Ahh, engorgement. It’s an unpleasant but common sign of an important hormonal shift.

Giving birth triggers this hormonal shift in the new mom’s body. Usually, as a result of that shift, two to four days after giving birth, the mom will experience an abrupt increase in her milk supply. This happens around the same time as her baby’s stomach grows in size a bit to readily accommodate feeds that are larger than the previous colostrum (the first milk) that the mom had.

Though it won’t happen to everyone who gives birth, it’s pretty common for the new mom to experience some engorgement, where the breasts become firm or even hard as the milk supply increases. This happens because the body hasn’t regulated the milk production yet. In most situations, if it’s managed well, painful breast firmness will resolve within 24-48 hours. (If it’s not handled well, it may last up to ten days.)

When the breasts are engorged, the baby can have a hard time latching well and removing milk. Sometimes, as a result, nursing with engorgement becomes a vicious cycle: mom getting nipple damage from the baby’s shallow latch, the breast getting firmer as not enough milk comes out at feeds, the baby getting frustrated trying to get milk, and the breast pain worsening.

But it can resolve quickly, with the right support, and this just becomes a temporary setback.

The biggest thing to understand about fixing breast engorgement is this: milk must come out of the front of the breast (through the nipple, naturally), and lymphatic fluid must go out of the back of the breast.

When the mom’s breasts are engorged, there is milk in there, but there’s also a good bit of inflammation. Inflammation involves lymphatic fluid, and in engorged breasts, a lot of the firmness comes from the lymph. As a result, the milk is often somewhat trapped by the firm hold of the lymphatic fluid around it. And the baby can’t get a good latch with all that lymphatic fluid in there.

So simply getting the milk out of the front, as parents are often taught to do with engorgement, is essential, but it is inadequate to the task of fixing the engorgement. First, it helps to get the lymphatic fluid under control so that the baby can latch better and so that the milk can flow more readily.

Here are the basic steps to getting the lymphatic fluid to move back into the lymph nodes through gentle lymphatic drainage massage. It’s certainly possible for the mom to do this for herself; if her engorgement is severe, she’s likely to be in a lot of pain, and it can be very helpful (and loving) if if her partner or someone else close to her does this massage the first few times.

Here’s the basic methodology:

Someone procures unscented, food-safe oil for the mom to use on her breasts. (Olive oil or coconut oil are fine options.)

If the mom feels up to it, standing, she bends over at the waist and gently shakes her breasts for a minute. This helps free up some of what may be trapped so that it can move more easily. If this step is simply too painful to use the first time doing this, it’s okay to skip it and add it back in during the next round.

The mom puts a towel or something similar underneath her and lies flat on her back (on a couch, bed, etc.). The towel is to catch any excess oil. The mom lies on her back because the lymphatic system requires gravity to work well.

The lymphatic fluid is throughout the engorged breasts. There are two areas of lymph nodes that the breasts primarily drain into. If the top of the breast is the twelve o’clock position, the lymph nodes are around the 10 o’clock and 2 o’clock positions. (So one of those hour positions is toward the armpit in each breast.)

Starting with the more impacted breast, someone gently rubs oil onto the breast to help reduce friction. Then the person gently massages the mom’s breast toward these lymph nodes. It’s helpful to use a variety of sweeping patterns: going in circles around the breast, and doing some straight lines over the breast toward the lymph nodes. The breast may be slightly more uncomfortable due to the massage, but the massage is very gentle; it should not involve deep or painful strokes into the breast.

Depending on the level of engorgement, the skill of the person massaging, and the mom’s body’s responsiveness, the breast will begin to soften slightly somewhere between two and five minutes into doing this for the first time. The initial difference will be subtle. The person doing the massage should be sure to include any part of the breast that is engorged; people who are not lactation consultants are sometimes surprised how far upward, and how far to the side, breast tissue extends in some parents. The first time of doing the lymphatic drainage massage, it often takes 10 to 20 minutes of massage on each breast for the lymphatic fluid to return to the nodes enough to make the breast a different experience for milk removal. (Subsequent massage sessions may be shorter or may be equally as long, but remember, this is something to do for 1-2 days. It’s not something a family has to sustain long-term.)

Then the baby can latch on better, or the mom can do some hand expression or pumping in order to relieve some of the pressure in the breast caused by the milk.

In the temporary period of engorgement, it’s good for someone to do this lymphatic drainage massage for the mother between each feed until the engorgement subsides. Because the baby will likely nurse frequently at this early stage, it’s important not to wait to do the massage until the baby is hungry, or the baby may grow quite frustrated. If the engorgement comes roaring back, go back to the lymphatic drainage massage.

If the mom is relying on the baby to latch, and the breast is softer after the massage but the baby is still struggling to latch, then it is a good idea for someone to create a moat on the areola for the baby to be able to latch better. This is called reverse pressure softening, and you can read more about that here.

If engorgement is persisting despite these methods, if the massage seems overwhelming to do alone, or if the engorgement is occurring alongside some other symptoms that concern the parents, then it’s time to book an appointment with an IBCLC for additional breastfeeding support.