Breastfeeding - self-care
Nursing mothers - self-care; Breast feeding - self-care

It's normal during the first week after a baby is born for a mother's breast to become heavy, and tender, and full as the milk is coming in. And even before that as the blood flow is expanding and the lymph flow is expanding to allow the milk to come in. But sometimes that progresses to something we call engorgement. I'm Dr. Alan Greene and I want to talk briefly about engorgement. What causes it, how you can prevent it, and what to do if engorgement does happen. We call it engorgement if the pain becomes really severe because the milk is so full in the breasts that it squeezes shut some of the blood and lymph vessels. So causes swelling in the tissues. It's not just too much milk. It's real swelling of the breasts. And it can be quite painful and make nursing kind of difficult. Probably the best way to prevent engorgement is frequent, early feeding. If you feed as often as the baby wants to, and at least every 2 to 3 hours when the baby is awake during the day, and no longer than 4 or 5 hours one stretch at night during that first week will often prevent engorgement. Engorgement is less common, too, if you don't do supplemental feedings. But even if you do everything perfectly, some women will still become engorged. It's not a guarantee. If you do and don't do anything, the engorgement will likely last for 7 to 10 days. But if you take steps to treat the engorgement, usually it will be gone within maybe 24 to 48 hours, at least the worst part of it. So what does treating engorgement mean? It's a couple of very simple steps. The first one is really to try to empty the breasts completely. Again, going back to frequent feeding and to encourage the baby to nurse to finish the first breast first. Don't try to switch breasts in between, but start and let them empty as much as they can. And then only after they come off it at their timing, try the other breast. Then start with the opposite one next time. Then you can do a lot with cool and warm compresses. Doing a cool compress in between nursing can help reduce the swelling and reduce the tenderness. And then a warm compress you want to switch to in the 10 to 15 minutes before nursing to help encourage let down and help the breast drain more fully. You can actually get compresses that are made for this purpose that you can warm or you can cool. And they can fit inside a nursing bra. Another thing that can be very helpful are cabbage leaves. There have been a few studies suggesting this and a lot of personal experience people have had just taking a cabbage leaf out of the refrigerator and wearing it as a compress. There seems to something in there that does help. Whatever you do, you may also want some pain relief, something like acetaminophen. And if that's necessary don't hesitate if that's something that's going to keep you nursing because breast milk is the very best thing for kids.
Eat to Stay Healthy and to Feed Your Baby
You should:
- Eat 3 meals a day.
- Try to eat foods from all the different food groups.
- Know that vitamin and mineral supplements are not a substitute for healthy eating.
- Know about food portions so that you eat the right amount.
Eat at least 4 servings of milk foods each day. Here are ideas for 1 serving of milk food:
- 1 cup (240 milliliters) of milk
- 1 cup (245 grams) of yogurt
- 4 small cubes of cheese or 2 slices of cheese
Eat at least 3 servings of protein-rich foods each day. Here are ideas for 1 serving of protein:
- 1 to 2 ounces (30 to 60 grams) of meat, chicken, or fish
- 1/4 cup (45 grams) cooked dried beans
- 1 egg
- 1 tablespoon (16 grams) of peanut butter
Eat 2 to 4 servings of fruits each day. Here are ideas for 1 serving of fruit:
- 1/2 cup (120 milliliters) fruit juice
- Apples
- Apricots
- Peaches
- 1/2 cup (70 grams) cut up fruit, such as watermelon or cantaloupe
- 1/4 cup (50 grams) dried fruit
Eat at least 3 to 5 servings of vegetables each day. Here are ideas for 1 serving of vegetables:
- 1/2 cup (90 grams) cut up vegetables
- 1 cup (70 grams) salad greens
- 1/2 cup (120 milliliters) vegetable juice
Eat about 6 servings of grains like bread, cereal, rice, and pasta. Here are ideas for 1 serving of grain:
- 1/2 cup (60 grams) cooked pasta
- 1/2 cup (80 grams) cooked rice
- 1 cup (60 grams) cereal
- 1 slice bread
Eat 1 serving of oil each day. Here are ideas for 1 serving of oil:
- 1 teaspoon (5 milliliters) oil
- 1 tablespoon (15 grams) low-fat mayo
- 2 tablespoons (30 grams) light salad dressing
Drink plenty of fluids.
- Stay hydrated when you are nursing.
- Drink enough to satisfy your thirst. Try to drink 8 cups (2 liters) of fluid each day.
- Choose healthy fluids such as water, milk, juice, or soup.
Do not worry about your food bothering your baby.
- You can safely eat any foods you like. Some foods may flavor your breast milk, but babies are often not bothered by this.
- If your baby is fussy after you eat a certain food or spice, avoid that food for a while. Try it again later to see if it is a problem.
Caffeine, Alcohol, Smoking, and Breastfeeding
Small amounts of caffeine will not hurt your baby.
- Limit your caffeine intake. Keep your coffee or tea at 1 cup (240 milliliters) per day.
- If you drink larger amounts of caffeine, your baby may get agitated and have trouble sleeping.
- Learn how your baby reacts to caffeine. Some babies may react to even 1 cup (240 milliliters) of coffee or tea a day. If that happens, stop drinking beverages with caffeine.
Avoid alcohol.
- Alcohol affects your milk.
- If you choose to drink, limit yourself to 2 ounces (60 milliliters) of alcohol a day.
- Talk to your health care provider about drinking alcohol and breastfeeding.
Try not to smoke.
- You put your baby at risk if you smoke.
- Breathing in smoke increases your baby's risk for colds and infections.
- Get help to quit smoking now. Talk to your provider about programs that can support you to quit.
- Smoking increases your risks for preterm birth, still birth, and for having a smaller than normal baby.
- If you can quit, you will feel better and decrease your risk for getting cancer from smoking. Your baby will not get any nicotine or other chemicals from cigarettes in your breast milk.
Know about your medicines and breastfeeding.
- Many medicines pass into mother's milk. Most of the time, this is safe and OK for your baby.
- Talk with your provider about any medicines you take. Do not stop taking your medicine without first speaking to your provider.
- Ask about medicines that are OK to take while you are breastfeeding. The American Academy of Pediatrics' Committee on Drugs keeps a list of these medicines. Your provider can look at the list and talk to you about medicines you take when breastfeeding.
Breastfeeding and Contraception
You can get pregnant when breastfeeding. Do not use breastfeeding for birth control.
You are less likely to get pregnant while breastfeeding if:
- Your baby is younger than 6 months old.
- You are breastfeeding only, and your baby does not take any formula.
- You have not yet had a menstrual period after having your baby.
Talk to your provider about birth control. Be aware that some birth control pills with estrogen may decrease your milk supply. You have lots of other choices. Condoms, diaphragm, progesterone-only pills or shots, and IUDs are safe and effective.
Breastfeeding delays the return of normal menstrual periods. Your ovaries will make an egg before you have your period so you can get pregnant before your periods begin again.
References
Louis-Jacques A, Lawrence RM, Lawrence RA. The breast and the physiology of lactation. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 11.
Newton ER, Stuebe AM. Lactation and breastfeeding. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 25.
Office on Women's Health website. US Department of Health and Human Services. Breastfeeding.
Version Info
Last reviewed on: 11/8/2024
Reviewed by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
