How to manage rock-hard engorgement when milk first kick in?

Some new moms experience rock-hard engorgement in both breasts when the breast milk first kick in. Despite frequent latching or pumping, little milk can be extracted. This condition can be very painful, and occasionally leads to mastitis when the mom develops fever. 

Your body is sending a lot of blood and water to the breasts to start making milk. The breasts can feel really hard and even painful because of the high volume of fluid inside. But these fluids HAVE NOT turned into milk yet, so very little milk can be expressed, even if you massage the breasts really hard. As a matter of fact, forceful breast massage increases the swelling and worsens the situation. 

Apply cold compress over the breasts for 5-10 minutes right before pumping or latching to reduce swelling. When the breasts are less swollen, milk can flow more easily. Do not massage forcefully.

Do not get discouraged by low supply. That is normal at this stage, when body is still producing colostrum instead of mature milk (when the milk turns completely white). Continue latching on demand, or pumping 3 hourly. For some moms, hand expression may be a more efficient way of milk removal at this stage, until the colostrum has turned into mature milk.

If pain is disturbing, take anti-inflammatory medication such as neurofen or ibuprofen. They are breastfeeding-friendly - just make sure that you are not allergic to them!

If the condition does not improve with the above measures after 1-2 days, try ultrasound/ Deep Oscillation Treatment for better relief. You can also consult a lactation consultant. Occasionally, antibiotics is required when the mom develops high or persistent fever.