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The First Week: Engorgement

© Jessica Williams

Engorgement is when the breasts feel swollen or uncomfortably full; it is also one of the most common fears in the first week of nursing. This fullness happens when additional blood flows to the breasts along with some tissue swelling. This additional blood flow is Nature's way of preparing the breasts for the release of milk. Engorgement isn't something that always happens, but if it does, it shouldn't have to make breastfeeding difficult during this wonderful time. Understanding why it happens, and what you can do about it, can make a big difference.

During the first few days after the birth, your nursing baby receives colostrum from your breasts. Colostrum is yellowish, and is a little thicker and more transluscent than milk. Nursing on cue (when the baby is hungry, not on a schedule) during the first week stimulates your breasts enough to make the change from colostrum to milk.

The immunoglobulins and other protectants the colostrum provides are very important for your baby. Think of colostrum as a concentrated form of the nutrients and antibodies your breastmilk will give to your baby in the months to come.

Many mothers worry that their babies might need supplements (formula or glucose water) before the colostrum gives way to the more plentiful milk. In most cases, this is not true. A rare infant does need supplements if he or she is suffering from dehydration or other problems, but the vast majority of healthy babies thrive on colostrum for the first nursing days. Supplements may delay changes in the mother's milk during the first week, and the baby misses out on the benefits of colostrum. Understanding the importance of colostrum can deter you from using supplements.

The transition from colostrum to milk can take anywhere from a couple of hours after the birth to seven days; the average is two to six days A number of factors can determine when your milk "comes in." Being able to nurse the baby soon after the birth, nurse on cue, use a minimum of medications at birth and feel comfortable and at ease in your surroundings are all factors that can help the transition. These factors can also help prevent engorgement.

It can be a little surprising when your milk "comes in." Some mothers feel a fullness in the breasts, while others may become engorged. This fullness usually lasts anywhere from 24 hrs to 48 hours. Engorgement can come on suddenly and can cause a feeling of swelling, or tightness. If, at any time, your breasts feel very hard (with no way to dimple the breast), advice from a lactation consultant or La Leche League leader should be sought because severe engorgement can interfere with nursing. For mild or moderate engorgement, there are ways to relieve any discomfort you may have. The first and best remedy is to nurse your baby.

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