How can I prevent mastitis at night?

It's usually cause for celebration when your baby starts sleeping through the night. But if you've been breastfeeding in the wee hours and your baby suddenly skips a feeding, you might be waking up uncomfortable with full and firm breasts. Occasionally your breasts may become so engorged that you wake up in pain. What's the solution?

What to do if you're becoming engorged overnight

If you become engorged overnight, you can nurse your baby or pump just enough milk to make yourself more comfortable.

When your baby is a newborn and wakes every two to three hours to nurse, it helps establish your milk supply. It also keeps your breasts from becoming too full. Now that your baby can go longer between feedings, your body needs to do the same. And it will, eventually.

Many babies do lengthen their night sleep gradually, which makes this process easier – your body will gradually adjust to going longer stretches at night without breastfeeding. But sometimes a baby who's been breastfeeding every three or four hours at night will suddenly sleep six or seven hours. That's when your breasts can get too full and you may wake up with them feeling as hard as rocks.

If you nurse to relieve engorgement, try not to fully wake your baby. Put them on your breast and encourage them to suck a bit while still half asleep (this is known as a "dream feed"). The problem with fully waking your baby for a feeding is that – if your baby empties your breasts – your body will keep producing milk for that nighttime feeding rather than adjusting.

You might also try to wait until your baby wakes, then feed them. You can also pump if your breasts are still very full after the feeding. This way you'll relieve any engorgement and create a little stockpile of pumped breast milk.

Don't wait too long while feeling engorged, though. Going more than an hour or two with overly full breasts can potentially decrease your milk supply. You could also end up with plugged ducts or even breast inflammation or mastitis.

You may be concerned about throwing off your baby's developing sleep habits by waking them to feed. After all, you want them to keep sleeping through the night! But if you're waking them just long enough to nurse (and especially if you barely wake them), this shouldn't be a problem. The hormones that are high in nighttime breast milk (tryptophan and prolactin) can help you and your baby relax and fall back to sleep easily.

But you may prefer to pump instead and let your sleeping baby sleep. If you spontaneously wake up because your breasts are full and uncomfortable, pump "to comfort" – just enough to soften them a bit. You can do this with an electric breast pump or a manual breast pump, or you can hand express into a bottle or cup. Continue for a few days, extending the time before you pump a bit each night if you can.

How often should I pump at night?

There's no strict rule, but the goal is to pump just often enough to be comfortable. If you wake up feeling overly full of milk and your baby shows no signs of waking, pump enough to relieve the engorgement. Pump no more than that, or you'll signal your body to continue to produce milk for a feeding at that time every night.

If you have to pump again before morning to be comfortable, that's okay, too.

After a night or so of pumping as needed to release pressure, you might be able to go a little longer before pumping, say five or six hours instead of four hours. Continue to gradually extend the time until you and your baby are in synch.

Will I always become engorged overnight?

Thankfully no. Give yourself some time (it may only take a few nights), and your breasts will adjust to your baby's new schedule.

Of course, like most things with babies, it may not be a step-by-step linear progression. Your baby may sleep through the night one night and wake to feed halfway through the next. They may sleep through the night for weeks only to hit a sleep regression, or start waking to cluster feed while going through a growth spurt. Follow your baby's lead. Breastfeeding is all about supply and demand, and your breasts can adapt to your baby's needs.

Once your baby keeps to a new schedule, your body will get the hint that an all-night milk buffet is no longer necessary. After just a few days, you'll be able to go longer and longer before waking up uncomfortable. Eventually you'll find yourself waking up at a normal time, when your baby is ready to eat. You'll feel more rested and just comfortably full in the mornings.

Learn more:

• Newborn sleep guide
• Night weaning your baby
• When can my baby go through the night without a feeding?

Finally! Your baby is sleeping through the night! You’ve been waiting for this moment so you can catch some precious zzzz’s too, but now something else is keeping you up—your breasts are engorged. Ugh!

If you wake up in the middle of the night to tight, painful breasts, they should be emptied within an hour to protect milk supply and reduce the chance of clogged ducts or mastitis. As your baby starts sleeping longer, it’s a good idea to get into the habit of pumping or nursing right before going to sleep yourself (think: dream feed for you both!).  

If your breasts become engorged as the baby sleeps, pump or hand express milk to get relief and take notice of the time. The next night, try to stretch the time 15 minutes longer and think of the night time milk as an added bonus. 

Each evening, extend the time slightly from the previous night and over a couple of weeks you will be able to join baby in sleeping longer while maintaining your breastmilk supply.

Want to ask our IBCLC more questions? Head to Instagram for more conversations every week and ask away.

This article was written in partnership with our International Board Certified Lactation Consultant, Wendy Wright, who loves working side by side with moms and babies to find that secret sauce! She’s also a mother of two and the Mom Experience Lead at Willow Pump.

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