By Tanya, IBCLC
You've spent the first few days after your baby's birth working on getting the hang of breastfeeding. Then, your milk comes in.
For most of us, the big event occurs once we're home and without hospital staff to help answer questions and provide support. So here is a general guide to what you can expect once your milk comes in, suggestions for dealing with engorgement, and suggestions on when to get help.
WHAT HAPPENS WITH YOUR BREAST MILK COMES IN?
Most moms notice that their breasts feel larger, heavier, and more tender sometime around the second or third day after birth (milk coming in after 72 hours is considered late). While most of us assume that the swelling is just an increase in milk, it's actually a combination of milk and other fluids (blood, lymph) which aid in milk production. The amount of breast fullness you experience appears to be somewhat individual.
Sometimes, generally, when breastfeeding isn't frequent or effective, this fullness can develop into engorgement, which means breasts are overly full, to the point of real discomfort. They often feel tight and hot and can appear shiny. You may run a slight fever, too. The most important thing you can do to prevent (and treat) engorgement is to nurse your baby frequently, making sure that she is latched well so she can effectively remove milk. If milk isn't being frequently removed, the swelling may worsen, causing more discomfort.
COMFORT MEASURES FOR ENGORGEMENT
1) Most importantly, make sure that your baby is feeding frequently (at least 8-12 times in 24 hours) and is well latched. Don't put any time limits on the baby's time at the breast, and allow her to “finish the breast” before moving to the other side.
2) Apply cold compresses (frozen peas will do in a pinch!) in between feedings.
3) If necessary, pump to relieve pressure. If your baby is unable to soften your breasts by feeding, or if your baby is not feeding frequently or effectively, you may want to consider hand expressing or pumping - just to the point of comfort.
4) Anti-inflammatory and/or pain medication. Breastfeeding Answers Made Simple recommends checking with your healthcare provider about the best anti-inflammatory or pain medication to take.
WHEN TO SEAK HELP
1) Anytime. Nearly all moms have questions and need support, so never hesitate to seek out help from a lactation consultant (IBCLC), a La Leche League leader, a Breastfeeding USA counselor, or your local WIC office breastfeeding peer counselor. Breastfeeding support works best when you get it early.
2) If your baby seems to be having difficulty nursing. Sometimes, when a mom's milk comes in, babies have difficulty latching - think to try to take a bite out of a basketball. Sometimes babies get a bit overwhelmed by the increased flow of milk, or suddenly start refusing the breast. Whatever the reason, if your baby starts having difficulty nursing, get help.
3) If you have concerns about your milk production. Some moms describe their milk coming in as a “non-event,” with no noticeable increase in milk production or swelling. Some moms experience delays in milk production and are concerned about their baby's intake. If either of these are the case for you, or if you have any other concerns about milk production, seek help.