Sore breast after birth not breastfeeding
Breast Engorgement: Symptoms, Treatment, and More
Once your little one has arrived, you’ll notice a few changes in your body. Your bump will get smaller and your breasts will fill up with milk. Sometimes, your breasts can feel overly full, heavy, and tight, even to the extent they are uncomfortable or even painful shortly after giving birth when the milk starts to come in. Read on to learn all about what breast engorgement is, how to prevent this condition, and how to help relieve engorged breasts.
What Is Breast Engorgement?
If you’re making more milk than your baby needs, your breasts can become overfilled with milk, which is known as breast engorgement. During pregnancy, your body starts producing colostrum, a thick and yellowish milk that’s full of antibodies and protein. This is the early milk that will nourish your newborn right after birth. Approximately two to four days after you’ve given birth, you’ll experience a change in your hormones and your breasts will fill with the standard white breast milk. When your hormones shift, the blood supply to your breasts increases and you make more milk; you’ll feel as if your breasts are fuller. A little fullness in the first few days is perfectly normal, but sometimes breast milk production can become excessive, leading to discomfort and possibly even causing pain in your engorged breasts. If you notice your breasts are engorged, take steps to treat this as soon as possible, as engorgement could lead to blocked milk ducts or mastitis.
What Are the Symptoms of Breast Engorgement?
During milk production, it’s perfectly normal to have full breasts, but you may have breast engorgement if you notice your breasts feel:
very full
hard
tender
painful or achy.
How Can You Prevent Breast Engorgement?
Breast engorgement usually doesn’t occur if the breasts are emptied frequently, meaning you’re nursing approximately every two to three hours. And if you experience engorged breasts, this may go away once you and your baby settle into a regular nursing pattern. If you’re breastfeeding your baby, then severe breast engorgement may go away within 36 hours. In situations when you can’t breastfeed right away, you can help prevent breast engorgement by using warm compresses, by expressing your milk manually, or by using a breast pump. Emptying your breasts can help with the initial discomfort.
How Can You Relieve Engorged Breasts?
If you’re not breastfeeding or expressing milk, then you may feel some discomfort from engorgement. But if the breasts are not stimulated to produce more milk, then the discomfort you feel from breast engorgement may go away gradually, usually within 7 to 10 days. You can try the following in the meantime to help with engorged breast pain relief even if you’re not breastfeeding:
Wear a well-fitting support bra or sports bra
Apply ice packs to your breasts to help reduce the swelling
Avoid expressing any milk if you don’t plan to continue nursing, as this will signal to your breasts to make more milk; you may want to discuss this with a lactation consultant or your healthcare provider
Take an over-the-counter pain medication, like ibuprofen, if you need it, but consult your healthcare provider if you’re unsure
You can try a popular home remedy—placing a refrigerated, clean cabbage leaf directly on the breast, so it's held in place by a bra. The coolness combined with the shape of the cabbage leaf, which fits the shape of breast, may help with the swelling, but this is a home remedy that may not work for all women.
If you’re breastfeeding and still suffer from breast engorgement, in addition to some of the above tips, you may also want to try feeding your baby in more than one position.
The Bottom Line
Breast engorgement can be uncomfortable, but it’s not something to worry about. It can be easily treated either by feeding your baby regularly or with cool compresses until the swelling goes down. However, sometimes a blocked milk duct or mastitis can feel like breast engorgement, so if you’re in doubt, consult your healthcare provider, especially if you notice any flu-like symptoms or your breasts are hot to the touch. The good news is that the uncomfortable swelling most likely will go down, either with regular feedings or just with time. Soon your breasts will feel less heavy and achy, and you’ll have more energy to focus on your little one.
Causes and Tips for Relief
What is breast engorgement?
Breast engorgement is breast swelling that results in painful, tender breasts. It’s caused by an increase in blood flow and milk supply in your breasts, and it occurs in the first days after childbirth.
If you’ve decided not to breastfeed, you may still experience breast engorgement. It can happen in the first few days after delivery. Your body will make milk, but if you don’t express it or nurse, the milk production will eventually stop.
Breast engorgement is the result of increased blood flow in your breasts in the days after the delivery of a baby. The increased blood flow helps your breasts make ample milk, but it can also cause pain and discomfort.
