Easing Engorgement in the Early Days of Breastfeeding

By: Courtney Miller, RN, BSN, IBCLC – Founder of The Better Boob Lactation

Welcoming your baby into the world is an exciting and emotional time — but it can also come with a few physical surprises. One of the most common challenges in the first few days after birth is engorgement. While it’s often a sign that your milk is “coming in,” the discomfort, swelling, and fullness can feel overwhelming.

The good news? With the right approach, you can find relief and get back to enjoying those early days with your baby.

Understanding Engorgement

Engorgement happens when the breasts become overly full of milk, blood, and lymphatic fluid. It usually occurs between days 2–5 postpartum as your milk supply increases. The breasts can feel hard, warm, swollen, and tender, and the areola (the darker area around the nipple) may feel tight.

In the past, engorgement was viewed solely as an “oversupply” problem, but we now understand it as a combination of increased milk volume and inflammation in the breast tissue. This inflammation can make it harder for milk to flow — creating a frustrating cycle of fullness and discomfort.

Common Causes in the First Few Days

Engorgement is a normal physiological change, but certain factors can make it worse:

• Delayed or infrequent feedings

• Baby having trouble latching or staying awake at the breast

• Excessive supplementation with formula or expressed milk without removing milk from the breast

• Separation from your baby after birth

• A history of oversupply

• Excess IV fluids during labor — If you received a large amount of IV fluids (for example, with an epidural), some of that extra fluid can collect in your breast tissue, making swelling and firmness worse. Gentle lymphatic drainage massage can be especially helpful in these cases to move that fluid away and improve comfort.

  
  

Gentle, Effective Relief Strategies

Managing engorgement in the early days is all about reducing swelling, keeping milk flowing, and protecting your comfort.

1. Feed Often and Effectively

Offer the breast 8–12 times in 24 hours. Aim for deep, comfortable latches and avoid long stretches without milk removal. If your baby is sleepy or struggling to latch, hand express or pump just enough milk to soften the areola and help them latch more easily.

2. Reverse Pressure Softening

This gentle technique uses your fingers to press back on the areola, moving swelling away from the nipple area so your baby can latch more effectively. Even 1–2 minutes before feeding can make a difference.

3. Breast Gymnastics

A simple but effective technique, breast gymnastics involves gently moving your breasts in a circular motion, forward and back, and side to side to encourage fluid movement and milk flow. It’s a quick, non-invasive way to help relieve pressure before feeding or pumping. Pairing this with gentle lymphatic drainage massage can be especially effective.

4. Cold, Not Heat

While warm compresses can be used briefly before feeding to encourage letdown, cold compresses or ice packs after feeding are more effective for reducing swelling and discomfort.

5. Gentle Lymphatic Drainage Massage

Instead of aggressive breast massage (which can worsen inflammation), use light, feather-like strokes toward the armpit and collarbone to encourage fluid movement out of the breast tissue — especially helpful if swelling is related to IV fluids from labor.

6. Anti-Inflammatory Support

Ask your healthcare provider if you can take an over-the-counter anti-inflammatory like ibuprofen. This can reduce swelling and make feeding more comfortable.

7. Avoid Overpumping

It can be tempting to pump until your breasts are completely empty, but this can signal your body to make even more milk, prolonging engorgement. Pump only enough to relieve pressure.

Prevention Tips for the First Week

• Keep baby skin-to-skin as much as possible to encourage frequent feeding cues.

• Avoid tight bras or restrictive clothing that can put pressure on the breast.

• Work with an IBCLC early if latching is painful or milk removal is inefficient.

• Learn hand expression before birth so you feel confident using it when needed.

When to Seek Help

If engorgement is severe, not improving with frequent feeds, or you notice fever, chills, or red, wedge-shaped areas on the breast, contact your healthcare provider or a lactation consultant promptly.

The Bottom Line

Engorgement in the early days is common, but it doesn’t have to derail your breastfeeding journey. By focusing on gentle care, frequent milk removal, breast gymnastics, and inflammation management — especially if swelling is worsened by IV fluids during labor — you can find relief quickly and set yourself up for a smoother, more comfortable breastfeeding experience.

At The Better Boob Lactation, we’re here to guide you through every step — from your first latch to your final feed. If you’re struggling with engorgement or just want reassurance that you’re on the right track, reach out to schedule a consultation.