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About 2 to 5 days after giving birth, you can expect your breast milk to "come in." Your breasts will most likely feel warm, heavy, and uncomfortably full. This fullness, called primary engorgement , is completely normal. It is caused not only by the milk you produce, but also by the presence of extra blood and lymph fluid in your breasts. Your body uses these extra fluids to make more breast milk for your baby. If you are breast-feeding, it is very important to keep milk moving out of your breasts. Empty them frequently so that milk can move freely and milk production can be stimulated.
Within a few days of your milk coming in, your milk supply should adjust to your baby's needs. As primary engorgement eases, your breasts will not feel so extremely full. Instead, you will notice that your breasts soften after an effective feeding and then gradually become full again in preparation for the next feeding. This periodic refilling is called secondary engorgement .
During your body's first week or two of adjusting to breast-feeding, take care not to let your breasts become overfilled. Overfilled breasts can easily become severely swollen and painful. This condition is called severe engorgement .
The most common causes of severe engorgement soon after childbirth are:
Waiting too long to begin breast-feeding a newborn.
Infrequent feedings.
Small feedings that don't empty the breast well. Babies who are given supplemental feedings with formula or water are less likely to breast-feed well.
Although engorgement is most common during the first two postpartum weeks, you can have engorgement problems later on if your usual breast-feeding pattern is disrupted. This topic offers helpful information for preventing and treating severe breast engorgement while breast-feeding.
The lactating breast
Within the breast, the milk-producing (lactating) mammary glands are grouped in lobes. Each lobe has a tube that carries milk to the nipple. The nipple has many openings through which the milk flows. See an illustration of breast anatomy .
During pregnancy, the mammary glands enlarge. After childbirth, the body releases hormones that trigger breast milk production. For a few days before and after childbirth, the mammary glands produce a thin, yellow fluid called colostrum. The breast-feeding baby is nourished with colostrum until mature milk "comes in" a few days after delivery.
Some women feel only slight swollen when their milk first comes in, while others feel uncomfortably swollen.
Primary engorgement during the first two postpartum weeks
If you plan to breast-feed: Breast engorgement can make it difficult for a baby to latch on to the breast properly . If your baby latches on incorrectly, he or she will breast-feed inefficiently. As a result, your:
Baby may not receive enough milk.
Breasts may not empty completely.
Baby's sucking will stimulate your breasts to produce still more milk. Increased milk production in partially emptied breasts increases engorgement.
Nipples may become sore and cracked. Decreased breast-feeding due to sore nipples increases engorgement.
You can take measures to prevent severe engorgement or to properly manage engorgement if it develops.
If you will not be breast-feeding: When you don't breast-feed or use a breast pump after labor and delivery, your breasts will still produce milk for a short time. Remember not to stimulate your nipples or areola during this time; stimulation increases your milk supply. You can expect engorgement to last from one to five days. Your breasts may leak small amounts of milk for days or weeks after the birth, but this is normal and will stop on its own.
Secondary breast engorgement in the weeks or months following delivery
If you have been breast-feeding or pumping breast milk, engorgement can occur even months after your baby's birth if:
Your baby's demand for breast milk stops or greatly decreases. This can happen during weaning, when solid foods are introduced, or when your baby's appetite is affected by illness.
You skip or delay a breast-feeding (for example, if you're away from your baby) and don't use a breast pump to empty your breasts
