A home health care nurse is reinforcing teaching about breast engorgement with a client who is postpartum and is breastfeeding her newborn. Which of the following client statements indicates an understanding of the teaching?

Choice A rationale Cold compresses are appropriate for reducing swelling and discomfort associated with engorgement; however, they should be applied after or between feedings, not before. Applying cold before feeding can cause vasoconstriction, which may inhibit the milk let-down reflex and make it harder for the infant to latch and effectively drain the breast, thus worsening the engorgement. Choice B rationale Breast engorgement is primarily caused by venous and lymphatic stasis and an increase in milk volume. Frequent and complete emptying of the breasts is the most effective preventative and therapeutic measure. Feeding every 2 to 3 hours helps keep the breasts drained, preventing the accumulation that leads to painful swelling, thus maintaining a positive feedback loop for milk production. Choice C rationale Engorgement is not an infection (like mastitis) and does not typically require antibiotics unless accompanied by signs of infection. Stopping breastfeeding suddenly (weaning) would lead to increased milk accumulation and worsen engorgement. If antibiotics are required for an unrelated infection, they should be checked for breastfeeding compatibility, and nursing should usually continue. Choice D rationale Wearing a supportive, well-fitting bra (like a sports bra or nursing bra) both day and night is recommended to provide gentle, even pressure and lift, which can reduce discomfort and swelling associated with engorgement by minimizing lymphatic and venous stasis and preventing trauma to the tender breast tissue.