1. Understanding the Lactation Process and
Engorgement as a CALL TO ACTION!
During pregnancy and for a few days after birth, colostrum is present in the mother's breasts.
Colostrum is what nature provides for the newborn, and there are many reasons for this.
From: WebMD.com, medically reviewed by Poonam Sachdev, MD on 10/7/22, written by Roma Kunde, 'Colostrum'
'Colostrum ...has a sticky consistency and is thicker than breast milk or cow's milk. Although it is thicker, colostrum is still easier to digest than normal breast milk because of its low fat and sugar components. Because it is so nutrient-dense, the baby requires much less colostrum to meet its nutritional needs. About 1-4 teaspoons per day should be enough, as the newborn stomach is only the size of a marble.'
'Unless advised by your health care provider, don't try to squeeze it out, to minimize the risk of premature labor.'
'Colostrum contains your (the mother's) white blood cells (leukocytes), which produce antibodies (immunoglobulin A) that can defend against infection. When your baby consumes your milk, they get antibodies, which can strengthen their immune system.'
'What is Colostrum used for? Colostrum:
-Provides immunization
-Is a rich nutrient source
-Improves gut health
-Acts as a natural laxative
-Assists in body regulation
-Promotes growth
These numerous colostrum benefits are enough to make a case for initiating breastfeeding as early as possible after delivery.'
This is why nature provides colostrum for the newborn, and why parents should learn how to protect this gift for their baby.
Using natural breastfeeding techniques will enable baby to nurse effectively from birth so he / she will receive this gift of colostrum, without any interventions.
It is easier for baby to learn how to latch, during his first few days, when there is only Colostrum in the breasts, before the mature milk arrives.
The breast will be softer (not engorged), and the nipple accessible.
This gives mom and baby a few days to practice.
Usually, it only takes a few nursing sessions for baby and mom to learn effective latching and nursing when natural breastfeeding techniques are followed.
Baby has practiced latching onto a softer breast and can now handle the fuller breast, when the mature milk arrives around day 3 to 5 after birth.
2. Initial Engorgement
Sometimes it seems like nature gives moms enough milk for twins!
Moms often feel overly full or engorged when the mature milk
comes in, around day 3 to 5 after birth.
This initial engorgement can be managed by nursing the baby on cue.
Nursing the baby whenever he shows signs of rooting for the breast, for as long and as frequently as he wants, tells mom's body how much milk to make.
This is the Supply and Demand Mechanism of breastfeeding in action.
Baby and mother are a team. They are partners in customizing the amount of milk mom produces to the amount of milk baby needs.
A delicate balance is established when mother and baby follow natural breastfeeding techniques.
When mom follows baby's cues and nurses on 'demand', the amount of milk that mom makes, is controlled by baby's sucking.
It takes a little time, sometimes only a few days, for the balance to be reached between how much milk baby needs and how much milk mom is producing.
Nature is not wasteful. While an overabundance of milk may be produced in the beginning, mom's body will not continue to make more milk than baby needs for very long.
It will only supply the quantity of milk that baby's sucking demands.
Mothers who have breastfed a previous baby and who understand this process, will often avoid this initial engorgement. They nurse on cue and if they are feeling overly full, they will pick up baby and offer to nurse, even if she must wake him.
We do not recommend pumping as this tells mom's body to make even more milk, at a time when she is already engorged.
Note: We do not recommend pumping in the first 6 weeks.
Yes, pumping is helpful for moms who want to have expressed milk available when baby is older. But if you are experiencing any breast or nipple pain, know that pumping and bottles may be a contributing factor.
We do not recommend pacifiers, as the sucking that baby does on a pacifier is not telling mom's body to make milk but is satisfying his urge to suck.
This may contribute to a low milk supply.
We do not recommend nipple shields, as they can interfere with the sensations that mom's breast receives. This is different than when baby is on the bare breast.
Nipple shields may contribute to a low milk supply, sore nipples, blebs (milk blisters), and may interfere with the baby's microbiome.
