Engorgement

• Give analgesics.
• Encourage mother to avoid wearing garments that constrict portions of the breast.
• Encourage frequent feedings, every 1½ to 2 hours during the day, every 3 to 4 hours during the night.
• Do not limit the length of the feedings.
• Use different positions to empty all areas of the breasts.
• Encourage her to take warm showers with the nozzle directed onto the mother’s back between her shoulders. She should lean forward slightly and massage her breasts, hand expressing milk until she is comfortable.
• Apply warm, moist compresses for 10-15 minutes before feedings. Or she can immerse her breasts in a basin of warm water.
• Gentle massage is encouraged.
• Use hand expression to soften the areola.
• Encourage gentle pressure to soften 1-2 inches around the base of nipple and areola. This helps to move swelling upward and away, also known as reverse pressure softening.
• Apply cold compresses after feedings for comfort and to reduce inflammation.
• Breast shells may be worn for about 20 to 30 minutes before a feeding; expect some leaking.
• If engorgement is not relieved by the measures mentioned above, use a hospital-grade electric pump on a low suction mode before feedings. Short term pumping may relieve engorgement will not excessively increase milk supply.
• For alternative measures and severe engorgement refer to the ABM Clinical Protocol #20.

Clinical Guidelines 

• Mitchell, K., Johnson, H., Rodriguez, J.,Eglash, A. (2022). ABM Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), 360-376.

References

1. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
2. Cotterman, K. J. (2004). Reverse pressure softening: a simple tool to prepare areola for easier latching during engorgement. Journal of Human Lactation, 20(2), 227–237. 
3. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier. 
4. Mangesi, L., & Zakarija-Grkovic, I. (2016). Treatments for breast engorgement during lactation. The Cochrane Database of Systematic Reviews, 2016(6), CD006946. 
5. Witt, A. M., Bolman, M., & Kredit, S. (2016). Mothers Value and Utilize Early Outpatient Education on Breast Massage and Hand Expression in Their Self-Management of Engorgement. Breastfeeding Medicine, 11, 433–439.