Engorged breasts: Unable to nurse

I recently gave birth and my milk is just 'coming in.' The problem is that it seems as though my left breast is clogged. It's engorged, swollen and nothing I do helps to relieve the pressure. When I try to feed my baby, nothing comes out. A breastpump doesn't even help to eliminate this problem. I've tried warm compresses and hot showers and nothing seems to help. What should I do?

Debbi Donovan

Debbi Donovan is the Director of ParentsPlace.com and is also a Board Certified Lactation Consultant.
Congratulations on the birth of your baby! I am very sorry that you are experiencing difficulties with breastfeeding.

When engorgement is severe and your breasts (and even your areola) feel hard, it can be very difficult to get your milk flowing. This is both painful and very frustrating. All that milk, and yet, it seems impossible to get out!

Your breasts may be so full that the swelling extends under your armpit, and the skin of your breast may be stretched tight. You may experience extreme tenderness, warmth and throbbing -- and even run a low-grade fever. The breast congestion and slowing of circulation results when milk is not effectively emptied from your breasts.

Because your breasts make milk independently of each other, I am assuming from your letter that your baby is able to nurse at the right breast. Continue nursing at least 10 to 12 times a day from that side, as you work on softening the affected breast and encouraging your baby to nurse on both sides.

Since you are having problems removing the milk in your left breast, even when using a breastpump, you will need to try some other measures. Many nursing mothers have reported that use of cold cabbage compresses has helped to relieve their engorgement. Wash leaves ahead of time, dry, and store in a zip-lock style bag in the refrigerator. When needed they will be cold and ready to use. Remove cabbage leaves and crumple the veins slightly before applying. Place inside your bra, being sure to cover all areas of your breast -- extending under your arm if there is swelling present. Change the leaves when wilted, or about every two hours. Repeat this process until breasts begin to soften. At this point, discontinue use, as the continued use of cabbage leaves may decrease your milk supply. See my letter, Cabbage Leaves for Engorgement for additional information.

After allowing the cold cabbage compresses to soften your breast, use a warm, wet compress along with some gentle breast massage toward the nipple to help soften your breast/areola and get your milk flowing. Or you might want to try a saline soak, using one half teaspoon salt to one cup of very warm water - along with gentle massage. Hand-expression, before you use a pump, or put your baby to your breast, may be just what you need at this time.

Until your baby accepts the affected breast, you will need to continue trying gently to express your milk as often as your baby would nurse. What type of breastpump are you using? I would not recommend using a manual or small electric pump when your engorgement is severe. You need a gentle and very effective pump, such as the Medela Classic or Lactina. When expressing your milk, begin by using the lowest setting.

As your breast and areola begins to soften, encourage your baby to nurse on the affected breast. He should find it much easier now that your breasts are more easily graspable and your milk is flowing. A baby who is nursing well is much more effective at removing milk from your breasts than the best pump available. Encouraging frequent feeds will help to keep you comfortable, and will help to rebuild your milk supply in the affected breast.

Wear a comfortable, yet supportive bra (such as a sports bra) in between feeds, and remove when nursing or expressing your milk to allow your milk to freely flow. In between feeds, for comfort and relief of swelling, you can use icy compresses (a bag of frozen peas works well). Speak with your Health Care Provider if you would like to use a medication, such as Ibuprofen for relief of pain and inflammation. The American Academy of Pediatrics considers Ibuprofen to be compatible with breastfeeding.

If you begin to a develop a fever and/or flu-like symptoms, and your breast is red, hot and swollen, it is very important to contact your Health Care Provider. You may be developing mastitis.

My very best wishes for comfortable feeds!

I am nursing my seven-week-old son and my nipples are still extremely sore. I am only nursing four times a day and pumping and bottle feeding three times a day. I have seen a lactation consultant and a dermatologist and have used Bacitracin, Lotrimin, Loprox, Hydrocortisone, Nystatin, antiinflamatories, Tylenol, Penicillin and more. My son latches on fine and he is ****ing properly. I really want to keep nursing but I am in so much pain. Please help!




Debbi Donovan

Debbi Donovan is the Director of ParentsPlace.com and is also a Board Certified Lactation Consultant.




