Postpartum Engorgement: What’s Normal and What Helps
Lately, I’ve been receiving a lot of inquiries about the very normal experience of immediate postpartum engorgement.
Is this normal?
Is something wrong?
What’s in my armpit?
How do I get my milk to flow?
If this sounds familiar—or like what you’re going through right now—read on to get the info straight from the horse’s mouth (Academy of Breastfeeding Medicine Mastitis Protocol #36).
Let’s dive into this expected postpartum phenomenon: engorgement that occurs about 3–5 days after birth due to milk “coming in,” also known as lactogenesis II. For many of us (myself included), hearing that this is a typical process can be absolutely shocking. How can something so uncomfortable—painful, even—be normal?!
However, after the baby is born, this clinical situation—mostly due to edema and hyperemia—will improve if managed correctly.
So, how is it managed postpartum?
• Ice between feeds
Because engorgement is related to swelling, I usually tell my clients to think of treating it more like a swollen ankle rather than milk that’s “stuck” inside the breast (it’s not). Ice constricts blood flow, which helps reduce swelling and fluid buildup at the site.
• Hand expression (one of my favorite skills!)
Often more effective than a pump at this stage, hand expression can initiate milk flow more easily, move enough milk to reduce discomfort, and is especially helpful if your baby isn’t yet an efficient eater at the breast.
• Reverse pressure softening
Again, because engorgement is related to swelling, the areola can become swollen and taut, making it difficult for the baby to latch. By manually pushing some of the fluid away from the areola and back into the lymphatic system—especially when coupled with a few minutes of hand expression—it can make latching and milk expression much easier and less painful.
• Lymphatic drainage
To further manage swelling, lymphatic drainage massage can be very helpful (see here: [link]). Just remember—it’s gentle! Moving lymph fluid doesn’t take much force.
Engorgement can feel overwhelming, but it’s a temporary and very normal part of your body’s adjustment to breastfeeding. With gentle care, time, and the right techniques, most parents find relief within a few days. If your symptoms are worsening, you notice red areas, fever, or persistent pain, reach out to a lactation professional for assessment and support.
Reference:
Academy of Breastfeeding Medicine Protocol Committee. (2008). ABM clinical protocol# 18: use of antidepressants in nursing mothers. Breastfeeding Medicine, 3(1), 44-52.