Early Postpartum Breast Engorgement Trajectory and Breastfeeding Adaptation: A Cohort Study
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Abstract
The first postpartum week represents a critical period for lactation establishment, during which mothers experience rapid physiological and psychological adaptations. Breast engorgement is a common breastfeeding challenge that may interfere with effective breastfeeding and maternal comfort. However, longitudinal patterns of breast engorgement and factors associated with its severity during early postpartum period remain insufficiently explored. This study aimed to examine changes in breast engorgement, breast pain, and breastfeeding adaptation during the first seven postpartum days and identify maternal factors associated with breast engorgement severity. A prospective cohort study was conducted among 50 postpartum women recruited from primary healthcare centers in Tuban Regency, East Java, Indonesia. Participants were enrolled within 24 hours after delivery and followed until postpartum day seven. Breast engorgement, breast pain, perceived milk production, and breastfeeding adaptation were assessed on postpartum days 1, 3, 5, and 7. Maternal hemoglobin level and psychological status measured using the Edinburgh Postnatal Depression Scale (EPDS) were assessed at baseline. Data were analyzed using repeated-measures analysis and generalized estimating equations. Breast engorgement and breast pain increased significantly during the early postpartum period, reaching the highest level on day 3 before declining by day 7 (p < 0.001). Breastfeeding adaptation improved progressively throughout follow-up (p < 0.001). Lower hemoglobin levels and higher EPDS scores were significantly associated with greater breast engorgement severity. Breast engorgement and breastfeeding adaptation undergo dynamic changes during the first postpartum week. Integrated assessment of maternal physiological and psychological conditions may support early identification of mothers at risk of breastfeeding difficulties.
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Amandeep, S. S. D. (2024). Breast Engorgement. International Journal of Science and Research (IJSR). https://doi.org/10.21275/sr24123215535
Babakazo, P., Bosonkie, M., Mafuta, E., Mvuama, N., & Mapatano, M. (2022). Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa. PLoS ONE, 17. https://doi.org/10.1371/journal.pone.0275477
Betts, R., Johnson, H. M., Eglash, A. R., & Mitchell, K. (2020). It's Not Yeast: Retrospective Cohort Study of Lactating Women with Persistent Nipple and Breast Pain. Breastfeeding Medicine, 16, 318 - 324. https://doi.org/10.1089/bfm.2020.0160
Boyles, S. L., Weinstein, S. R., Bell, A. F., & Erickson, E. N. (2025). Postpartum Hemorrhage and the Likelihood of Exclusive Breastfeeding Through 6 Months Postpartum: A Case-Control Study. Journal of midwifery & women's health, 70, 780 - 790. https://doi.org/10.1111/jmwh.13781
Brown, A., Rance, J., & Bennett, P. (2016). Understanding the relationship between breastfeeding and postnatal depression: The role of pain and physical difficulties. Journal of Advanced Nursing, 72(2), 273–282. https://doi.org/10.1111/jan.12832
Cairns, A. E., Pealing, L., Duffy, J. M. N., Roberts, N., Tucker, K. L., Leeson, P., MacKillop, L. H., & McManus, R. J. (2017). Postpartum management of hypertensive disorders of pregnancy: A systematic review. In BMJ Open (Vol. 7, Number 11). BMJ Publishing Group. https://doi.org/10.1136/bmjopen-2017-018696
Cindy-Lee Dennis. (2019). The Relationship Between Infant-Feeding Outcomes and Postpartum Depression: A Qualitative Systematic Review. PEDIATRIC.
Douglas, P. (2022). Re-thinking benign inflammation of the lactating breast: Classification, prevention, and management. Women's Health, 18. https://doi.org/10.1177/17455057221091349
Douglas, P. (2022). Re-thinking lactation-related nipple pain and damage. Women's Health, 18. https://doi.org/10.1177/17455057221087865
Giannì, M., Bettinelli, M., Manfra, P., Sorrentino, G., Bezze, E., Plevani, L., Cavallaro, G., Raffaeli, G., Crippa, B. L., Colombo, L., Morniroli, D., Liotto, N., Roggero, P., Villamor, E., Marchisio, P., & Mosca, F. (2019). Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation. Nutrients, 11. https://doi.org/10.3390/nu11102266
Huda, M. H., Chipojola, R., Lin, Y.-M., Lee, G., Shyu, M.-L., & Kuo, S. (2021). The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis. Journal of Human Lactation, 38, 156 - 170. https://doi.org/10.1177/08903344211029279
Islam, M., Broidy, L., Baird, K., Rahman, M., & Zobair, K. M. (2021). Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support. PLoS ONE, 16. https://doi.org/10.1371/journal.pone.0251419
Kent, J. C., Gardner, H., & Geddes, D. T. (2016). Breastmilk production in the first 4 weeks after birth of term infants. Nutrients, 8(12). https://doi.org/10.3390/nu8120756
Khusniyati, E., & Purwati, H. (2024). Analisis Faktor Yang Mempengaruhi Kelancaran Produksi Asi Pada Ibu Menyusui (Analysis Of Factors That Influence The Production Of Breast Milk In Breastfeeding Mothers). Jurnal Ilmu Kesehatan, 13(1).
