After about 20 to 24 weeks of the pregnancy, the woman's breasts start to produce colostrum or the 'first milk'. Some women may notice this 'early milk' leaking from their breasts in the last weeks, or months of their pregnancy. The colostrum remains present for about the first 48 hours after the birth. If you try to hand express colostrum (although not every women is able to express colostrum), it can look like a clear, or creamy yellow, substance that is syrupy in consistency. It is normal only to get a few drops of colostrum out at one time. A drop or two of colostrum may still be expressed from the breasts of women (and grandmothers) years after they have their baby, even if they do not ever breastfeed.
Some women decide to initially breastfeed their baby in the first 24 - 48 hours to give their baby the benefits of the colostrum. This is because it is high in protein and contains substances such as fat- soluble vitamins, and anti-infective agents, or 'antibodies' that are designed to help provide protection for the baby until their own immune system matures. Other women will breastfeed for a few days, or a few weeks, or start to bottle-feed once the colostrum changes to what is known as 'mature milk', (or when the milk 'comes in'). The milk will usually 'come in' about 48 to 96 hours (or 2 to 4 days) after the birth. Stimulation of the nipples through the feeding of colostrum, will usually make the milk come in earlier, within 48 to 72 hours.
The breasts will feel 'soft' to touch while the colostrum is present (similar to during the pregnancy). As the milk 'comes in' (about 2 to 4 days after the birth), the breasts will start to become 'fuller' and usually feel 'heavy', with the veins on the breasts often being seen more readily. Most of the 'fullness' in the breasts is due to an increase in blood supply to the breasts and an expansion of the lymph supply, as well as some milk production. The milk coming in often coincides with the3rd day blues.
As the breasts are not being emptied, they will become 'overfull' for a few days, until the woman's body realises that the milk is not needed, and stops producing milk. If the nipples are not stimulated (through the baby sucking) and breast milk is not removed (through the baby feeding or expressing the milk), then the woman's body is not given the message to produce more milk, eventually stopping.
When the milk 'comes in' the breasts are usually quite uncomfortable, and often feel hot, hard and sore to touch (known as 'engorgement'). The breasts will usually be engorged for about 2 to 5 days, and then improve, often feeling 'normal' by about 10 to 14 days after the birth. During this time, the increased blood and lymph supply to the breasts subside, and the milk that was produced is reabsorbed back into the woman's body (or 'dries up'). Some women find it takes up to 2 to 4 weeks for their breasts to 'settle back' completely to how they were before the pregnancy.
When your breasts are engorged, it can sometimes hurt to even hold your baby close when bottle feeding. This will pass once the milk 'dries up', and the breasts become softer again. Many women will wear a well fitting bra, to help support their tender breasts and reduce stimulation of their nipples. You may wish to wear breast pads at this time, to soak up any leaking milk. However, some women prefer to wear no bra, (just a loose T-shirt) and allow the milk to slowly drip (although not every woman will actually 'leak' milk), lying on a towel at night to soak up the milk if it is leaking. This can sometimes feel more comfortable and reduce the 'engorged', painful feelings.
If your breasts develop painful, reddened patches on the skin and you have a fever and/or feel unwell (similar to the flu), you may be developing mastitis (or an infection of the breast tissue). This may need to be treated with antibiotics. Seek the advice of your local doctor or caregiver.
In the past, some caregivers gave women specific tablets to suppress the milk supply if they did not wish to breastfeed. These were called bromocriptine, or 'Parlodel'. The tablets were usually taken twice a day for 2 weeks, but at times needed to be continued for a further 2 weeks, as the milk often came 'back in', once the medication stopped. This was referred to as 'rebound lactation'.
The use of bromocriptine for milk suppression has been generally discontinued in most western countries during the period from 1995 to 1998, when it was becoming apparent that the medication carried an unacceptable risk of causing heart attack or stroke. Initially, it was abandoned as a treatment for women who had a family history of these health problems, but occasionally a woman who was considered 'low risk', also experienced a severe side effect, so use of the drug has tended to be discontinued altogether. (The medication was, and continues to be used to treat Parkinson's disease).
There is a newer drug available called Cabergoline (or Dostinex). This medication is less likely to lead to 'rebound lactation' and less serious side effects, when compared to bromocriptine. The side effects of Cabergoline can include nausea (for about 30% of women) with headaches, vomiting, dizziness, heartburn, low blood pressure or constipation occurring for 5 to 20% of women. If any medications are prescribed to suppress breast milk production, Cabergoline is currently the one most preferred. However, in most circumstances, it is usually recommended that women suppress their milk naturally.
The following are some strategies that women will use to help with breast pain and discomfort while the production of their breast milk slows, and dries up.
- Wearing a well-fitting bra day and night (or a 'breast binder' - ask your caregiver about this). Making sure the bra (or binder) is not too tight. The bra will usually hold the breasts firmly and reduce stimulation of the nipples.
- Using cool gel packs, or cold compresses, to help relieve hot, sore breasts. They may also assist with the softening of hard and lumpy breasts. Cold packs are usually placed on for about 10 minutes every half hour, (only when awake). Be aware that the prolonged application of cold packs can interfere with the blood circulation in the breasts. Check with your caregiver.
- Avoiding running hot water over the breasts while showering. This is thought to generate an increased blood supply to the breasts, therefore increasing the swelling, and possibly stimulating the nipples. It is usually advised to avoid expressing milk, unless absolutely necessary, as this will stimulate the breasts to make more milk. However, it is OK to hand express a few millilitres of milk for comfort and to ease the pressure, but to do this as little as possible.
- Caregivers will often recommend the woman take some oral analgesics (such as paracetamol), when needed for pain relief. Discuss this option with your caregiver.
- Sometimes homoeopaths will recommend remedies that can help with engorgement. You may wish to arrange a remedy during the pregnancy, so you can start taking it soon after the birth.
- Herbalists may prescribe herbs such as parsley and sage to help with suppressing the milk supply. See your herbalist.
- Aromatherapists may suggest a few drops of Clary sage oil, mixed with a carrier oil (such as almond) to gently rub into the breasts, to help with drying up the milk (or burning the oil). It is important not to stimulate the breasts too much, but simply apply the oil with some very light stroking. Do a small skin test first to make sure you are not allergic to it. Consult with your aromatherapist.
In the past, many caregivers used to recommend using cooled, white cabbage leaves on the breasts, but recent research has so far been unable to show they provide any benefits.
Last revised: Friday, 21 December 2012
This article contains general information only and is not intended to replace advice from a qualified health professional.