How to manage breast engorgement and prevent mastitis following your second or third trimester abortion
By Grace O.
Many women who terminate a pregnancy after the first trimester will experience an unwelcome memento of their loss: their breastmilk coming in and the resulting discomfort of breast engorgement. Your milk coming in may seem like a cruel trick of nature, magnifying an already overwhelming sense of loss. But it is really just the body’s normal reaction to the shift in hormone balance that takes place when a pregnancy ends.
You may find it emotionally excruciating to have your body is making milk for the baby you have lost. This turn of events can be physically painful as well because unrelieved milk production makes your breasts engorged. As they become congested with milk they may feel larger, heavier, very firm and quite tender to the touch. To make matters worse, virtually all the advice one can find about relieving breast engorgement revolves around nursing the baby and preserving the milk supply, none of which is appropriate for a grieving mother.
If you do nothing about engorgement your milk should begin dry up on its own within one to two days and associated tenderness should be gone in a week. But that can seem like an eternity when you are grieving the loss of your baby, especially if you’re experiencing severe physical discomfort. If you’ve ended a wanted pregnancy, you are already in more than enough pain. The following tips can help you get through the milk drying process more quickly and with less distress.
It is not an old wives’ tale. Cabbage leaves really do relieve engorgement, possibly more effectively than icepacks or other treatments. Regular green cabbage such as you’ll find at the grocer contains sinigrin, magnesium, oxylate, mustard oil, rapine and sulphur heterosides. This natural mixture of compounds reduces tissue congestion by dilating the small blood vessels to improve blood flow to the area.
To use, crush the green cabbage leaves with a rolling pin to break the veins and to better accommodate the shape of your breast. You can snip out a hole for your nipple if that is more comfortable for you.
Place the cabbage leaves over your breasts, inside of your bra. Leave it in place until they wilt, usually 2-4 hours. Many mothers report relief about 8 hours after treating with cabbage leaves. You can stop using the cabbage as soon as the engorgement goes down.
IMPORTANT: Cabbage leaves are not recommended if you are allergic to cabbage or sulfa.
You may use over the counter pain relievers such as acetaminophen (Tylenol™) or Ibuprofin (Motrin™), or whatever prescription pain reliever your doctor may have prescribed following your procedure. In addition to reducing pain they will minimize swelling.
If at any point you develop a fever in association with hot, painful breasts, contact your health care provider.
Drink to Thirst
Restricting fluids will not relieve your engorgement. Continue to drink to thirst as usual.
Ice Packs or Cold Compresses
Crushed ice or ice cubes in a Ziplock™ bag, or even a bag of frozen peas or corn from your freezer can also relieve your discomfort and diminish swelling. Wrap them in a thin towel and apply for about 20 minutes at a time.
Do not use warm compresses unless you are doing so to encourage the letdown reflex (letdown is when your milk flows out) in order to relieve engorgement. Overuse of warm compresses may actually increase milk production.
Contrary to what you may have heard, it is fine to express a little milk (using a breast pump or hand expression) to relieve engorgement. Be sure to express only the amount of milk you need to get comfortable. This will not increase your milk supply, and may help prevent mastitis, a complication of engorgement. However, keep in mind that milk production works by supply and demand. If you express a great deal of milk, your body may respond by making even more, thereby setting back your milk drying progress.
If you are very uncomfortable, try sitting in a warm bath and lean over into the water to allow your milk to leak out. Gentle breast (not nipple) compression may help in this process. Some women find they have better luck with hand expression in a warm shower. To learn more about hand expression of breastmilk, read about the Marmet Technique.
Choosing a Bra
You will be more comfortable wearing a well-fitting supportive bra. Improperly fitted bras, and particularly underwire bras, may further constrict milk flow causing mastitis.
A few grieving mothers have taken comfort in donating their expressed breastmilk to milkbanks which process and provide the milk to hospitalized or fragile newborns whose own mother’s milk is not available. If you find you have an abundant milk supply, are comfortable with pumping and storing milk and feel strongly that contributing your milk for babies in need would be a help in your own healing process, this may be a good option for you. The following links explain how:
Hang In There
The first several days following your loss can be some of the most emotionally overwhelming and intensely sad times you will ever experience. It is my hope that these strategies for dealing with engorgement will at least provide you with some small measure of control as you cope with the difficult days ahead. For private mother-to-mother support, consider joining our private support group.
The author is a former La Leche League leader and a mother who had an L&D abortion at 20 weeks gestation due to severe heart and chromosomal issues.