Breast Engorgement

Subject: Midwifery III (Theory)

Overview

Breast engorgement develops in the mammaries as a result of the expansion and pressure exerted by the synthesis and storage of breast milk. Engorgement commonly occurs as the breasts transition from colostrum to mature milk. Breast engorgement is caused by a mismatch between milk supply and newborn demand. Breast engorgement can occur due to four main factors, including a sudden increase in milk production, which is common in the first days after the baby is delivered, or when the baby abruptly stops breastfeeding, either because it is starting to eat solid foods or because it is ill and has a poor appetite. Breast engorgement can also occur when the mother does not a nurse or pump the breast as frequently as she should. Suggest to the mother how to reduce breast engorgement.

Breast engorgement develops in the mammary glands as a result of the expansion and pressure exerted by breast milk synthesis and storage.

Engorgement typically occurs as the breasts transition from colostrum to mature milk. However, engorgement can occur later if lactating women miss numerous nursing sessions and do not release enough milk from the breasts. Inadequate nursing and/or clogged milk ducts can aggravate it. Breasts that are engorged may swell, throb, and produce mild to severe pain.

Causes

  • Breast engorgement results from a mismatch between milk supply and newborn demand. It frequently develops in women who choose not to breastfeed.
  • Breast engorgement can occur as a result of four major factors, including a sudden increase in milk production, which is common in the first few days after the baby is born, or when the baby abruptly stops breastfeeding, either because it is starting to eat solid foods or because it is ill and has a poor appetite. Breast engorgement can also occur when a mother does not nurse or pump her breasts as frequently as she should.
  • The quantity of colostrum is swiftly replaced by increasing milk production after the first 3 to 4 postpartum days. When milk production increases rapidly, the volume of milk in the breast can exceed the capacity of the alveoli to store it, and if the milk is not evacuated, the alveoli become over-distended, potentially leading to the rupture of the milk-secreting cells.
  • Milk accumulation and engorgement are key causes of apoptosis, or programmed cell death, which results in involution of the milk-secreting gland, milk resorption, collapse of the alveolar structures, and termination of milk supply.
  • Severe breast engorgement can cause flattening of the nipples or inverted nipples, making it impossible for the baby to suck out all of the milk from the breast. This is one of the most common causes of milk stagnation in the breast.

Clinical features

  • Significant pain and tenderness or heaviness in both breasts.
  • Malaise in general, or even a brief spike in temperature.
  • Breastfeeding is excruciating.

Management

  • Before each breastfeeding session, place a warm, damp towel on the breast for 5-10 minutes or take a warm shower.
  • Before breastfeeding, express a small bit of milk manually before placing the infant on the breast. This softens the skin around the nipple and promotes milk flow.
  • Breastfeeding should be done at least every 2-3 hours. If the baby cannot suck, express milk every 2-3 hours.
  • At each feeding, empty the first breast before offering the baby the other breast.
  • Encourage her to feed longer or express breast milk for a few minutes if her breast still feels full after breastfeeding.
  • After nursing, place a cool cloth on both breasts for 5-10 minutes to help shut the milk ducts and make the breast more comfortable.