I'm sorry to hear that breastfeeding has been so painful for you. That is definitely not normal. Have you had pain since your baby was born? Usually when there is unresolved nipple pain from birth, it is due to poor positioning and attachment, or a problem with your baby's ****. Maybe your baby has a tight or short lingual frenulum (the piece of tissue under his tongue.) If he is unable to extend his tongue past his gum line, and does not have good movement of his tongue, that could be causing your nipples to remain sore.

In the seven weeks since your baby's birth you have tried many medications. While working on correcting this problem you can continue to use Tylenol or Ibuprofen if recommended by your Health Care Provider for pain relief. If you take about one half to one hour prior to nursing your baby, this may help you to nurse more comfortably. Of course, this will not correct the problem.

Since medication was prescribed for thrush (Lotrimin, Loprox, and Nystatin) I would wonder if you and your baby were treated simultaneously for at least a two-week period. This is very important when treating thrush. It takes a while to get rid of thrush. It can be very persistent.

Was penicillin given for treatment of mastitis? Mastitis most commonly, involves a staph infection (usually only one breast is involved.) Penicillin is not always effective. Dicloxacillin is often used for a period of 10 days to 2 weeks with good results (if staph is the offending organism).

If nipple eczema was suspected, hydrocortisone might have provided some relief. Women who have thrush, and are treated with hydrocortisone often find their nipples are even more sore after using it for a day or so, and need to discontinue its use (while thrush is present.)

Bacitracin was probably used on your nipple because a bacterial infection was suspected. Bacterial infections and thrush can be present in nipple cracks that refuse to heal.

What type of pump are you using to express your milk? Use of a bicycle-horn style pump, one with a continuous suction, or using too high a suction can cause nipple damage.
Since you haven't really given me much history, it would be irresponsible for me to even guess at what your nipple pain could be caused from. You didn't mention what the dermatologist determined your problem might be. I would advise getting a second opinion from a breastfeeding-friendly dermatologist in your community. It may be that with all the different treatment that you have used over the past seven weeks, no treatment was maintained long enough to see a difference. I would also advise working with another Board Certified Lactation Consultant. I think that a second opinion in this area, and a reevaluation of positioning, attachment and a breastfeeding session would be wise. Very best wishes for resolving your nipple pain!

Shamma youre bringing back *NOT so pleasant* memories...

But I know you mean well, by bringing info here


ETA: I Feel like I could have written these

SORE is an UNDERSTATEMENT. Painful, cracking, burning nips, boobs: HARD AS A ROCK (when engorged), shooting pains. Its just something (like labor ) that cant be explained in words and that hopefully not everyone has as painful an experience.
As far as my making it through. I nursed for 3months. During times that I was sore/cracked/burning in pain (nips) the mere THOUGHT of nursing was like pouring salt into an open wound, and although many lactation consultants give you a big smile, pat you on the back, and tell you 'keep nursing' its physically PAINFUL, and at the time emotionally and physically exhausting so I began to supplement with a bottle here and there of formula... Since I Was also having problems with my latch (how baby latches on), JA took quickly to the bottle (the formula from the bottle requires ALOT less work from the baby, and from there I began to nurse les and less. ITs really sad and you do feel a bit like you let yourself down when you 'give up'. But I did try my best and spent many a long afternoon, midnite, early morning in tears from the pain... and looking at that baby that did nothing wrong... you get mixed emotions...
wow that brought back memories and emotions just now...
I really hope to try again and I plan to set small goals for myself... 3m, 6m...

i wish you all the best this time around. I never heard of problems with this until I started reading these kinds of boards the women in my life never ever mentioned this or women in my country, this is so weird. Just reading your response makes it sound painful. You are not a quitter of that I am certain. I can only imagine it was no day in the park. I wonder why its so hard and tv makes it seem so easy

Ive met many moms who never once had the slightest pain or problem and it came very natural and easy to them.. and then there are those that had a rough start. Again, similar to labor, 'dream' labors and 'nightmare' Labors...

I hope this doesnt discourage anyone from having babies or nursing.

I am still willing to try, all the great stories I hear about bonding makes me want to do it.