In general, if you are only getting drops, or a very small amount of milk while pumping, but your breasts still feel heavy and full after you've pumped for 10 to 15 minutes, then it is very likely that you are having difficulty letting down in response to your pump.
Change the settings on your pump: Try increasing (or even lowering) the speed to see if you respond better to that. Change your flange size: If your breast is too constricted in your flange, you may not be able to express as much milk. Try upping the flange size to give your breast more room to move.
If you pump for too long, you may make the engorgement worse or last longer than usual. If your breasts still hurt after your baby is 5 days old or you feel a lump in your breast that does not go away after you breastfeed, call your doctor or breastfeeding specialist.
Breast engorgement is swelling, tightness, and an increase in size of the breasts. It usually occurs in the early days of breastfeeding, between day 3 and 5, but may occur as late as day 9-10. Moderately severe breast engorgement results in hard, full, tense, warm and tender breasts with throbbing and aching pain.
Causes of Engorgement
Engorgement happens when milk isn't fully removed from your breast. It can happen any time, but it's most likely to happen: As your milk transitions from colostrum to mature milk. If there are sudden changes in how often you nurse, such as skipping a few feedings or pumping sessions.
Excessive or habitual pumping can lead to overproduction of milk and prolonged engorgement. If you're exclusively pumping and feeling engorged, make sure you're pumping enough (eight to 12 times in a 24-hour period) and that your pump is working well.
You may think pumping will relieve breast engorgement, and it will—in the short term. But in the long term, pumping only encourages your body to produce more milk, exacerbating the issue.
Despite views to the contrary, breasts are never truly empty. Milk is actually produced nonstop—before, during, and after feedings—so there's no need to wait between feedings for your breasts to refill.
Engorgement is less common, too, if you don't do supplemental feedings. But even if you do everything perfectly, some women will still become engorged. It's not a guarantee. If you do and don't do anything, the engorgement will likely last for 7 to 10 days.
Talk to your midwife, child and family health nurse, GP or lactation consultant or an ABA counsellor if engorgement doesn't go away.
Pumping shouldn't make engorgement worse—in fact, it might help alleviate engorgement. If your breast is engorged, it might become too firm for your baby to latch. Pumping a little bit before breastfeeding may help soften the areola and lengthen the nipple to make it easier for your infant to connect with your breast.
If your breast doesn't feel full of milk, this is usually not a sign of low breastmilk supply. For most breastfeeding problems related to breastmilk supply, the answer is: “more breastfeeding.” Keep breastfeeding, keep pumping, and that will keep stimulating your body to produce more milk.
There's no set time for engorgement to subside. The engorgement you feel after giving birth is usually the most severe. Most people stop feeling engorged within 10 days; however, feeling “full” can last several weeks. Breast engorgement can come back as long as you breastfeed, chestfeed or pump breast milk.
Engorged breasts will normally feel tight or hard, while mastitis is more often characterized by redness and inflammation (engorgement does not normally cause redness). Though both can cause pain and tenderness in the breasts, mastitis pain can worsen when your baby feeds, and can feel like burning.
If your baby has only fed from one breast and you are comfortable at the end of a feeding, you don't need to pump. But if either breast is still full and uncomfortable, pump or hand express to comfort.
Massage your breasts before you pump.
This causes a faster let-down and milk with more fat. Massaging your breasts near the end of the pumping session will ensure that you fully drain your breast of milk. It may also help you to make more milk, if you need to.
Adequate hydration also is important for breast milk production. The amount of liquid you put into your body affects how much breast milk you can produce. I encourage women to carry a bottle of water for themselves in their diaper bag.
But you'll know when it's too much or too often. Look for signs that your baby is having tummy aches, such as arching their back while crying or making a strained facial expression. If you notice that gas is a daily, constant issue for your baby, then an oversupply of breastmilk might be the culprit.
You're not getting let down. If your breasts feel like they're full but you're not able to get the milk flowing out when you pump, it could be that you're not achieving let down. The let down reflex releases your milk from the milk ducts. This only occurs when you're either breastfeeding or pumping.
Milk production is a demand and supply process. As milk is removed from your breasts, your body is signalled to make more milk. The more frequently and thoroughly the breasts are emptied (though breasts are never truly 'emptied'), the faster they try to refill.
Mastitis
If your breasts are feeling heavy, tender to the touch and swollen, you may have mastitis, which is common for breastfeeding moms. Mastitis is inflammation of the breast tissue and can lead to pain and a burning sensation when pumping which can affect the amount of milk you express.
For engorgement and mastitis, a further helpful massage technique is to massage the outer sides of the breasts in long strokes up towards the lymph nodes in the axilla (arm pit) and massage the inner sides of the breasts toward the lymph nodes in the center of the chest.
Even though the setting may have worked well for you in the past, your body may not be reacting to it anymore. Pumping too soon. You may be pumping too soon after nursing or your last pumping session. If you are trying to pump after breastfeeding your baby, try waiting an hour or pump one side and feed on the other.