recognize that for some people, this *may* be a much-needed bridge to full-blown breastfeeding. In my case my milk didn’t come in for 6 full days and my lactation consultant from La Leche League didn’t get back to me for almost 36 hours, which is a lifetime when your baby is hungry and crying constantly and no one is sleeping. At day 5 we decided to use some formula and this covered us until my milk arrived. I beat myself up over this repeatedly (as did so-called “friends” who viewed using formula as practically the equivalent of giving the baby red Kool-Aid). Formula isn’t poison; try not to add guilt to everything else you’re probably feeling in those weeks.

  8. says:

    Excellent article Babble – bravo! I am mixed with the formula in the house debate. I only have one can and one bottle that someone gave me – low and behold a month later and I’m being rushed to the ER with a serious intra-uterine infection. My neighbors took our daughter and gave her her first bottle. They kept asking him how much she took and we were like “we have no idea!” we went right back to BFing when I got home from the hospital. but if we hadn’t had that one little can and lone bottle we would have really been up a creek and inconvienced our neighbors.

    I totally agree with the comment of don’t do anything that you don’t HAVE to. I am about as earthy as the come….but the first two weeks solid..we used paper plates and cups. It’s just a “pass” I gave myself. I threw all the laundry into the machine together and went to bed at 7 when the baby went “down for the night”

    DON”T FEEL GUILTY and DON”T LET ANYONE ELSE MAKE YOU FEEL GUILTY for doing whatever you need (within reason obviously!!!) to get by! This is even more true with subsequent babies

  9. says:

    I was so relieved at how easy it was to switch back and forth between breastfeeding and formula. I had been told that my baby, given a bottle, would never go back to the breast and that was absolutely not the case. It saved my health and sanity for my husband to be able to feed the baby overnight — and gave him (and my parental visitors) a chance to bond with her as well. If you must use breastmilk only, you can always pump, but I highly recommend getting used to not being the sole feeder early on. You will be grateful for the rest and your partner will be grateful to share such an important role.

  10. says:

    I agree with most of the advice in this article, however breastfeeding mothers should NOT keep formula in the house “just in case”. Breastfeeding can be hard in the beginning and having an easy out right under your nose is counter-productive. If the baby isn’t gaining well and you need to supplement, it can be easy enough to pick some up on the way home from the pediatrician’s office, as someone already pointed out. Also, pumping a little milk from engorged breasts will not make your body produce even more milk. It’s *emptying* the breast that signals the brain to produce more milk. Pumping or hand expressing a little to soften the breasts and allow the baby to latch easier, relieve the mother’s discomfort and prevent a plugged duct is absolutely fine.

  11. Jane says:

    I disagree with many of these comments. You should absolutely have a good formula on hand (organic!) even if you plan on exclusively breastfeeding. I had to go to the ER for postpartum hemmorhage when my son was just 10 days old, and I was there for 18 hours (had to have a D&C). I didn’t have time to pump before I went (obviously) and if I hadn’t had formula on hand at home, it would have been a lot more difficult for my sister to deal with at 3am in the middle of the night. And I’d rather have the best formula on hand than have someone run out and buy the crappy stuff, not to mention having a screaming hungry newborn who has to wait for them to go to the store and back and then make a bottle. Anyway, I believe in having formula on hand for other emergency situations (storms, earthquakes, etc). Be prepared! If you really want to breastfeed, you can do it and a bottle of formula in your pantry won’t deter you.

  12. Hi,

    Thanks for your valuable tips about Parenting. I am also a mother of 2 year old daughter and I know how naughty she is. Your tips is really helpful to calm in irritating situations as well

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