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3.1 Early problems

Key Points - Case Study C

Joanne is discharged early on day three and comes to see you for a follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?

Topic 3.1: Early problems
There is a difference between breast fullness and engorgement. Early frequent feeding and good breast drainage helps prevent and manage engorgement.

Joanne is discharged early on day three and comes to see you for a follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?

Breast fullness is a physiological response to the initiation of copious milk production, and is a function of increased vascularity, increased milk production and increased oedema due to increased vascularity and milk production1. Breast fullness is associated with some tenderness and pain beginning around day two and peaking by day five2.

Breast engorgement is an exaggeration of the physiological process, with breasts becoming swollen, hard and very painful, and the nipple being flattened by underlying breast fullness. The skin of the breast is often red and shiny and the mother may be slightly febrile (38°C). The baby is often unable to latch well, resulting in painful, cracked nipples and poor milk drainage. With severe engorgement, the breasts may extend from the clavicle to the lower rib cage and from the midaxillary to the midsternal line.1

Breast Engorgement


© S.Cox IBCLC

Early and frequent emptying of the breast reduces the incidence of engorgement3, while predisposing factors for engorgement include:

Management of engorgement focuses on ensuring good breast drainage and maternal comfort (5,6), and includes the following points:

Click on some of the bullet points below for more detail:

Reverse pressure softening for areolar oedema

Some women, especially those who receive large amounts of IV fluids during labour, have oxytocin augmentation of labour, or use high suction electric breast pump early postpartum, develop pitting oedema of the breast and areola. In these situations, a technique of reverse pressure softening reduces the oedema surrounding the nipple so that the infant can attach/latch more easily. Click on the icon to be read how this is performed.

Case Study Activity

Think about what your response would be to the scenario presented, write it into the exercise, then submit it and read the suggestions given.

Notes

  1. # Lawrence RA et al. (2005) Breastfeeding: a guide for the medical profession
  2. # Hill P et al. (1994) The occurrence of breast engorgement
  3. # Renfrew MJ et al. (2000) Feeding schedules in hospitals for newborn infants.
  4. # Moon J et al. (1989) Engorgement: contributing variables and variables amenable to nursing intervention
  5. # Brodribb W (2004) Breastfeeding Management
  6. # Mass S (2004) Breast pain: engorgement, nipple pain and mastitis
  7. # Evans K et al. (1995) Effect of the method of breastfeeding on breast engorgement, masitits and infantile colic
  8. # Roberts KL (1995) A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement
  9. # Swift K et al. (2003) Breast binding... is it all that it's wrapped up to be?