Top 5 Breastfeeding Difficulties: Avoiding Engorgement and Mastitis
Even the name of breast engorgement sounds painful... especially since it can lead to problems such as lowered milk supply or even mastitis (an inflammatory condition that may lead to infection).
So what causes engorgement and how can you prevent it?
Engorgement feels like the breast tissue is very hard, overfull, and may be painful to touch.
Mastitis is when engorgement turns into an infection of the breast and nipple. If the breast becomes red, hot, and shiny you may have mastitis and should go see a doctor for medical treatment.
The main reason engorgement occurs is from pressure or restriction of the breasts. This happens with the use of tight bras or breast shells that restrict the breast tissue. It can also occur if you are not regularly expressing milk and emptying the breasts. This typically is presented when breastfeeding sessions are missed or the periods of time between breastfeeding sessions are too long and milk begins to build up. Most frequently this occurs from not having overnight feedings.
This could also be a common problem for women who are regularly separated from their baby and unable to pump OR their baby is having difficulty transferring milk resulting in a build-up in the breast.
Another more uncommon issue that causes mastitis or engorgement is anemia which results in decreased milk 'flow'. If women do not have enough iron stores it affects lots of functions in the body and one of them is the milk letdown and flow. That's why we don't just emphasize iron during pregnancy but, breastfeeding as well.
All of these situations can cause engorgement, but being aware may help you prevent engorgement in the future.
But what about if you already have engorgement and want to make sure it does not lead to mastitis?
One of the main ways to prevent mastitis is emptying the breast. If your engorgement is to the point that your baby is unable to latch, you may need to pump or express by hand enough milk to soften the breast tissue so that they can latch on. It is also recommended to wear loose-fitting bras as well as non-restrictive clothing.
Action Item: Express some milk before breastfeeding so that your baby is able to latch on even if you are engorged. This will also help with the letdown in case it is too strong.
Please note: Cabbage leaves have been used to reduce high supply and engorgement but use with caution. If used for too long or too frequently, it may dry up/decrease a mother's milk supply.
"Can I breastfeed if I am engorged or have mastitis..."
Yes, you can breastfeed even if you are engorged and even in most mastitis cases. Breastfeeding/emptying your breasts can help in both cases because the milk flow helps resolve both issues. As we discussed before, you may just need to express some milk so that your baby is able to latch on due to the hardness. When women have mastitis, typically you are still able to breastfeed as long as you feel comfortable. If expressing your milk in another way is more comfortable for you, then that is totally okay as well. You just want to make sure that you are emptying the breasts 1) to help with the mastitis/your comfort level and 2) to make sure your supply doesn't decrease.
Action Item: If you feel engorged or you have mastitis make sure to empty the breasts to speed up healing and reduce symptoms.
Again, if you are showing signs of mastitis, you need to seek help from your doctor so that your breast tissue does not become infected. You should be able to breastfeed in most cases of mastitis, but the severity of each case must be reviewed by your doctor before any conclusions are made.
Your health today is a LIFETIME of health for you AND your baby.
Until next time!
Coaches Cassie and Mikayla
Reference: The Lactation Counselor Training Course Notebook (2018)., Healthy Children Project, Center for Breastfeeding
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