In the euphoria of giving birth to your baby, especially the first baby, you find yourself not thinking of anything that can go wrong while breastfeeding, as it should be the most natural thing to do, right? Wrong - because when the end of second day arrives, and you start producing milk, your thoughts and emotions change, your breasts are engorged and very sore, with it you might have developed cracked nipples and you wonder where is the calm and serene picture you had in your mind, of you and your baby, and the bliss of breastfeeding. The following points or plans of action hopefully will help you to attack and prevent and treat these little (or not so little) problems.
Start each feed on the side with the plugged duct (when baby’s suck is the strongest) and aim baby’s chin in the direction of the plug and feed baby in a breastfeeding position which allows the flow of the milk from the affected side. It’s also a good idea to change breastfeeding positions each time you feed so the different milk ducts can each flow and drain properly. It is also a good practice to alternate the breasts from the beginning, although baby might prefer one breast to the other.
A baby that is not latching properly is the culprit for most breastfeeding issues. It can result in insufficient emptying of the breast, which can in turn contribute to plugged ducts. Sometimes an improper latch is due to a lip or tongue tie, and can be diagnosed by a lactation consultant, pediatrician. But most times it is because the mother is not shown how to latch the baby properly from the onset of breastfeeding.
Frequent & thorough emptying of the breasts
Don’t wait too long in between feeds or when expressing milk (every 1-2 hours with a plug present) and be sure the breasts is thoroughly drained because the longer the milk stays in the breast, the thicker it becomes, making it more likely to cause a plugged duct. It is very important not to neglect the unaffected breast – you want to make sure it’s also being thoroughly drained to avoid a potential issue.
The longer milk sits in the breast, the thicker it becomes, making it more likely to cause a plugged duct. Applying heat helps with a heating pad, hot water bottle, rice sock or basin of hot water, by spraying hot and cold water alternatively on the breasts. Use caution not to burn your skin by using too much heat for too long. Moist heat are most effective particularly before a feed or expressing milk. You can also take frequent hot showers (as hot as you can tolerate) or soak in a hot bath while firmly massaging with olive oil, the plug towards the nipple and hand expressing the milk.
Another way to help with engorged breasts is to put cold cabbage leaves on the breasts, changing the leaf as soon as it becomes warm. Remember to cut a hole in the leaf for the nipple. Keep the cabbage in the fridge.
Milk blister or bleb
Sometimes, but not always, a plugged duct is associated with a “bleb” or milk blister on the end of the nipple where the nipple pore is. It is usually painful and commonly due to a poor latch. A lactation consultant can help open the blister with a sterile needle. She will gently puncture the top or side of the blister and squeeze just behind the blister to see if the plugged up milk will come out. This might result in the duct unblocking by expressing the milk and then have the baby latch again once the milk is flowing again.
This method of massage works by applying pressure to the edge of the lumpy area closest to your chest wall with the heel of your hand to the point just before it becomes too painful. Hold the pressure at that level until the pain eases off. Then increase the pressure again, (without moving your hand) and hold it until the pain eases. Continue to gradually increase pressure at that same site until you are pressing as hard as you can. Then pick your hand up, move it down toward your nipple about a half inch, and repeat the pressure massage in this area. Continue moving your hand a half inch and repeating the massage until you get all the way down to the nipple. You may see the dried milk come out from an opening in your nipple. Even if the plug doesn’t actually come out, you will at least have dislodged it and moved it toward the nipple so that when baby goes to the breast and sucks, it can be more readily removed by baby’s suction or you can dislodge it by expressing first before putting the baby to the breast.
Rest, De-Stress and “Babymoon”
It’s not always easy to get some rest with a baby. Get help with chores and errands or just let them be - this is not the time to fuss over the dishes or housework. If you work outside the home, take the day off if you can. Take baby to bed with you (babymoon) and breastfeed there. Stress can also contribute to plugged ducts so try to “keep calm and carry on.”
Holistic & Natural Approaches
B-complex vitamins, vitamin C, evening primrose oil, thyme and probiotics have been known to help plugged ducts. Also, try eating wholesome, nutritious foods, reduce your intake of saturated fats and drink water only to quench thirst or suck on ice cubes. To take less fluids until the engorgement has been subsided, it normally last for 36-48 hours for the inflammation to subside and engorgement to lessen and the mother will only produce according to the demand of the baby to feed properly.
Ibuprofen is the preferred anti-inflammatory pain medication by lactation professionals for breastfeeding women and will help reduce swelling and gives you the relief you need to get a good milk letdown which is essential for good milk transfer and thorough emptying of the breast. Most plugged ducts will be go away with all these measures within 48 hours. But do speak to an expert first before taking any medication.
Sometimes with really stubborn plugs, therapeutic ultrasound treatments are painless and have been proven effective. It is especially effective when combined with lymphatic drainage massage. Most physiotherapists can provide these treatments for you. Each treatment should last for about five continuous minutes on the affected area. If two consecutive treatments (for two days) don’t work, then it should be evaluated by a specialist.
Other causes / ways which can obstruct the flow of milk:
and thus causing a plug:
Seatbelt Straps. Be aware of how your seatbelt fits across your chest and adjust it as needed to alleviate pressure on the breast itself. Many vehicles have adjustable heights, but if yours does not you may want to use a folded soft cloth or cloth diaper to place underneath where a belt presses against your breast to redistribute the pressure.
Bras. Wear a comfortable, loose fitting nursing bra without underwire. Most nursing bras are made for comfort and should fit well and be supportive.
Sleeping Positions. A sleeping position that puts pressure on your breasts is likely to contribute to plugged ducts. If you are a tummy sleeper, try sleeping on your sides.
Support. Plugged ducts are no day at the park, it will be very tempting to give up when in the throes of a plugged duct attack. Get friends and family to help with chores and errands, have a good cry if you need to, enlist your partner to give you a relaxing foot massage and find a local breastfeeding support group such as La Leche League.
Note: When you finally do break up the blockage, it might take a day or so before the tenderness subsides. Plugged ducts can also lead to mastitis. If left untreated, mastitis can result in a breast abscess. If you think you have an infection or are experiencing flu-like symptoms, consult a breastfeeding consultant.