There are two ways to think of engorgement and I feel like it is important to understand the differences. If you have given birth in a hospital setting and have had IV fluids for an extended period of time, you could have a form of engorgement that stems from too much fluid filling the tissues of the breast from your IV. Or 2-3 days after birth when your milk transitions from colostrum to milk your breasts can become full, heavy and warm. They can be painful and hard as more milk is made than is removed at this point.
If you are experiencing excessive swelling that is keeping baby from latching well you can do what is called “reverse pressure softening” where you make a flower shape with your fingertips and form them over the areola (the dark part of your breast and nipple) and push gently in and back. Your goal is to gently move the fluid back and away from your nipple towards your armpits. This “softening” should allow some room for baby to be able to latch on. Here is a video you can watch on Reverse Pressure Softening.
Hand expression is always a great way to relieve some of the pressure so you will feel more comfortable and baby can latch better. Here is a video showing how to do hand expression if you need it.
You can also stand in a warm shower, allowing the water to run over your breasts(avoiding direct spray onto the breasts) which can stimulate milk to flow out enough for baby to latch on once you are out of the shower. Pumping a little milk off just to comfort will also help baby to latch, especially hand expression. You really want baby to take what he wants and be the one to “empty”(although the breasts are never truly empty) the breast if possible as his nursing will start setting the stage for your milk production.
Soon the demand of milk will regulate the production of breastmilk through the frequency of feedings and the amount baby takes. But engorgement can sneak up on you if baby sleeps longer than normal or if baby is fed expressed milk while mom is away.
Here are some suggestions for dealing with engorgement from the La Leche League:
KellyMom.com has some great additional information on engorgement here including the use of cabbage leaves for engorgement. But beware that cabbage leaves are also suggested for helping to dry up milk so you want to just use them until you are comfortable. https://kellymom.com/bf/concerns/mother/engorgement/
As always, if you have concern, fever, chills or reddened warm areas please check with your care provider. Engorgement can lead to mastitis if not corrected. If you feel that baby is not latching on appropriately or draining your breasts adequately, please reach out to a Lactation Specialist to determine how they can help.