Breast Engorgement

Breast engorgement usually occurs on the 3rd or 4th day of the postpartum period when the milk production in the breasts rises.

Anatomy of the breast

Each breast gland is composed of 20 lobules that are drained by 20 lactiferous ducts. These ducts open on the tips of the nipple.

Milk is formed in the lobules from the mother's blood and carried by the lactiferous ducts to a structure called the ampulla where some of the the milk is stored. The initial milk that is sucked by the baby comes from the ampulla and the later part from the lobules.

Immediately after the baby is delivered, and another for 3 - 4 days, the breasts secrete a thin yellowish liquid called the 'colostrum'. The amount of colostrum secreted is adequate for the baby in these days.

But as the baby's need increases and suckling becomes more vigorous, there is increased production of milk in the baby. Blood supply to the breasts rises.

The increased blood supply to the breast causes engorgement of the breast tissues which presses on the ducts, damming the milk in the lobules. As the breast tissue gets more and more engorged, it pulls on the nipple, flattening it, or even inverting it. The baby may be unable to suck out all the milk from the breast from the flattened nipple, causing more stagnation.

Both increased blood supply and stagnation of milk are responsible for breast engorgement.

Signs and Symptoms of Breast Engorgement

The general body temperature may rise slightly. A low rise of temperature of about 1 -2 degree on the 3rd or 4th postpartum day usually indicates mild or moderate engorgement of the breasts.
Pain and tenderness in one or both the breasts may be present. The breast which is engorged feels tense and heavy and acutely painful on movement.
The nipples may be edematous and flushed. If the breast is greatly engorged, the nipples may appear to be retracted into the surrounding skin.
General malaise There may be a general feeling of ill health with loss of appetite, general weakness, fatigue and chills in breast engorgement.

Management / Treatment of Breast Engorgement

The breasts should be supported by by well fitting brassieres. Nursing Bras without wires that hold the breasts firmly should be advised. Wires in the breast may occasionally press on the ducts and prevent adequate expression of milk.
The accumulated milk should be removed from the breast manually or by a breast pump, preventing stagnation.
Regular breastfeeding should be continued. This causes the breast to empty out. It also maintains the flow of milk.
Pain relieving tablets (Analgesics) should be given for the pain.
The breasts should be kept as clean as possible to prevent breast abscess formation.
If there is cracked nipple however and breastfeeding is very painful, it is better to use a breast pump to express the milk rather than to continue breastfeeding.
Clean vaginal pads must be used and changed frequently to prevent bacteria spreading to the breast.

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