what to do about engorgement when milk comes in

So you had your baby. You went to a billion doctor appointments at the end, when it was time to push (or operate) it seemed like the entire hospital staff was in the room with you, and someone has probably talked to you about everything from how to care for the umbilical cord to post-partum depression. You feel prepared. And then you start breastfeeding.  Where’s your support now? You may have access to a lactation consultant at the hospital but not everyone has access after they leave, or may not be covered by insurance.  Here are the things I wish someone had told me about breastfeeding.

And then you start breastfeeding.  Where’s your support now?

Pain: It hurts at the beginning. At least it did for me. I saw 5 lactation consultants with Katie and they all said her latch was great and that it shouldn’t hurt. Guess what? It did. Badly. To the point where every time she woke up crying to eat, I started crying too because I didn’t want to feed her. With a vaginal birth and a c section under my belt, the only pain I ever said was a 10 was nipple pain around day 2 or 3 and gradually got better until it was around a 4 or 5 after a week. It was the same with Isabelle even though her latch was slightly different. I imagine all of this was made worse by the fact that I was in pain from everything else and also adjusting to a new baby, but I felt incredibly unprepared for this level of pain. It made sticking with breastfeeding incredibly difficult and if it were not for the encouraging support of my partner, I probably wouldn’t have stuck with it.

I saw 5 lactation consultants with Katie and they all said her latch was great and that it shouldn’t hurt. Guess what? It did.

Your boobs get giant and hard as rocks when your milk comes in. If you have tiny boobs, you may appreciate your new size. If you have big boobs to start, they may become giant and heavy and veiny and I don’t want to say gross because it’s beautiful that they feed babies and that’s beautiful and blah blah blah, but I felt like mine looked pretty gross. My boyfriend described the feel of them as a sock filled with crushed ice. And they hurt when they’re engorged and they leak everywhere and if you squeeze them, they squirt super far like a squirt gun. Of course you will squirt your partner at least once on purpose because it’s hilarious. And then after a week or so everything in your life is just covered in breast milk but you don’t really notice anymore.

Of course you will squirt your partner at least once on purpose because it’s hilarious.

Engorgement: So back to your new engorged boobs. You supposedly can relieve the pressure by squeezing out some of your milk in the shower . That was never enough for me. When my milk came in with Katie, I sent Jason to the store to buy an electric pump. Meanwhile, my boobs were so full K couldn’t latch (imagine trying to put your mouth on a beach ball – not happening) and I couldn’t get enough milk out with my hands. The electric pumps are expensive but if you plan on using it every day, it’s a worthwhile investment.  I bought a double pump that is also hands free and used every day with K and now am using every day with Isabelle. If you are pumping for engorgement, you are only supposed to pump enough to be comfortable as any more than that will increase your supply and tell your body to make more milk. I never had the problem of having an oversupply from pumping but this is what I’ve heard. At this point I am pumping to make bottles though.

My boobs were so full K couldn’t latch – imagine trying to put your mouth on a beach ball.

Pumping: it’s not easy.  Like the hugest pain in the ass trying to fit it in.  I only pump once a day at this point to make a bottle for Jason to feed Belles in the evening, and finding time to pump is the most difficult part of my day.  I can only do it while Belles is asleep and half the time she wakes up 5 minutes in.  This is where you decide what kind of mom you are.  You can’t really pick up the baby while you pump so you can either pull off your pump to pick your baby and hope you can find time to resume later, or you shake toys in front of your baby while they cry and tell yourself they’ll be fine if they cry for a few minutes.  I generally chose the latter and here’s why:   If I have a bottle pumped for Belles and I can get some sleep while Jason watches her, I will be better rested and have more patience and can be a better mom.  You can’t pour from a cup that’s empty.

You can’t pour from a cup that’s empty.

There is also a whole lot you can’t do while pumping.  I have a hands free electric pump, which is great.  I can play on my phone, I can do a few dishes, I can fold clothes on the table.  But your movement is restricted.  If you bend over, milk spills out, so no picking up.  If you lean back, milk splashes back on you, so you can’t really relax.  It’s one of those things that may look like you’re taking a break (your partner may even comment on this “break” you’re getting), but you really aren’t.  Not to mention you’re being milked while all of this is going on.

If you bend over, milk spills out, so no picking up.  If you lean back, milk splashes back on you, so you can’t really relax.

Thrush: Your nipples are cracked and bleeding so you’re using lanolin on them and your breast pads are wet from leaking half the time.  This is the perfect recipe for you to get thrush.  Thrush is like a yeast infection that you can have on your nipples and the baby can have in their mouth.  And because the baby’s mouth is always on your nipples, you end up passing it back and forth a lot.  And it hurts like hell.  Katie and I both got it and we called her doctor.  They said I had to bring her in so they could check the inside of her mouth for white spots, so I did, and they prescribed her with an oral medication after confirming she had it.  “But what about me?” “You can put this on your nipples too.” That didn’t add up to me.  This was an oral medication…. “Oh and to prevent reinfection, you need to wash your nipples before and after every feeding and then apply the medicine.”  Are you effing kidding me? All this child does is nurse.

