Breastfeeding Basics: Engorgement and Mastitis

Hundreds of years ago, when it really took a village to raise a child, breastfeeding moms had only to look left or right to get the support they needed when something seemed awry. Nowadays, we come home from the hospital and plant ourselves — by ourselves — in our oh-so-beautiful nurseries, hoping our well-meaning houseguests don’t barge in on us half-naked with the babe at the boob.

So it’s no surprise we often miss the warning signs of some of the breastfeeding biggies — engorgement and mastitis — which, left to their own devices, can be the downfall for a nursing mom. If you and baby are working in sync, breastfeeding shouldn’t be painful, says Rosenfeld. Pain is a sign that something’s not right, and with a little help from a lactation consultant or doctor, you can — and should — keep right on breastfeeding.

Below, certified lactation consultant Freda Rosenfeld points out the warning signs of engorgement and mastitis and shows you how to prevent pain from hijacking your nursing experience.

When you might notice engorgement. On about Day 3 after birth, your milk comes in. Virtually all women have some hardness or engorgement. The better the baby nurses, the less likely you are to get engorgement. In these first few days, you want to nurse on the baby’s schedule. The more frequently you nurse baby, the more your body will adjust and the more you can drain your breasts.

How to spot engorgement and what to do about it. If the baby is not draining the breast, or you’re making too much milk, you might need help. You can try putting ice on your breast because it reduces inflammation. Sometimes people use green cabbage leaves — cabbage has similar properties to ice and constricts the blood vessels. If that doesn’t do the trick, then there’s something else going on. When your areola gets too hard for the baby to latch, or your breasts feel red or hot, those are signs that something is not good. There are some medical issues that cause engorgement; women who have thyroid issues or retain placenta are often women that make too much milk. If by Day 6 you’re not feeling engorgement resolving, it’s time to call a lactation consultant.

Engorgement vs. clogged milk ducts. Clogged milk ducts in your breast can be a variation of engorgement. These can be pockets of hard spots — it may not be that the whole breast is hard as a rock — but that too can lead to mastitis if you don’t address it. If your baby is 5 weeks old, but suddenly you have a hard spot, you can try a warm compress, but if it doesn’t get better, call in a professional.

Engorgement can lead to mastitis. If engorgement is left untreated, it can lead to mastitis, which is an infection of the breast. Mastitis can be extremely dangerous. The best way to avoid mastitis is to nurse as much as you can so that you and baby get off to a good pattern. Before we assume you have mastitis, a professional may be able to suggests techniques that will help reduce the engorgement and help baby drain the breast. But once you’ve determined that you have mastitis, it needs to be treated with antibiotics, so call your doctor. You can continue to nurse with mastitis, even while you’re being treated.

Nursing on both breasts helps mastitis. More often than not, mastitis is unilateral, so you need to get into a pattern where you are nursing on both breasts and emptying both breasts at the same time. Depending on the way your body produces milk, a professional could give you advice on varying breasts for nursing and determine if that’s safe, but you shouldn’t make that choice without the help of a lactation consultant or a doctor.

Repeat mastitis might mean something’s wrong. If you’ve had mastitis three times, something is wrong. There’s lots of ways to slow your milk flow besides ice, so you should seek help to evaluate your milk supply, nipple conditions, baby’s sucking or other issues. Pain is a horrible thing and can be caused by many things, but with most women, we can find a way to make it better and continue nursing.

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