Breastfeeding: Medical solutions for engorgement, breast engorgement, and milk shortage Breastfeeding 🤱🍼

Nirupama (age 25) came to my clinic last Tuesday, a new mother who had given birth to her first child 4 days earlier. She was extremely tired and tearful.

"Dr. Priya, both my breasts are hard as rocks and hurt terribly. The baby is crying because he can't latch on to the nipple. I wonder if I don't have enough milk to give the baby," Nirupama described her fear and pain.

I calmed her down and explained: "Nirupama, you are facing a very common condition known as breast engorgement in medical terms. In the first week after delivery, the breasts swell and become hard due to the simultaneous influx of blood and lymph fluid into the breasts and the production of milk. Then, the nipple and the dark area around it (areola) flatten and stretch, making it difficult for the baby to latch on properly. Many people think that this is 'lack of milk' (lack of milk). But in fact, in order for milk to flow , the let-down reflex must be activated. The flow of milk is controlled by the hormone oxytocin, which is released from the pituitary gland in the mother's brain. Today, let's see how to control breast engorgement and breastfeed correctly."

🚨 Red Flags that require immediate medical attention

Normal breastfeeding discomfort will go away in a few days, but you should see a doctor immediately if you experience any of the following warning signs:

• Severe pain, tenderness, redness, and fever in only one breast (this may be a sign of mastitis, a breast infection).
• Severe nipple discharge or bleeding, cracked nipples, or soreness.
• The child is showing signs of dehydration - such as urinating less than 6 times in 24 hours, dark yellow urine, excessive sleepiness, or weight loss.
• The baby's birth weight does not increase steadily even after 10 days after birth.

Main causes of insufficient milk supply

Many mothers, even though they don't actually have a shortage of milk, reduce their milk production due to incorrect methods:

• Poor Latch: The baby is not latching on to the breast properly, resulting in milk not being removed properly.
• Decreased breastfeeding frequency: Not breastfeeding for more than 3 hours.
• Use of artificial milk and soups: Feeding formula to the baby reduces the amount of breast milk he or she drinks.
• Stress and fear: When the mother is under severe stress, the secretion of the hormone oxytocin from the pituitary gland is inhibited and the "let-down reflex" is deactivated.

How to control breast engorgement?

Follow the following steps when your breasts become tight, according to physical therapy and clinical advice:

1. Warm Compress Before Breastfeeding: Placing a warm towel on your breasts for a few minutes before breastfeeding or taking a warm shower can help relax the milk ducts and make it easier for milk to flow.
2. Manual Expression: If the breast is too engorged, manually express a little milk until the area around the nipple is soft enough for the baby to latch on.
3. Feed frequently and regularly: Feed whenever the baby asks (Responsive feeding) or at least every 2-3 hours. Feeding at night is also essential.
4. Cold Compress After Breastfeeding: After breastfeeding, place an ice pack on the breasts to reduce swelling and pain. Placing washed, cleaned, and refrigerated cabbage leaves on the breasts is a method recommended by both local and Western medicine.

Correct Breastfeeding Positioning & Latching

• Chest-to-Chest: Turn the baby's entire body toward the mother, keeping the baby's chest close to the mother's chest.
• Chin on Breast: The baby's chin should be pressed against the breast.
• Opening the mouth wide: The baby should open his mouth wide and take in not only the nipple, but also most of the dark area around it.

Do's & Don'ts

Scientific sources (References)

• 📚 Breast pain and breastfeeding - NHS
• 📚 ABM Clinical Protocol #20: Engorgement, Revised 2016 - PMC