Milk production may not occur until three to five days postpartum. Engorgement may occur for the first time in the first week or two after delivery. It can also reoccur at any point if you continue to breastfeed.
Not producing enough milk? Here are 5 tips to increase breast milk production.
Certain conditions or events may make you more likely to experience the swollen fullness that’s commonly associated with breast engorgement. These causes include:
- missing a feeding
- skipping a pumping session
- creating an overabundance of milk for the baby’s appetite
- supplementing with formula between nursing sessions, which may reduce nursing later
- weaning too quickly
- nursing a baby that’s ill
- difficulty with latching and sucking
- not expressing breast milk when it first comes in because you don’t plan to breastfeed
The symptoms of breast engorgement will be different for each person. However, breasts that are engorged may feel:
- hard or tight
- tender or warm to touch
- heavy or full
- lumpy
- swollen
The swelling may be contained to one breast, or it may occur in both. Swelling can also extend up the breast and into the nearby armpit.
The veins running under the breast’s skin may become more noticeable. This is a result of the increased blood flow, as well as the tightness of the skin over the veins.
Some with breast engorgement may experience a low-grade fever and fatigue in the first days of milk production. This is sometimes called a “milk fever.” You can continue to nurse if you have this fever.
However, it’s a good idea to alert your doctor to your increased temperature. That’s because some infections in the breast can cause fever, too, and these infections need to be treated before they become bigger issues.
Mastitis, for example, is an infection that causes inflammation of the breast tissue. It’s most commonly caused by milk trapped in the breast. Untreated mastitis can lead to complications such as a collection of pus in the clogged milk ducts.
Report your fever and any other symptoms you’ve recently experience to your doctor. They will want you to monitor for signs of an illness or infection so you can seek immediate treatment.
The treatments for breast engorgement will depend on whether you’re breastfeeding or not.
For those who are breastfeeding, treatments for breast engorgement include:
- using a warm compress, or taking a warm shower to encourage milk let down
- feeding more regularly, or at least every one to three hours
- nursing for as long as the baby is hungry
- massaging your breasts while nursing
- applying a cold compress or ice pack to relieve pain and swelling
- alternating feeding positions to drain milk from all areas of the breast
- alternating breasts at feedings so your baby empties your supply
- hand expressing or using a pump when you can’t nurse
- taking doctor-approved pain medication
For those who don’t breastfeed, painful engorgement typically lasts about one day. After that period, your breasts may still feel full and heavy, but the discomfort and pain should subside. You can wait out this period, or you can use one of the following treatments:
- using a cold compress or ice packs to ease swelling and inflammation
- taking pain medication approved by your doctor
- wearing a supportive bra that prevents your breasts from moving significantly
You can’t prevent breast engorgement in the first days after giving birth. Until your body knows how to regulate your milk production, you may overproduce.
However, you can prevent later episodes of breast engorgement with these tips and techniques:
- Feed or pump regularly. Your body makes milk regularly, regardless of nursing schedule. Nurse your baby at least every one to three hours. Pump if your baby isn’t hungry or you’re away.
- Use ice packs to decrease supply. In addition to cooling and calming inflamed breast tissue, ice packs and cold compresses may help decrease milk supply. That’s because the cool packs turn off the “let down” signal in your breasts that tells your body to make more milk.
- Remove small amounts of breast milk. If you need to relieve the pressure, you can hand express some breast milk or pump a bit. Don’t pump or express too much, however. It could backfire on you, and your body may end up trying to produce more milk to make up for what you just removed.
- Wean slowly. If you’re too quick to stop nursing, your weaning plan may backfire. You could end up with too much milk. Slowly wean your child so your body can adjust to the decreased need.
If you don’t breastfeed, you can wait out breast milk production. In a matter of days, your body will understand it doesn’t need to produce milk and the supply will dry up. This will stop the engorgement.
Don’t be tempted to express or pump milk. You’ll signal to your body that it needs to produce milk, and you may prolong discomfort.
Breast engorgement is swelling and inflammation that occurs in your breasts because of increased blood flow and milk supply. In the days and weeks after giving birth, your body will begin to produce milk.
Until your body knows how much you need, it may produce too much. This can lead to breast engorgement. Symptoms include hard, tight breasts that are swollen and tender. Regular nursing or pumping can help prevent breast engorgement.
