Nipple oedema

Are you a breastfeeding mother? Have you ever wandered why your breasts are swollen and what the cause could be? In the Breastfeeding world there are two main causes of swelling of your breasts and they are:

  • Nipple oedema
  • Breast Engorgement

What makes it difficult is that they are often confused, however they are two different concepts and getting it wrong can cause a breastfeeding mother unneeded pain and stress.

Breast engorgement

1. Differences and Similarities between Nipple Oedema and Breast Engorgement

  Breast engorgement Nipple oedema
When it occurs? Intense fullness of breast from day 3-5 days after birth. Swelling of breast takes up to 2-weeks) Intense fullness of breast that occurs day 1-2 after giving birth. Fullness can last 10-14 days dependant on amount of IV fluids given.
  • Painful and fever (24 hour after fullness presents)
  • Tired


  • No fever
  • May be painful around the nipple and darker area of the breast (areola)
  • Feet may swell
Appearance of breast
  • Reddening of the breasts (Warm and tender)
  • Breast may ache
  • Rock hard breasts (that if pressed leaves an indent).
Appearance of the nipple
  • Flat and dark portion of breast also flat and hard
  • Stands erect


2. What Does It Mean If I Have Breast Engorgement or Nipple Oedema?

If you have breast engorgement or nipple oedema it may influence your breastfeeding effectiveness in the following ways:

  • Your baby might find it difficult to attach to your breast
  • Your baby might not be able to draw breast milk from you breast as the swelling can decrease the movement of your breast milk from the duct (place where breast milk is released into in the breast) to the nipple
  • Your baby might not get enough breast milk resulting in weight loss
  • Your baby might not be able to attach well onto your breast, resulting in your baby biting down on your nipple. This can cause nipple damage (bleeding, cracks, pain etc.) which may lead to a breast infection

crying baby


3. What Causes Breast Engorgement and Nipple Oedema?

Causes of Nipple Oedema Causes of Breast Engorgement
  • High Blood Pressure during pregnancy
  • Receiving high amounts of IV (Intravenous) Fluids- This is the fluids given to you by a drip
  • Oxytocin induced labour
  • Not breastfeeding frequently
  • Poor breast milk clearance by baby from breast
  •  Incorrect positioning of baby by the breast
  • Removing baby too soon from breast
  • Giving baby other fluids instead of breast milk without expressing breast milk out

Positioning and attachment

4. Treatment of Breast Engorgement and Nipple Oedema

It is very important to ask advice from your lactation consultant when it comes to breast engorgement and nipple oedema.

4.1. Treatment of Breast Engorgement

Prevention is always better than cure. At the beginning of your breastfeeding journey it is important that you breastfeed as often as the baby would like to. If your breast still feels full it is recommended to express the breast till relief is achieved. Ask your Health care professional to check whether your baby is attached well to the breast. A good attachment to the breast is important to ensure that your baby can remove sufficient amounts of breast milk at a feed. Providing your baby breast milk within the first hour of birth also assists to prevent engorgement.

If breasts are engorged the following can be done (please note that if relief is not achieved, it is best to consult a lactation consultant)

  • Regular emptying of breasts (preferably by your baby, however it can be done by using hand expression or a breast pump-if there is no oedema)
  • Applying a cool cloth on your breasts up to 20 minutes before breastfeeding your baby (Cold gel packs/ cooled cabbage leaves also work well)
  • If cabbage leaves are used- they may not be applied to breast for longer than 20 minutes at a time and more than 3 times a day (as it can decrease breast milk produced)
  • Performing a breast massage starting from the upper breast and moving towards the nipple

Cabbage leaves

4.2. Treatment of nipple oedema

A mother with nipple oedema usually needs help to attach her baby to the breast. It is advisable not to use a breast pump if nipple oedema occurs, as this can worsen the oedema. This happens because the breast pump will pull more fluid towards the nipple making it even harder for your baby to breastfeed. A health care professional can also teach a mother how to perform Reverse Pressure Softening. This is a technique used to help push fluid backwards allowing your baby to attach better to your breast. This method involves using your fingers or thumbs pressing your breast inwards towards your chest for between 1 to 3 minutes.

5. References

Cotterman, K.J. 2004. Reverse pressure softening: a simple tool to prepare areola for easier latching during engorgement. Journal of Human Lactation, 20(2):227-237.

Hughes, K. & Watson, C.J. 2018. The mammary microenvironment in mastitis in humans, dairy ruminants, rabbits and rodents: a one health focus. Journal of mammary gland biology and neoplasia, 1-15.

Kujawa-Myles, S., Noel-Weiss, J., Dunn, S., Peterson, W. E. & Cotterman, K. J. 2015. Maternal intravenous fluids and postpartum breast changes: a pilot observational study. International Breastfeeding Journal, 10(18)
Mosby’s dictionary of medicine, nursing and health professions. 2009. Missouri: Mosby Elsevier.

Wouk, K., Tully, K.P. & Labbok, M.H. 2016. Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3: Prenatal Breastfeeding Education. Journal of human lactation.


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