    Other ways to provide comfort to the mother include:
  • Avoid wearing a tight-fitting brassier.
  • Between feedings, apply a cold compress to the breast to help reduce swelling and pain.
  • Place cold cabbage leaves on top of the breast.
  • Explain the symptoms of breast infection and that the mother should seek medical attention if she experiences any of the following symptoms: pain, redness, heat, lump, and so on.
  • In cases when the breast remains tight despite sucking and expression, give a pill of pyridoxine 100mg BD for a few days to reduce engorgement.
Things to remember
  • Breast engorgement develops in the mammary glands as a result of the expansion and pressure exerted by breast milk synthesis and storage.
  • Engorgement typically occurs as the breasts transition from colostrum to mature milk.
    However, engorgement can occur later if lactating women miss numerous nursing sessions and do not release enough milk from the breasts.
  • Inadequate nursing and/or clogged milk ducts can aggravate it.
  • Breasts that are engorged may swell, throb, and produce mild to severe pain.
  • Breast engorgement results from a mismatch between milk supply and newborn demand.
  • It frequently develops in women who choose not to breastfeed.
  • Breast engorgement can occur as a result of four major events, including a significant rise in milk production, which is frequent in the first few days after giving birth.
  • Breast engorgement can also occur when a mother does not nurse or pump her breasts as frequently as she should.
  • Inform the mother about how to reduce breast engorgement.
  • Before placing the baby on the breast, advise the mother to place a hot wet clean cloth on the breast for 5-10 minutes or to take a warm shower, and to manually express a small amount of milk.
  • This softens the skin around the nipple and promotes milk flow.
  • Advice the mother on other comfort measures such as avoiding tight-fitting brassier, applying a cold compress to the breast between feedings to help reduce swelling and pain, and applying cold cabbage leaves to the breast, as well as explaining the signs of breast infection and that the mother should seek medical attention if she has any of these symptoms.
Questions and Answers

As breast milk is produced and stored, it expands and puts pressure on the mammary glands, causing breast engorgement. Typically, engorgement occurs when the breasts transition from colostrum to mature milk. Engorgement, however, can also develop later if a breastfeeding woman skips many feedings and fails to release enough milk from her breasts. Insufficient nursing and/or clogged milk ducts may make it worse. The breasts may swell, throb, and hurt in a mild to severe way when they are engorged.

  • A discrepancy between milk production and infant demand results in breast engorgement. When a woman decides not to breastfeed, it frequently happens.
  • There are four main reasons why breast engorgement can happen, including a sudden increase in milk production, which is typical in the first few days after the baby is born, or when the baby abruptly stops nursing, either because it is starting to eat solid foods or because it is ill and has a poor appetite. When a mother does not breastfeed or pump her breasts as frequently as usual, breast engorgement may also result.
  • The amount of colostrum is immediately replaced by an enhanced milk production after the first three to four postpartum days. When milk production grows quickly, the amount of milk in the breast may be more than the alveoli's capacity to hold it. If the milk is not evacuated, the alveoli may become overextended, which might cause the milk-secreting cells to rupture.
  • Apoptosis, or programmed cell death, which results in the involution of the milk-secreting gland, milk resorption, collapse of the alveolar structures, and the end of milk production, is primarily triggered by milk accumulation and the engorgement that follows.
  • The nipples may become flattened or inverted as a result of severe breast engorgement, which prevents the baby from sucking out all of the milk from the breast. This is one of the typical reasons why milk in the breast stagnates.
  • Give the mother advice on how to lessen breast engorgement. Give your mother the following advice:
    • Take a warm shower or apply a hot, clean cloth to the breast for 5 to 10 minutes before nursing.
    • Manually express a tiny bit of milk prior to breastfeeding before placing the infant on the breast. This facilitates milk flow by softening the region around the nipple.
    • At least every 2–3 hours, breastfeed. Every two to three hours, if the infant is unable to sucke, express milk.
    • Before presenting the baby with the other breast during each feeding, empty the first breast.
    • Encourage her to feed more time or express breast milk for a few minutes if the breast feels still full after breastfeeding.
    • After breastfeeding, place a cold compress on both breasts for 5–10 minutes to help close the milk ducts and improve breast comfort.
  • Give the mother other comforting suggestions like:
    • Keep your brassier loose-fitting.
    • In order to lessen pain and edema between feedings, apply a cool compress to the breast.
    • The breast with chilled cabbage leaves.
    • Describe the symptoms of breast infection and urge the mother to consult a doctor if she has any of them, such as discomfort, redness, heat, lumps, etc.
    • Give a 100mg BD tablet of pyridoxine on specific days to relieve engorgement if the breast is still tight despite sucking and expression.

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