In one sense, engorgement is part of a very normal process that prepares a new mother to breastfeed her infant. The breasts enlarge with mature milk and other fluids, typically within the first three to five days after birth. Up until this time, the breasts have colostrum, a highly concentrated first milk. This "liquid gold" is perfect for the newborn's tiny stomach and digestive system as he learns to milk the breast effectively. When he is ready to handle larger meals, the breasts are ready with more milk. Eventually, the breasts will settle into a pattern of making milk based on the infant's needs, as judged by how much he takes from them.

When the mature milk comes in, generally, there is no mistaking that it has arrived! The breasts are noticeably larger, and feel "full." There generally is no pain associated with this fullness, and while it may feel different - especially to the first time mom - it doesn't prevent a baby from nursing well. This fullness is completely normal, and technically isn't considered "clinical engorgement."

Clinical engorgement is a serious condition in which the breasts become so full that they feel like rocks. The swelling may extend well into the armpits and upwards towards the neck. The breasts are typically hot to the touch and painful, and interfere with a baby's nursing. Remember that in order to effectively nurse the breast, baby has to be able to compress the areola, the dark area surrounding the nipple. With true engorgement, baby can't get onto the breast far enough to milk the sinuses below the areola. It is a little like trying to nurse a basketball! Unfortunately, when that milk is not effectively removed, initially more milk will be added to these already distended breasts. If the condition isn't treated, the breasts will take this as a signal to cut back on milk production. Obviously, this is a condition to be avoided when possible, and treated quickly if it does happen!

If your baby is sleepy, keep him close by and learn to watch for cues that he is hungry and ready to eat. Babies will cycle in and out of deep sleep every 90 minutes or so, and in a light sleep stage will often nurse quite well. Look for baby's eyes to move under his eyelids, and smacking motions and noises from his mouth. He may suck on his hands as well. When you see these signs, go ahead and offer the breast to him. Don't wait for him to wake up and scream for his next meal!

Treating engorgement

Engorgement can happen - and generally, the more complicated your delivery the more likely it is to happen. Complications that include various pain medications during labor, and such interventions as forceps delivery and deep suctioning of the newborn, can make baby more sleepy and unreceptive to frequent breastfeeding. And for whatever reason, you may miss feedings. Sometimes, even when mom does everything "right," engorgement still happens. It is important to catch it as early as possible, and it is important to know how to treat it - just in case.