If you continue to experience the painful swelling of breast engorgement, reach out to a lactation consultant or a lactation support group at your local hospital. Both of these resources can help you with your questions and provide support.
Also, call your doctor if the engorgement doesn’t subside in three to four days or if you develop a fever. They’ll ask you to monitor for other signs that may indicate a more serious problem, such as a breast infection.
Solving nine breastfeeding problems in the first month
Expert advice on solving major breastfeeding problems in the first month.
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Cathy Garbin, child health nurse, midwife and lactation consultant:
Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.
Breastfeeding is as much a skill as driving a car, and in the first month mother and baby may encounter some obstacles along the way. It takes time and experience to make it familiar to both of you. Solving breastfeeding problems in the first month helps to establish good milk production and increase the duration of breastfeeding in the future. Below you will find tips on how to overcome the main breastfeeding challenges that mothers often face from the end of the first week to the end of the first month after giving birth.
Problem #1. A painful lump appeared in the breast
Lumps and lumps in the breast of a nursing woman can appear for various reasons. One of the most common is blockage of the milk ducts, which results in a hard and painful lump that can become inflamed.
Solutions 1-3
- Massage the inflamed area, especially while breastfeeding or expressing, to clear the blockage.
- Gently apply warm flannel to your breasts or take a warm shower before feeding to relieve discomfort.
- Continue breastfeeding as usual to avoid milk accumulation that can cause mastitis.
- Try to express milk from the inflamed breast after feeding to ensure that it is completely emptied. This will help to remove the blockage and restore the patency of the duct. See what breast pumps* Medela has to offer and choose the right one for you.
- Try ultrasound therapy. If you have repeated blocked ducts, your lactation consultant or healthcare professional may suggest this procedure to help restore milk flow. The procedure is performed by a physiotherapist.
- Call your healthcare provider, if you notice signs of infection (breast redness and tenderness or flu-like symptoms such as fever, aches, malaise and headache), or if you think the lump is not related to breastfeeding .
Problem #2. The breast is red and sore
If one or both mammary glands are red and sore, and this is not due to blockage of the ducts, mastitis, that is, inflammation of the breast tissue, is not excluded. Mastitis is characterized by redness, burning, and soreness of the breasts, combined with flu-like symptoms: You feel hot and cold, your joints ache, and your temperature rises above 38.5 °C (101.3 °F). Seek medical attention immediately if you experience these symptoms. Mastitis needs to be treated as soon as possible, as your condition can worsen in just a few hours. 3
Mastitis can be caused by the following causes:
- untreated blocked ducts,
- Bacteria entering the breast through cracked and damaged nipples,
- incorrect attachment of the child to the breast,
- long periods between feedings,
- breasts too full,
- wearing a bra that is too tight or that cuts into the skin,
- Abrupt weaning,
- excess milk.
Solutions 3
In addition to seeking medical attention:
- Continue to breastfeed or express milk frequently. Your milk is still safe for your baby. Its release will help eliminate blockage of the ducts and prevent painful accumulation of milk. Sudden cessation of feeding or pumping may exacerbate symptoms. After feeding, it is advisable to express any remaining milk.
- Give the child the inflamed breast first. This way the child can empty it completely. If it hurts too much, start feeding on the healthy breast, and when milk begins to flow, go back to the first one.
- Have a good rest, drink and eat. You need to get enough fluids and good nutrition.
- Massage the sore area under a warm shower or apply a warm flannel or warm pack to clear the blockage and relieve symptoms before feeding or pumping.
- Apply a cooling pack after feeding, , to reduce inflammation.
Problem #3. My strength is running out
Breastfeeding in the first weeks can be very tiring and seem endless. The baby will ask for a breast every few hours, day and night, and you have not yet grown stronger after giving birth.
Solutions
- Take care of yourself. This may be easier said than done when you have a newborn in your arms, but still try to get as much rest as possible, eat healthy and regular meals, and drink plenty of water. Do not refuse the help of your partner, relatives and friends, or even hire an assistant if you can afford it.
- Feed lying down. This will allow you to relax and reduce stress on sore spots, stitches or c-section scars.