Lukman, S., Wahyuningsih, S., Keperawatan, P., Yapenas, A., & Kunci, K. (2020). Perbedaan Pemberian ASI Eksklusif dengan PASI terhadap Tumbuh Kembang pada Anak Usia 0-12 Bulan Difference Between Exclusive Breastfeeding and Substitute Breast Milk to Growth and Development in Children Aged 0-12 Months. 1(1), 19–27. https://doi.org/10.36590/kepo
Moya, E., Phiri, N., Choko, A. T., Mwangi, M. N., & Phiri, K. S. (2022). Effect of postpartum anaemia on maternal health-related quality of life: a systematic review and meta-analysis. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-12710-2
Nadeem, G., Rehman, A., & Bashir, H. (2021). Risk Factors Associated With Birth Asphyxia in Term Newborns at a Tertiary Care Hospital of Multan, Pakistan. Cureus. https://doi.org/10.7759/cureus.18759
Nagel, E. M., Howland, M. A., Pando, C., Stang, J., Mason, S., Fields, D., & Demerath, E. (2021). Maternal psychological distress and lactation and breastfeeding outcomes: A narrative review. Clinical therapeutics, 44, 215 - 227. https://doi.org/10.1016/j.clinthera.2021.11.007
Pérez-Escamilla, R., Tomori, C., Hernández-Cordero, S., Baker, P., Barros, A. J. D., Bégin, F., Chapman, D. J., Grummer-Strawn, L. M., McCoy, D., Menon, P., Ribeiro Neves, P. A., Piwoz, E., Rollins, N., Victora, C. G., & Richter, L. (2023). Breastfeeding: crucially important, but increasingly challenged in a market-driven world. In The Lancet (Vol. 401, Number 10375, pp. 472–485). Elsevier B.V. https://doi.org/10.1016/S0140-6736(22)01932-8
Pmb, D., Sidotopo, D., Surabaya, W., Ummah, K., Khairoh, M., Nur, S., Sit, S., & Kes, M. (2023). Efektifitas Abon Jantung Pisang Terhadap Kelancaran Asi pada Ibu 2 Minggu Post Partum (Vol. 1, Number 1).
Pope, C. J., & Mazmanian, D. (2016). Breastfeeding and postpartum depression: An overview and methodological recommendations for future research. In Depression Research and Treatment (Vol. 2016). Hindawi Publishing Corporation. https://doi.org/10.1155/2016/4765310
Scime, N. V., Metcalfe, A., Nettel-Aguirre, A., Nerenberg, K., Seow, C., Tough, S., & Chaput, K. (2023). Breastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: a latent class analysis. BMC Pregnancy and Childbirth, 23. https://doi.org/10.1186/s12884-023-05407-w
Sharma, R. (2018). Effectiveness of Chilled Cabbage Leaf Application on Breast Engorgement among Post Partum Women’s. Journal of Medical Science And Clinical Research, 6(6). https://doi.org/10.18535/jmscr/v6i6.147
Subarto, C. B., & Yasmin, R. (2025). Pengaruh Pijat Oksitosin terhadap Breast Engorgement pada Ibu Post Partum. Borneo Nursing Journal (BNJ). https://doi.org/10.61878/bnj.v7i2.126
Trisnawati, I., Antini, A., Aryani, S., Kebidanan Karawang, P., & Kesehatan Kemenkes Bandung, P. (2023). PENGARUH KADAR HB IBU MENYUSUI DENGAN TINGKAT KECUKUPAN ASI BAYI USIA 2 MINGGU DI KABUPATEN KARAWANG The Effect of Hb Levels in Breastfeeding Mothers with Adequacy Levels of Breast Milk for 2-week-old Babies in Karawang Regency. 15(1). https://doi.org/10.34011/juriskesbdg.v15i1.2165
Ummah, K., ¶½í, Ganisia, A., & Kwarta, C. P. (n.d.). Relationship Between Hemoglobin Levels, Breast Milk Production, Blood Type, And Psychological Factors With The Incidence Of Breast Milk Engagement In Postpartum Mothers. Retrieved https://binar.poltekkesbanten.ac.id/
Villepin, B. P.-D., Barasinski, C., & Rigourd, V. (2022). Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives.. Journal of midwifery & women's health, 67 Suppl 1, S56-S73. https://doi.org/10.1111/jmwh.13420
Wang, Y., Mao, K., Chu, M., & Lu, X. (2024). Perinatal maternal factors influencing postpartum feeding practices at six weeks. BMC Pregnancy and Childbirth, 24. https://doi.org/10.1186/s12884-024-06711-9
WHO recommendations on maternal and newborn care for a positive postnatal experience. (2022). World Health Organization.
Wong, B. B., Chan, Y. H., Leow, M. Q. H., Lu, Y., Chong, Y. S., Koh, S. S. L., & He, H. G. (2017). Application of cabbage leaves compared to gel packs for mothers with breast engorgement: Randomised controlled trial. International Journal of Nursing Studies, 76, 92–99. https://doi.org/10.1016/j.ijnurstu.2017.08.014