Breast engorgement should be differentiated from breast fullness and should not be confused with a transient increase in milk production. Breast fullness should not prevent a baby from latching on and feeding normally. Engorgement often stems from a delay or limitation in the duration and frequency of breast-feeding1 which can cause milk stasis. Milk backs up in the breast, the areola becomes flat and taut (which precludes adequate latch-on), feeding becomes increasingly difficult and breast tightness or hardness may develop. If the mother becomes feverish, she may have mastitis and will therefore require GP referral.
The number and duration of feeds should be monitored and may need to be complemented by milk expression using by hand or using an electric breast pump fitted with intermittent minimum pressure features, to prevent further trauma of the stretched breast tissue. Expression helps to soften the areola and facilitate easier latch on: gently massaging breast tissue before or during a feed may help the breast to empty properly.
Applying ice-cold flannels, gel ice packs or cold cabbage leaves may relieve pain and swelling, and intermittent use of breast shells may reduce engorgement while the breasts adjust to suit the baby’s demands for milk. Although there is no clinical evidence for the efficacy of cabbage leaves, sulphur and amino acids in these leaves may have antibiotic and anti-inflammatory effects, thereby increasing blood flow to the breast.2Changing feeding positions can sometimes help the baby to latch on more easily and empty the breast efficiently. Specialist devices can be used to draw out the nipple if it becomes flat due to engorgement. See: Mastitis

References

1. Snowden H M et al. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev  2001; 2: CD000046.

2. Nikodem V C et al. Do cabbage leaves prevent breast engorgement? A randomised controlled study. Birth 1993; 2: 61–64.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6). http://www.jfhc.co.uk/images/stories/breastfeeding.pdf