- Do not skip feedings. Your partner may offer to bottle feed your baby while you are resting. However, despite this temptation, it should be remembered that milk production is best established in the first four weeks through breastfeeding. When breastfeeding is well established, you can give your baby expressed milk, but before that, ask family or friends to help you with other things so you can fully focus on breastfeeding.
Problem #4. How can I increase breast milk production?
It's easy to question whether you're making enough breast milk, especially when your baby has developmental spikes between the third and fourth weeks. It may seem to you that the child asks for breasts more often because he does not have enough milk. However, if the number of wet and soiled diapers doesn't change—see Breastfeeding: What to Expect in the First Month—the baby is likely to breastfeed more often to calm down. The baby is surrounded by many new sounds and images that are easy to get tired of, and at the breast he feels safe. 4
Solutions 4.5
- Do not try to supplement your baby with formula, unless doctors are worried about weight gain or fluid loss. Continue breastfeeding your baby. This will help naturally increase breast milk production.
- Do not feed on a schedule. Feed your baby on demand. Thus, the production of breast milk will adapt to his needs.
- Use the breast pump, , to help increase breast milk production while continuing to breastfeed.
Problem #5. I have too much milk
Hyperlactation, or too much milk, can also be difficult for you and your baby. You may experience discomfort from swollen and leaking breasts, and your baby may have difficulty latch-on, choke on the milk flowing too fast, and be unable to empty the breast properly. 6
Solutions
- Express some breast milk at the start of a feed to reduce the force of the flush. Don't pump too much as this can aggravate the situation - pump only as much as needed to ease the discomfort. Try hand pumping or use a breast pump (check out the Medela* breast pump range and choose the right one for you).
- Use towel or pad to soak up excess milk, or place the Milk Collection Pad** on the other breast while you breastfeed first.
- The child must feel supported. Hold him firmly (this gives a sense of security) and in a comfortable position so that he can turn his head. Talk to the baby during the first rapid flush, then he will not be frightened by surprise and will not push the breast.
- Contact a lactation consultant or health care professional who will monitor you and suggest single-sided feedings or hourly breast changes (“breast duty”) to normalize your milk supply.
- Be patient . Problems with milk production usually go away after a few weeks.
Problem #6. I have different breasts!
You have noticed that the baby has a preference for one breast, or that one breast produces more milk than the other, and as a result, the mammary glands have become of different sizes and shapes. This happens quite often and does not pose any problems for breastfeeding. If this does not bother you or your baby, you can leave everything as it is. If this makes you uncomfortable, try the following tricks.
Solutions
- During feeding, offer the less demanded breast first as babies usually suckle more vigorously at the beginning of feeding.
- Use the breast pump to increase breast milk production in the smaller breast.
- Don't give up on bigger breasts. Breastfeeding should continue with fuller breasts to avoid blocked ducts and mastitis.
- See a doctor. Sometimes an ear infection is the reason for a baby to latch on only one side. However, some positions may cause him discomfort, so try to keep the child more upright. In addition, a breast infection can change the taste of milk and cause milk to be rejected as well.
Problem #7.
A blister has appeared on the nipple With frequent feeding, sometimes painful friction occurs, and a blood bubble may appear on the breast,
nipple or areola. 7
Solutions
- Ask a lactation consultant or specialist to check the baby's latch on. A shallow grip can cause blistering of the nipples and areolas.
- Talk to your doctor about what medicine you can take to relieve pain if needed.
- Try other feeding positions to avoid pressure on the painful area.
- Lubricate inflammation with pure lanolin.
- Use Breast Pads** to avoid rubbing your blister with clothing and help it heal faster with air circulation, or try cooling hydrogel pads** to help relieve pain and promote healing.
- Try expressing milk. Using a breast pump can be an alternative way to get breast milk without bladder irritation. Choose the correct funnel size so that the nipple can move freely and the bubble does not rub against the walls of the tunnel.
- Do not pierce the vial as this may lead to infection.
- Seek medical attention, if the problem persists and causes you pain.
Problem #8. Painful white spot on nipple
When the orifice of the milk duct becomes blocked with milk or a thin layer of skin grows over it, a small white or yellowish spot may appear on the tip of the nipple. For some, these blocked ducts, sometimes called milk vesicles or blisters, cause pinpoint pain, especially during feeding or pumping. Others do not experience any discomfort. White blisters may persist for several days or weeks until the skin breaks and hardened milk comes out. 8
Solutions
- Follow the tips above to solve friction bubble problems.
