Engorgement initially happens 2-6 days after birth and is your milk coming in. Engorgement is when a mother's breast size and fullness increases as her hormone levels change and her milk production increases. It is important to note, that mothers do have milk in the first days after birth. Colostrum is what the baby gets in the first three days, is rich in nutrients and very dense. Only a small amount is needed until mother's milk increases and the baby requires more.
Engorgement can mean that breasts are a little tender and swollen. Engorgement does not always just happen around days 2-6, and simply refers to the swelling of the breast due to the increased volume from the mother's milk supply. Swelling can occur at the breast up to the collarbone and underneath in the armpit, it may be in one breast or both breasts, it generally feels swollen and is tender to touch. It is important for mothers to understand what engorgement is and to be prepared for it, as engorged breasts that do not reduce can cause other problems for both mother and baby that can be painful and stressful, but can easily be avoided.
If a mother becomes really engorged, the breast will swell, and the swelling can flatten the nipple, which in turn makes feeding more difficult for the baby. Other problems that occur due to unrelieved engorgement is pain due to the pressure from the swelling which can turn to mastitis.
The good news is that there are a range of treatments available as well as precautionary measures that can help you avoid these problems all together. Room in with your baby, this will help your breast become attuned to your baby’s needs and you will nurse on demand. When your breast fill they need to be emptied to tell the body to produce more milk for the baby, this includes night time. Make sure that you empty both breasts and do so for an adequate amount of time nurse using skin to skin contact wear a supportive bra soft bra (no underwire) use your pump to empty your breasts if baby is having problems feeding. Do not over pump causing too much stimulation, as this may make the problem worse.
When you are engorged you can do gentle breast message. Next use your fingers to press back on your areolas, which is the dark area around your nipples. Then hand express to release some of the milk, this will give you relief and also make it easier for the baby to latch. If you are using a pump start on a low setting prevent soreness. If you are in pain, use a cold press between feedings to relieve the pain massage your breasts before, during and after. Here is a great video link on breast massage: https://vimeo.com/65196007.