The decision not to breastfeed while experiencing the onset of milk production can be physically uncomfortable. Breast engorgement, the swelling and tightening of the breasts as milk volume increases, can be painful, but it is a temporary process. Safe self-care is important to manage the discomfort and signal to your body that milk production should cease. This guidance provides practical steps for managing this phase while prioritizing your comfort and health.
Why Milk Production Starts
The body initiates the process of full milk production, known as lactogenesis II, automatically following childbirth, regardless of the intent to breastfeed. This physiological response is primarily triggered by a sudden hormonal shift after the delivery of the placenta. During pregnancy, high levels of progesterone and estrogen suppress the milk-making action of prolactin, the primary hormone responsible for milk production.
Once the placenta is expelled, the levels of these inhibiting hormones drop rapidly, allowing prolactin to become fully active. This hormonal signal tells the mammary glands to begin producing copious amounts of milk, which typically results in the sensation of milk “coming in” between 48 and 72 hours after delivery. If milk is not removed, pressure builds within the breast, and a local factor known as Feedback Inhibitor of Lactation (FIL) begins to accumulate, which gradually slows and stops production.
Immediate Relief for Engorgement
Engorgement can cause breasts to feel hard, heavy, and warm, often accompanied by throbbing pain. The primary goal for immediate relief is to reduce swelling and manage pain without stimulating the breasts, as stimulation signals the body to make more milk.
A supportive, well-fitting bra, such as a firm sports bra, can help by gently compressing the breasts and limiting movement. Ensure the bra is supportive but not so tight that it causes pain or injury, and avoid underwire which can put uneven pressure on the milk ducts.
Applying cold compresses can help constrict blood vessels and reduce inflammation and swelling. You can use ice packs wrapped in a thin cloth, or chilled products like frozen bags of vegetables, for about 15 to 20 minutes at a time, several times a day.
Another common remedy is the use of chilled, clean green cabbage leaves placed inside the bra, which many find soothing for the pain and hardness of engorgement. The leaves should be replaced once they begin to wilt.
Minimizing breast stimulation is crucial. Avoid allowing warm water to run directly onto your breasts for extended periods while showering, as heat encourages blood flow and can trigger the milk ejection reflex. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be taken to manage pain and inflammation, following the recommended dosages on the label.
Steps to Safely Stop Milk Production
The long-term strategy for suppressing your milk supply involves systematically avoiding milk removal to signal to the body that milk is not needed. If the engorgement is extremely painful, you may hand-express a very minimal amount of milk—just enough to relieve pressure and discomfort. Removing too much milk will encourage the body to maintain or increase production, prolonging the engorgement phase.
This process of natural suppression takes time. The most severe engorgement typically peaks around the third to fifth day postpartum and gradually decreases over the next seven to ten days. Consistency in avoiding stimulation is paramount during this period. The discomfort should slowly subside as the hormonal stimulus wanes and the accumulated milk is reabsorbed by the body.
Some medications, such as the over-the-counter decongestant pseudoephedrine, have been shown to potentially decrease milk production by reducing prolactin levels. Estrogen-containing medications, like certain birth control pills, can also suppress lactation. However, you must consult with a healthcare provider before taking any medication to suppress lactation, as they can have side effects and may not be suitable for everyone.
When to Seek Medical Attention
While discomfort is normal during this phase, certain symptoms can indicate a complication that requires professional medical evaluation. You should contact your healthcare provider if you develop a fever of 101°F (38.3°C) or higher, or experience flu-like symptoms such as body aches and chills. These can be signs of mastitis, which is an inflammation of the breast tissue that may be caused by a trapped milk or an infection.
Seek immediate medical advice if you notice a localized, hard, red, and hot area on your breast that does not resolve with self-care. Persistent, worsening pain or the presence of red streaks radiating outward from the breast can also be signs of infection or a breast abscess.
If the engorgement does not begin to subside after three to four days, or if you continue to feel severely swollen and uncomfortable after a week, consult with your obstetrician or midwife for further guidance.