How to care for your breasts when they're engorged
What to do if you have engorgement
Here's what to do if your breasts are engorged.
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Offer your baby frequent flexible breastfeeds. You can find out about the importance of this here.
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Make sure there is no nipple and breast tissue drag when baby is feeding and ensure positional stability. You can find out about breast tissue drag starting here.
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Reverse pressure softening of the areola may help a baby who is having difficulty coming on due to engorgement. You can find out about reverse pressure softening, including a video demonstration, here.
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Hand expression of your milk is not as effective as a vacuum for milk removal but has a place in the management of engorgement for some women. Hand expression risks backpressure and micro-vascular trauma in a very tight full breast, and should be used carefully, without causing pain. You can find a demonstration of hand expression here.
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Regular anti-inflammatories may help if you have a severe engorgement, though there haven't been research studies on this. Anti-inflammatories may help interrupt the cycles of raised pressure in the breast stroma or connfective tissue caused by interstital or tissue fluid, which occludes your milk ducts, which then causes worse swelling. (Having frequent let-downs from frequent flexible breastfeeds or gentle hand expression in a warm shower is, to my mind, by far the most powerful way of doing that though.)
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Some women with very generous breasts might benefit from gentle movement of the breasts with the palms of their hands, as long as this doesn't cause pain. Pain is your body's warning that something isn't right, and we do need to listen to this.
What doesn't help with engorgement?
You can find about about the things that don't help with engorgement here. For example, the following things (that you might hear advised) don't help.
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Application of cabbage leaves
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Hot or cold compresses
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Acupuncture
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Therapeutic ultrasound
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Enzyme therapy or probiotics
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Lymphatic drainage or therapeutic breast massage. You can find out about this here.
