"Mommy, is that your milk for 'Gabin'? How come that one has a tiny bit and the other one has a lot?" Well, I had a clogged duct on BOTH sides and one unclogged and the other just HURT.
Obviously one side did not unclog and the other did. This has been an issue for the last couple of weeks. One time it was so swollen and painful I was nauseous for 3 days. It didn't hit me until doing the research that I probably had mastitis and didn't know. So it went untreated and caused frequent recurrent plugs... until now. I spoke with my friend who uses a Midwife, my doula, and my OB-GYN to get some tips/tricks and treatment. I'm starting Keflex (antibiotic) tonight and integrating probiotics, Lecithin, Vit C & E capsules, and less salt into my diet/supplements. I already drink tons of water and nurse every 2 hours, so that's not a problem. I think I basically overproduce milk and baby can not drain it. I am going to start pumping once a day to drain and save for when I go back to work (Sept. 21!).
Plugged ducts are caused by inadequate removal of milk. They often occur if mom has a really high milk supply or when nursing gets off to a slow start, but there can also be a number of other contributing factors, such as missed feedings, rapid weaning or a pump with an ill-fitting breast shield. Not only do they lower milk supply, but they can also lead to mastitis, since the residual milk is a breeding ground for bacteria. Nipple damage can make this more likely.
- Sore, hard lumps or a swollen area in the breast which remains after the breast has been pumped or the baby has nursed.
- Decreased milk supply.
- Plugged ducts may also be accompanied by a “bleb”, which is a white spot on the nipple—either a spot of dried milk or a milk filled blister, which covers the nipple pore.
Milk which hasn’t been removed becomes more thick and “sticky” so it is difficult to remove by pumping or nursing. It is usually necessary to compress the breast behind the hardened areas to drain the milk.
- Heat—Warmth and wetness help to induce letdown and expand the ducts, allowing easier expression of milk. A heating pad before nursing can be helpful.
- Pressure—with counterpressure-- from behind the hard areas or working back from the areola toward the blocked ducts—whichever works. Hold until the milk flows and keep holding until it stops. Move your hands and repeat. It can also be helpful while your baby is nursing to use a technique explained by Dr. Jack Newman called
- Breast Compression.
- If your baby is nursing well, increase drainage of blocked areas by pointing baby’s chin toward the plugged area.
- Ultrasound therapy combined with lymphatic drainage massage techniques is extremely effective in clearing stubborn plugged ducts. Two Fairfield county physical therapy centers provide this service, which is usually covered by insurance. A prescription is necessary.
- Ibuprofen (Motrin or Advil)—400-600 mg. for inflammation and pain. Acetominophen (Tylenol) is helpful for pain if ibuprofen is not tolerated.
- Bleb treatment—warm olive oil compresses applied to the nipple, then using a washcloth or fingernail to loosen the callous of milk that has formed. Antibacterial/antifungal treatment for skin helps reduce the associated skin inflammation.
- Change nursing positions—always using the same position or always using a nursing pillow can encourage drainage of only one area and neglect others.
- A bra that continuously compresses some ducts is occasionally a problem.
- Lecithin—1000 mg. three or four times a day can help prevent plugs.
- Correcting oversupply problems which make it difficult to effectively drain the breast is important.
Lecithin treatment for recurrent plugged ducts
By Kelly Bonyata, IBCLC
Lecithin has been recommended to combat recurrent plugged ducts. The usual recommended dosage for recurrent plugged ducts is 3600-4800 mg lecithin per day, or 1 capsule (1200 milligram) 3-4 times per day. After a week or two with no blockage, mom can reduce the dosage by one capsule. If there is no blockage within another 2 weeks she can reduce it again by one. Mom may need to continue taking 1-2 capsules per day if stopping the lecithin leads to additional plugged ducts.
Lecithin is a very common food additive, and is found naturally in many other foods. There are no known contraindications to its use by breastfeeding mothers.
The reason why lecithin may help resolve and prevent plugged ducts is not clear. Per Dr. Jack Newman, "It may do this by decreasing the viscosity (stickiness) of the milk, by increasing the percentage of polyunsaturated fatty acids in the milk." Lecithin is an emulsifier (used to keep fats/oils dispersed and in suspension): phospholipid molecules (such as lecithin) contain hydrophobic and hydrophilic elements; the hydrophobic portion has an affinity for fats and oils, and the hydrophilic portion has an affinity for water.
Some moms with recurrent plugged ducts or mastitis have also had good luck with the following homeopathic treatment -- 2 doses Hepar Sulphur and 2 doses of Phytolacca (allow pellets to dissolve in mouth). The doses are to be taken as follows:
First, take Hepar Sulphur 30C - 3 pellets;
3 hours later, take Phytolacca 30C - 3 pellets;
3 hours later, take Hepar Sulphur 30C - 3 pellets;
3 hours later, take Phytolacca 30C - 3 pellets.