- Remove the blockage, if you see that the milk cork is starting to bulge. Try to squeeze it out very gently with clean nails.
- Continue breastfeeding or pumping, to clear the milk duct. If the milk duct clears during feeding, it will not harm the baby in any way.
- Apply hot wet flannel to the vial just before feeding or pumping. This will help open the blocked duct. You can also try rubbing the area quickly with a clean, damp cloth.
- Manually express some milk before feeding, trying to push out hardened milk clots. If this does not help, feed the baby or express milk as usual. Repeat several times a day.
- Soak a cotton swab with olive oil and place it in the bra, pressing it against the bubble nipple. This will help soften the skin.
- Seek medical attention, if problem persists. Your doctor may remove the plug with a sterile needle. This should be done immediately after feeding, when the bubble is as inflated as possible.
Issue #9. My nipples hurt while breastfeeding
At the start of breastfeeding, my nipples may become more tender, sore, and even inflamed, but this usually goes away after a few days. If your baby's latch is checked by a specialist and the inflammation persists or the nipples hurt with every feeding, you may need medical attention to resolve this problem. 2.7
The following symptoms and signs that appear on one or both breasts during or after feeding may indicate a bacterial infection or thrush:
- burning, itching or moderate to severe pain in the nipples
- pain in nipples aggravated by contact with clothing,
- nipple pain persists despite attempts to attach baby differently,
- nipples hurt to touch,
- stitching, shooting, burning or deep aching pain,
- chest pain during feeding and almost an hour after,
- hot pink nipples,
- discoloration and texture of the areola (hot pink, darkening, dryness or peeling),
- white rash on chest or areola.
Also check if your child has the following symptoms and signs:
- hard white patches or coating on the tongue,
- white indelible spots on the cheeks,
- bright red spotted rash on buttocks not helped by diaper rash creams.
Solutions 7
- Seek medical attention. He will most likely suggest testing for infections to make a diagnosis. Bacterial and fungal (yeast) infections are treated differently, so appropriate treatment should be started as soon as possible. There are other reasons that can cause similar nipple pain, such as eczema, psoriasis or vasospasm (narrowing of the blood vessels) in the mother and problems with latch or tongue frenulum in the child. Therefore, it is very important to make an accurate diagnosis.
- Strict hygiene. Wash hands before and after feeding and applying any medication, and after changing diapers. Change bra pads regularly, wash bras, tank tops and towels in high temperature water, thoroughly wash breast cups and anything your baby puts in her mouth, such as nipples.
- Let the nipples dry after feeding, as all infections love a warm and humid environment.
- See your doctor again if there is no improvement after a few days. Do not let the problem run its course, otherwise the situation may worsen.
Related materials. Breastfeeding: what to expect in the first month
Breastfeeding: what to expect after the first month
Breastfeeding problems after the first month
Literature
1 Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol # 20: Engorgement. Breastfeed Med. 2009;4(2):111-113.- Breastfeeding Academy Protocol Committee, "AVM Clinical Protocol #20: Breast engorgement." Brestfeed Med (Breastfeeding Medicine). 2009;4(2):111-113.
2 Jacobs A et al. S3-guidelines for the treatment of inflammatory breast disease during the lactation period. Geburtshilfe and Frauenheilkunde . 2013;73(12):1202-1208. - Jacobs A. et al., "Recommendations 2014;9(5):239-243.
4 Kent JC et al. Principles for maintaining or increasing breast milk production. 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Milk Production". G Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.
5 Amir L. Breastfeeding managing ‘supply’ difficulties. Aust fam physician . 2006;35(9):686. - - Amir L., "Breastfeeding: problems of 'supply'. Aust fam physis. 2006;35(9):686.
6 Trimeloni L, Spencer J. Diagnosis and management of breast milk oversupply Journal Am Board Fam Med . 2016;29(1):139-142. - Trimeloni L., Spencer J., "Diagnosis and correction of excess breast milk production. " Journal Am Bord Fam Med. 2016;29(1):139-142.
