Engorgement
Publication Date: May 1, 2016
Last Updated: March 14, 2022
RECOMMENDATIONS
A recent study suggested considering distinguishing between ‘‘breast engorgement’’ and ‘‘breast edema’’ although both may cause significant issues for mothers and infants in the postpartum period. (II-2, )
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Breast edema is fluid accumulation in the interstitial space caused by generalized fluid accumulation late in pregnancy or as a result of large amounts of intravenous fluids during labor and may be responsible for edema around the areola and nipple. (III)
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Engorgement symptoms occur most commonly between days 3 and 5 postpartum, with more than two-thirds of women experiencing tenderness by day 5, but the onset may be as late as days 9–10. (, )
(II-2, III)
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In the 2008 Infant Feeding Practices Survey, 36.6% of women reported overly full breasts within the first 2 weeks postpartum, while other studies indicate that up to two-thirds of women experience at least moderate symptoms of engorgement. (III)
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The incidence of engorgement may depend on breastfeeding management within the first few days following birth. Engorgement occurs less commonly when infants spend more time breastfeeding in the first 48 hours and when mother and infant are rooming in. (III)
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Assessment of Engorgement
Predictors
The onset of lactogenesis II (secretory activation) occurs sooner in multiparous compared to primiparous women and tends to resolve more rapidly than in primiparous women. (II-2)
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It is not uncommon for women who have undergone any breast surgery or lumpectomy to experience engorgement, and so, they should be given anticipatory guidance regarding these potential complications. (III)
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The influence of length of labor, premature delivery, and anesthetic options remain unclear. (III)
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Treatment
While one study found an increase in milk production on day 4 for primiparous women with marked engorgement, adequate management of engorgement is important for successful long-term lactation. (III)
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Experiencing engorgement is temporarily uncomfortable for mothers and appears to be associated with an increase in the likelihood of early weaning. (III)
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Experiencing engorgement is temporarily uncomfortable for mothers and appears to be associated with an increase in the likelihood of early weaning. (I)
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Enzyme therapy using a protease complex enteric-coated tablet containing 20,000 U of bromelain and 2,500 U of crystalline trypsin, another anti-inflammatory agent taking orally, was compared to a placebo. However, this study is now 50 years old and it is not certain that the preparation is in general use. (I)
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Researchers continue to explore the effect of cabbage leaves. (I)
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In Japan, grated potatoes are used for the same purpose, although there is no evidence for its use. (III)
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Other treatment considerations
Breast massage
- Gua-Sha Therapy
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- Oketani breast massage
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compared to conventional breast massage in control groups found that there was a reduction in pain, engorgement, and discomfort in the control and intervention groups in both studies, but the intervention groups had a significantly greater reduction in symptoms.
Herbal remedies
One randomized trial of the application of Hollyhock compresses in conjunction with hot and cold compresses found a significant reduction in engorgement severity compared to hot and cold compresses alone. (II-1)
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Hot and cold packs
Hot and cold packs may be as effective as other treatments. (II-3)
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Recommendation Grading
Overview
Title
Engorgement
Authoring Organization
Academy of Breastfeeding Medicine
Publication Month/Year
May 1, 2016
Last Updated Month/Year
April 13, 2023
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this protocol is to evaluate the state of evidence as to the prevention, recognition, and management of breast engorgement to encourage successful breastfeeding.
Target Patient Population
Mothers experiencing breast engorgement
Inclusion Criteria
Female, Adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Nurse midwife, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D007775 - Lactation Disorders, D064186 - Prenatal Education
Keywords
promote breastfeeding, Promote Breastfeeding, Engorgement, Mastitis, Gigantomastia
Source Citation
Berens, P., & Brodribb, W. (2016). ABM Clinical Protocol #20: Engorgement, Revised 2016. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 11(4), 159–163. https://doi.org/10.1089/bfm.2016.29008.pjb