WE DO recommend that mothers avoid products for the first 6 weeks and thus cooperate with the supply and demand mechanism of natural breastfeeding to establish their milk supply.
3. What to do if Mother is so engorged that the nipple flattens out.
Sometimes the mother is so engorged that the nipple has 'flattened out' and baby has a hard time latching on.
Try:
-place a cold wet washcloth on nipple, this helps to make nipple protrude
-hand express a little to relieve the fullness in the breast so baby can latch
-Reverse Pressure Softening - place a glass over the nipple with nipple in center of the mouth of the glass. Gently push glass into breast for a few seconds.
This acts to relieve some of the pressure so the nipple will protrude, and baby can latch.
4. Healing from engorgement:
-Breastfeed on demand for as long and as frequently as baby desires
-Breastfeed only in a position that helps: the Cradle Hold,
Lap Nursing Hold or Lying Down position.
-Keep baby close so that you can see and follow his cues to nurse
-Cold, wet compresses, such as wet washcloths, may reduce swelling
-Avoid pumping and using bottles. If baby won't latch and the engorgement continues and you need to pump, try pumping only for your comfort, not to empty the breast. The idea is to have baby's nursing be the guide to tell your body how much milk to supply. Pumping signals your body to make more milk and if you are engorged, you don't need more milk!
-Stand in the shower, let warm water run over your back. Try hand expressing in the shower.
This is not to save the milk; it is to relieve the engorgement pressure so the nipple will protrude, and baby can latch.
Nurse baby immediately after the shower when the nipple protrudes.
5. Engorgement may happen as baby grows,
CALLING FOR A RETURN TO BASICS.
Engorgement may happen at other times, as baby grows.
We encourage you to listen to your body. If your breasts are feeling overly full,
if you have been away from baby longer than usual, a 'reminder flag' should go up. The flag says, 'IT IS TIME TO NURSE!'
The flag means 'It is time to nurse!'
Avoiding engorgement helps to avoid other breast issues.
Ignoring engorgement (which is hard to do), may lead to more serious problems.
Here is another call to action, a call to review how baby is nursing and to learn what may have caused the engorgement.
The basics of effective, comfortable breastfeeding include only 3 things:
baby, mother, and natural breastfeeding techniques.
Recall that the breast is like a manufacturing site that operates 24/7.
It expects to produce milk according to baby's sucking schedule. It expects to let down the milk and to produce more milk for the next feeding.
If baby sleeps longer at night or too many feedings are skipped for other reasons, mom may get engorged.
If bottles or pacifiers take the place of regular breast feedings, the mom's breast may be overly full. It expects to be emptied by the nursing baby but is not for whatever reason.
For example: Think of a baby who is a 'big attraction' at a family event.
Think adorable 6-week-old baby being passed around to all the bridesmaids, bridesmaids who have 'baby-fever', at a wedding reception. A pacifier had been introduced for 'just in case baby cries during the wedding ceremony'.
Mom may miss baby's cues, when he needs to nurse, as the bridesmaids hold him and are keeping him entertained.
Then, baby may sleep extra-long after all the excitement of meeting his extended family and he misses a couple feedings.
At this point mom will feel overly full. That fullness is a call to action for mom. This is the cue for mom to breastfeed baby, to relieve the fullness. The sooner the better!
6. Hyperlactation - Oversupply Syndrome
A question to ask when a mom is told that she has Hyperlactation - Oversupply Syndrome.
- How was nursing handled during the first 6 weeks, during the initial lactation period? How is nursing handled currently?
Did the mom nurse on demand, nursing whenever her baby asked (whenever he was rooting and fussing) until he is put on the breast?
Or was baby nursing AND mom was pumping whenever she felt overfull, instead of just nursing and allowing the supply and demand mechanism of breastfeeding to work?
Pumping, in this case, tells the mom to produce more milk than the baby needs.
This is not a case of 'Hyperlactation or Oversupply Syndrome'. This is a case where the pumping interfered with the natural supply and demand mechanism of breastfeeding and hence, too much milk was supplied.