To prevent reinfection, you need to wash your nipples before and after every feeding and then apply the medicine.

After a few days things weren’t getting better. My nipples were now sticking to my breast pads and they still stung badly every feeding. So now I have to make an appointment with my doctor.  After a very “Who’s on first” type conversation about who treats who, my doctor talks to her supervisor who comes back to talk to me.  They agreed to give me medication that is normally used to treat yeast infections, but had to give me a disclaimer that it was not FDA approved for this use. But it should work.  A few days after starting my medicine and with Katie taking her medicine, which is about 10 days after this all started, both of us are starting to clear the thrush.

What to wear:  You are super psyched to be out of maternity clothes.  Guess what? If you are nursing and want it to be easy for you while you’re out and about, you need to wear things with easy access to your boobs.  Some people are okay with lifting their entire shirt, pulling a boob out of their bra, and flashing both boob and tummy to the world.  I am not a fan of this and prefer shirts where I can pull a boob out easily.  This means t-shirts or anything with a high neck is out, and boobalicious shirts are in.  Which brings me to my next point.

This means t-shirts or anything with a high neck is out, and boobalicious shirts are in.

Modesty:  If you had any sense of modesty left after your pregnancy, it will be gone when you start nursing.  Whether you choose to feed out in the open, choose to use a cover, or choose to go into a private room, just the fact that your boobs are out so often and you are using them for their actual intended use creates a shift in how you view boobs.  You forget most of the rest of the US still views boobs as sex objects. I’m not here to debate whether or not that’s so wrong of society, I’m just saying that you might find yourself walking around in a super boobalicious shirt for functional reasons and not realize people are drooling over your new giant rack or may be offended by it.

You might find yourself walking around in a super boobalicious shirt for functional reasons and not realize people are drooling over your new giant rack.

Judgement: You’re breastfeeding in public? Gross.  You’re supplementing with formula? You don’t love your baby enough.  You introduced a bottle or pacifier before 3 weeks? Get ready for nipple confusion.  Everyone will have an opinion on everything you do.  Don’t stress, you can’t please everybody.

“I think she’s hungry!”  You just fed the baby, passed her off to a partner/friend/family member, put your boobs away, and started to relax for a second.  The baby whimpers and your baby holder says “I think she’s still hungry.” “She’s not fucking hungry!!”  My partner and I had this argument constantly with K and are having it again with Belles. There is something about being the only food source that makes this offensive to you.  You know your baby best, you know when they need to eat and when they are full, and you know that sometimes babies cry for reasons other than hunger.  It shouldn’t bother me so much, but it does.  Hopefully you will be different.

How big of bottles? NO ONE KNOWS.  This was one of the biggest shocks to me as a breastfeeding mom.  Because there’s no way to know exactly how much breast milk your baby takes at each feeding, there’s no way to know how big of a bottle to give them.  You can look at what other moms say on forums and blogs, look at how much formula moms give their same age or same weight formula-fed babies, but it really comes down to trial and error.  Don’t worry, if you overfeed a little you’ll only deal with an insane amount of projectile vomiting.

Don’t worry, if you overfeed a little you’ll only deal with an insane amount of projectile vomiting.

Food sensitivities/foremilk-hindmik/colic/constipation/reflux: But wait, there’s more trial and error fun!  You baby is spitting up or constipated or colicky and you are breastfeeding.  You may feel a little responsible because you are their food source.  It’s hard.  You can read about all of these things until your head explodes, but this really comes down to more trial and error.  You can try eliminating certain foods from your diet, drinking more water, letting baby finish one side before switching to the next to get enough hindmilk… I don’t have all the answers.  K’s colic was mostly due to constipation and what helped us was introducing water.  We gave a half ounce in the morning and half at night and we are currently giving Isabelle an ounce a day broken up into thirds.  This was at the advice of our nurse and after trying suppositories and food eliminations and everything else.  Talk with your doctor and don’t get discouraged if it takes a while to get things straightened out.

K’s colic was mostly due to constipation and what helped us was introducing water.

It’s so easy!  Once you get all the kinks worked out, it becomes second nature.  You can breastfeed with one arm while picking up your house, you can cosleep topless and your kid can help themselves while you half sleep through the feeding, you can go places without having to pack anything but your boobs and some diapers… it’s worth sticking with it.  I’m not saying breastfeeding is for everyone.  I respect every mom’s choice to feed their kid in the way that works for them.  But if you are a mom who wants to breastfeed and you encounter some bumps in the road, you will not regret pushing through and sticking with it.