7 Berens P et al. Academy of Breastfeeding Medicine. ABM Clinical Protocol# 26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11(2):46-53. - Behrens, P. et al., Academy of Breastfeeding Medicine, AVM Clinical Protocol #26: Persistence of Breastfeeding Pain. Brestfeed Med (Breastfeeding Medicine). 2016;11(2):46-53.
8 Australian Breastfeeding Association [Internet] White spot nipple; March 2015 [Accessed 02/08/2018]. - Australian Breastfeeding Association [Internet], "White spots on the nipples", March 2015 [visited 02/08/2018].
Read instructions before use. Consult a specialist about possible contraindications.
* RU № ФСЗ 2010/06525 dated 03/17/2021
** RU ФСЗ 2010/07352 dated 07/19/10
Laktostasis: causes, symptoms, treatment and prevention
Laktostasis: causes, symptoms, treatment and prevention | "Rinat Akhmetov Foundation"10/16/2016
One of the troubles that nursing mothers face is lactostasis, that is, blockage of the milk duct. When milk in any one lobe of the mammary gland stops being removed. Ksenia Solovei, Head of the National Movement in Support of Breastfeeding "Milk Rivers of Ukraine", UNICEF partner in the Breastfeeding Support Program in Crisis Situations, talks about the first signs of lactostasis, its treatment and prevention.
“The main causes of lactostasis are ineffective suckling of the mother’s breast by the child, long breaks in feeding, limitation of the duration of suckling, overwork of the mother, etc. breast, he sucks milk poorly, and therefore it can stagnate. A logical conclusion follows from this: the best prevention of lactostasis during breastfeeding is the correct attachment of the crumbs to the breast and the absence of pacifiers and nipples in care, ”says Ksenia Solovey.
How does lactostasis manifest itself during breastfeeding:
- in one part of the breast a painful induration is felt, in size it can be like a bean or even like a quail egg;
- there may be slight redness over the induration;
- the temperature may rise.
White spot on the nipple. Examine the nipple for a white spot. It happens that the opening of the duct overgrows due to improper attachment, and a white film forms on the nipple, which prevents the milk from flowing freely, and it stagnates. To get rid of it, warm the nipple, rub it with a hard towel to break the integrity of the film, and start feeding.
What to do if you have lactose intolerance:
- Keep breastfeeding! During this period, you should feed more often than usual, at least every 1.5-2 hours. Always start breastfeeding with the breast that hurts, and end with healthy breasts.
- Check attachment. The child's mouth is wide open when sucking, the chin rests on the chest, most of the areola has entered the child's mouth from below, the lower lip is turned inside out. Swallowing is heard when sucking. After feeding, the nipple comes out of the baby's mouth in an even cylinder (a beveled nipple is like a new lipstick - indicates improper attachment).
- Get plenty of rest and don't limit your sucking! You should focus on yourself and your health. Stay in bed with the baby and feed until you feel better.
- Use cold treatment . In most cases, lactostasis is accompanied by swelling of the breast tissue and this can aggravate the situation. Therefore, 3 times a day, apply cold to the seal area for 10-15 minutes. It can even be a leaf of white cabbage from the refrigerator, pre-soften it with a rolling pin or beat it off.
- Drinking mode. It is very important to continue to drink enough without reducing fluid volumes. If a nursing woman stops drinking during lactostasis, her milk becomes more viscous and it becomes more difficult to cope with lactostasis.
- Express breast milk. If for some reason you do not feed your baby directly from the breast, but feed with expressed milk, it is important to regularly and effectively express milk manually or with a breast pump.
Signs of improvement:
- If your temperature returned to normal in a day, this indicates that you are acting correctly.
- Breast tenderness will go away.
- Compaction will gradually decrease. All this happens gradually, within 3-7 days.
Signs of deterioration:
- The temperature lasts for several days.
- There are cracks on the nipple.
- No temperature, but the seal does not change during the week.
In this case, you should contact your doctor for prescription medication. Tell your doctor that you plan to continue breastfeeding and they will prescribe medications that are compatible with breastfeeding.
If you have a situation of lactostasis and you feel that you cannot cope on your own, it is best to seek help from specialists so that they can accurately determine at what stage of the disease you are and give more detailed recommendations for solving the problem.