Waiting to pump until baby is 6 weeks old gives the mom's body time to customize the milk supply to baby's needs.
Recall that all moms will go through an initial engorgement phase when the mature milk first comes in. This engorgement is best managed by nursing on demand, and by avoiding pumping.
We see many moms being told to pump from birth, even before birth
(for colostrum harvesting).
This:
-interferes with the supply and demand mechanism of breastfeeding
-which can cause too much milk to be produced
-moms are then told that they have 'Oversupply Syndrome'
-moms then lose confidence in the natural process of breastfeeding to regulate the milk supply according to the needs of the growing baby
-moms attempt to control the milk supply by pumping
-moms will be spending a lot of time pumping, cleaning bottles and pump parts, researching pumping and hyperlactation,
instead of just nursing their baby on cue
It makes sense that breastfeeding would have a mechanism to nourish a
constantly growing baby without needing the mom to manage it.
This is the amazing supply and demand mechanism of breastfeeding.
From the beginning of humankind, mother's milk supplies have increased according to the needs of the growing baby, and gradually decreased as the baby went through the weaning process, controlled only by the baby's sucking.
To recap: please look at the mom's nursing and pumping history, before saying that she has 'Over Supply Syndrome or Hyperlactation'.
This term: 'Over Supply Syndrome and Hyperlactation', became very popular, at the same time that poor positions started being taught and pumping promoted, instead of natural breastfeeding techniques.
Mothers usually have what seems like enough milk for twins in the beginning, then the milk supply is customized to be the correct amount to nourish the baby, while not over producing. Nature is not wasteful.
This initial abundance of milk is not an ongoing condition or 'syndrome'.
It is a natural part of establishing lactation.
7. Plugged Milk Ducts
A milk duct is a small tube that carries milk from the lobes in the breast to the nipple. There are many milk ducts (lactiferous ducts) and lobes in each breast.
A plugged milk duct presents as a sore spot on the breast. Usually there is redness, a painful lump, and swelling.
Plugged ducts may be caused by:
-Improper positioning which leads to baby not effectively emptying all the milk ducts in each breast
-Time between feeds is prolonged
-Bottles or pacifier are given instead of the regular feeding
-Overly tight bra
For information on breastfeeding positions that help see
8. Healing from a Plugged Duct:
To heal from a plugged duct, try the following:
-Make sure you are using a breastfeeding position that HELPS:
the Cradle Hold, Lap Nursing Hold, or Lying Down Position.
Look at the pictures of each position in this website to see which hold is the one you are using.
Lactation literature often call positions by different names.
-Nurse as much as baby desires. Start on the breast with the plugged duct. Baby nurses more vigorously when he is the hungriest.
-Baby's sucking often helps to relieve the plug.
-Take a shower, let the warm water run down your back.
Then immediately nurse your baby. Sometimes the warmth and baby's sucking removes the plug.
-Avoid restrictive bras. Go without a bra as much as possible.
Make sure that your bra is the correct size for your body after going through pregnancy and while breastfeeding.
-Try to rest with baby as much as possible.
-Plugged ducts often improve in 24 hours, with these suggestions.
9. MASTITIS
Mastitis is an infection of the breast caused either when:
1) bacteria enter through a cracked or sore nipple or
2) due to ineffective milk drainage of the breast.
Mastitis can occur due to a blockage, a plugged duct.
Mastitis causes inflammation of the breast tissues with pain, redness and swelling. There may be flu-like symptoms such as fever, chills, fatigue, and body aches.
And while mastitis can make breastfeeding uncomfortable, it is very treatable.
10. Treatment for mastitis includes:
-Nursing in an effective breastfeeding position, such as the
Cradle Hold, Lap Nursing Hold or Lying Down position, always with
an effective latch.
Baby will drain the breast more effectively in these positions and sore nipples will heal, preventing any further damage to nipples.
-Nurse as much as possible, as much as baby is willing.
Baby is the best pump.
-Start on the most engorged side first, so that baby will reduce the engorgement before he falls asleep.
Usually, one would alternate sides when starting feedings, but
if one side is in more pain from engorgement than the other side, we suggest starting on the more engorged side first.
