If you are demand feeding, your breasts should not be engorged although they may feel full. Full breasts are normal; they feel uncomfortable but are relieved when the baby sucks. However, if you do become engorged, the milk will not flow due to a build-up of tissue tension and you could feel thoroughly miserable particularly if you are experiencing third day blues’.

Oxytocin, the hormone which is produced to signal the release of milk, may not be flowing adequately because of the presence of the hormones of pregnancy, progesterone and oestrogen. As a result of this hormone cocktail carousing through your system, days three and four are often grim. To prevent engorgement which is common on these days, the baby must be put to the breast frequently to stimulate the release of oxytocin and get the milk flowing.

Symptoms of engorgement. The breasts are hard, lumpy and tender and the skin is pulled taut. The milk does not flow, but only drips out in small quantities and the nipple is flattened because of the pressure in the breasts. Do not allow the baby to suck on a nipple that is flattened because of engorgement; she will not be able to grip properly and you will get sore nipples.

Although the breasts must be drained to ease the engorgement, they must first be softened before the baby is allowed to suck.

Treatment of engorged breasts. For severe engorgement you will need the help of an oxytocic drug to get the flow going. Ask your doctor to prescribe:

1 tablet buccal pitocin to be taken immediately, place between the cheek and gum and allow to dissolve.

Stand under a hot shower and allow the water to splash on your breasts. Soap your hands well and massage gently with the palm of your hand in a downwards direction, from your armpit towards your nipple.

Lean forward as you massage so that the milk can drip out. It may take quite a while and be initially painful, but persevere until your breasts are considerably softer and the nipple is no longer flattened.

Do not pummel or pull the skin of the breasts as you could cause damage. The soap is to make your hands glide easily and prevent dragging. Do not soap the nipples. As soon as your breasts are no longer painful and the area round the nipple is pliable again, feed your baby to help drain the milk. If your baby will not take a good feed, ask for an electric breast pump so that you can express most of the milk.

If your breasts are painful you must be given an analgesic. Paracetamol or aspirin are best but if you are given a codeine cocktail’ ask for a senna based laxative as well, because codeine is very constipating.

If the above methods do not bring relief, your doctor may prescribe a quick-acting diuretic (a drug which removes excess fluid from the body).

Take a quarter tablet buccal pitocin 10 minutes before every feed until the flow is satisfactory and the engorgement subsides.

Feed your baby as often as possible and feed during the night as well.

Severe untreated engorgement can cause the milk producing and expulsion cells to become damaged or to atrophy so that they no longer function properly. Therefore it is vital to treat engorgement properly and urgently since successful breast feeding may depend on it.


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