Once the engorgement is reduced, go back to alternating the side you start nursing on.
-Rest as much as possible. Ideally Mom will nurse baby and someone else will do all the other baby care and house care tasks.
-If flu-like symptoms occur, especially a fever, talk to your health care professional, you may need antibiotics.
-Delaying care for mastitis could lead to a Breast Abscess.
Treat mastitis as soon as possible.
Yes, a mother with mastitis is sick. She needs immediate care so that she will heal and be able to care for the baby.
Our society is not always empathetic with breastfeeding moms, perhaps thinking that formula would be a better choice.
But mastitis is treatable, and the health benefits of breastfeeding for baby and mother far outweigh the inconvenience of having a mom sick for a period of time and needing help with baby.
11. To Prevent Mastitis:
-Learn and use one of the 'breastfeeding positions that help' and latch on properly so that the breasts are effectively drained while nursing and that nipples remain healthy.
-Nurse on demand, whenever baby asks.
Keep baby close so you can see when he needs you.
Mastitis may be the result of irregular nursing patterns.
-Avoid pacifiers.
-Pace yourself. Lactating Mamas are on call 24/7. Adding too many other activities to your days may cause you to get run down and thus susceptible to fatigue, illness and mastitis.
It seems that when a breastfeeding mom gets sick, it targets her breasts.
My 2 cents...
-Avoid sudden weaning to decrease the risk of engorgement.
-We do not recommend weaning because of mastitis, but when your baby does wean, we recommend that you wean gradually.
Gradual weaning avoids engorgement and other potential problems.
Mastitis presents with breast pain, redness, swelling, fever, and
flu-like symptoms.
12. Repeat Breast Infections
Questions to consider if you are having repeat mastitis / repeat breast infections.
-If you took antibiotics with your previous bout with mastitis, did you take the full course of the medicine?
-If you did not take antibiotics, with your previous bout with mastitis,
do you need to?
-Are your nipples cracked or sore? This can allow an entry point for bacteria into the breast, which may lead to mastitis.
Again, poor positions; the Cross Cradle Hold, Football Hold, Log Hold, and the
Laid Back Nursing position, often cause sore, cracked nipples which can lead to mastitis.
Positioning makes all the difference for effective, healthy, natural breastfeeding.
To learn how to use the natural breastfeeding positions that help;
the Cradle Hold, Lying Down or Lap Nursing Hold, see
-Are you run down and thus more susceptible to illness?
Yes, all moms are tired, but could fatigue be a contributing factor to repeat mastitis?
It could mean that there are just too many activities in your day right now.
Many moms find naps help a bit with the broken sleep, the 24/7 needs of a young baby, the needed recovery time from pregnancy and labor, and establishment of lactation.
Amazingly, women's bodies are created to handle all these things and thrive, but are there things we can do, like pace ourselves, napping, and eating as healthy as possible, that would keep us healthier?
Many of us head for the sweets when we are tired, but cravings for sugar are often a need for more protein, for more iron. My 2 cents...
-Are you drinking enough fluids? Fevers and inflammation as well as being a Lactating Mama, increase our needs for water and other fluids.
-FYI: The American Cancer Society states that:
'Inflammatory breast cancer has symptoms that are a lot like mastitis and can be mistaken for a breast infection. If you've been diagnosed with mastitis and antibiotic treatment doesn't help within a week or so, you might need a skin biopsy to be sure it's not cancer. Inflammatory breast cancer can spread quickly, so don't put off going back to the doctor if you still have symptoms after antibiotic treatment.'
13. Breast Abscess
A breast abscess is a complication of mastitis.
Delaying treatment for mastitis may lead to an abscess.
A breast abscess is a collection of pus in the breast tissue.
Minor surgery may be required to drain the abscess.
See the previous 'Preventing Mastitis' and 'Treating Mastitis' information and please see your health care professional ASAP.
Untreated mastitis may lead to a breast abscess.
For information on the causes and healing of sore nipples
see Sore Nipple Help.