Posted on: 5th February 2016
Breastfeeding is natural, but it does not come naturally for everyone. It is very common to have some early challenges. Here are a few of the most common early hurdles so you know what to watch for and how to overcome them. Your healthcare professional should be consulted if you suspect you are experiencing any of these conditions.
A blocked duct occurs when the flow of breastmilk through a duct is restricted or blocked, causing the milk to bank up behind the blockage. This typically causes a hard lump or a lumpy, engorged area. It may feel tender, hot, swollen or look reddened. If the blockage is close to the nipple, a wedge-shaped segment of the breast may be affected.
As soon as you recognise that you have a blocked duct, give priority to emptying the affected breast as thoroughly and frequently as possible. A delay in recognising and/or taking preventative measures could lead to the milk being forced into surrounding breast tissue. This can lead to mastitis, which is a breast inflammation that can be accompanied by infection.
Feed from the affected breast first each feed – your baby can help to empty the breast and therefore help resolve the blocked duct. You can also express your milk by hand or with a pump after or between feeds, to make sure the affected breast is kept well drained.
While your baby is actively feeding, or the milk is flowing during expression, gently but firmly massage the affected area towards the nipple, as this can help the milk flow to clear the blockage. A small amount of lubricant such as vegetable oil will help your fingers slide more gently over the tender area. You can also massage the area between feeds.
At the start of feeding or expressing from the affected breast, you may feel more pain particularly with your let-down. But after your baby has finished feeding from that breast the pain and tenderness usually lessens and any lumps may feel smaller or have been resolved.
Sometimes you may see ‘strings’ of thickened milk or fatty looking milk – this is normal and will resolve as the duct becomes dislodged. They will do the baby no harm if swallowed, but sometimes the baby may sense them and spit them out.
The use of a warm pack, such as Lansinoh® THERA°PEARL 3-in-1 BREAST THERAPY when it has been heated, before a feed or during expression, may help the milk to flow and assist in relieving the blockage. The use of a cold pack, such as Lansinoh® THERA°PEARL 3-in-1 BREAST THERAPY when it has been frozen, between feeds may help to relieve discomfort.
A blocked duct can feel more tender before breastfeeding and less so afterwards because the strength of your baby’s suck can dislodge some of the blocked duct. You may also feel tenderness increasing between feedings as milk builds up.
If you cannot clear the blocked duct or if you develop a fever or flu-like symptoms, it is important that you see your healthcare provider as soon as possible, as you may be developing mastitis.
Some causes of blocked ducts can include:
- Engorgement, or inadequate milk removal. Watching the clock and not your baby can cause delays in your feedings. This can cause milk stasis and blocked ducts, as the milk has nowhere to flow once it has built up. This can also be caused by your baby having problems with attachment at the breast.
- Infrequent or skipped feedings. It is important to feed “on demand” by watching for your baby’s hunger cues. If you and baby are apart when your baby usually feeds, or if your breasts become uncomfortably full, it is very important to express to release the milk that has built up.
- Your milk ducts are easily compressible. Pressure from restrictive clothing, especially bras, can cause a blockage to form. Be especially wary of anything that might cause a restriction to milk flow during feeding, such as a “trapdoor” style bra, especially if it is tight fitting when your breast is full. Some women find they are prone to getting blocked ducts from wearing underwire maternity bras, tight clothing, sleeping in a bra (try a crop top instead if you need support or want to hold nursing pads in place), or feeding in positions where all of the breast cannot drain adequately, especially the underside of a heavy breast.
- Occasionally, the skin on the surface of the nipple may grow over the opening of one or more milk ducts, causing the same symptoms as a blocked duct. A small milk blister or white spot is often visible on the nipple. Management of the symptoms is similar to that of a blocked duct and your healthcare professional should be consulted. A small number of women are prone to milk blisters reoccurring and may need to be particularly vigilant.
If you think you have a blocked duct:
- Continue breastfeeding, and get proper rest and nutrition
- Breastfeed or express frequently to drain the breast
- Use heat and gentle massage on the affected area before and during breastfeeding or expressing to encourage milk flow. Use warmed compresses or warmed Lansinoh® THERA°PEARL® 3-in-1 BREAST THERAPY packs before feeding sessions to encourage milk to flow and relieve the blocked duct
- Avoid wearing restrictive clothing and bras, especially in bed at night
- Breastfeed first on side with the blocked duct as baby’s strong sucking at the beginning of breastfeeding can help dislodge the blocked area; but make sure your other breast does not become over full.
- Gently but firmly massage the affected area towards the nipple during feeding or expressing; use a lubricant such as vegetable oil to assist.
- After breastfeeding, pump or hand express any leftover milk to ensure the breast has been emptied
- Use cold compresses or cooled Lansinoh® THERA°PEARL® 3-in-1 BREAST THERAPY packs in between feeding sessions to soothe the pain and reduce inflammation
- See your healthcare provider if your early symptoms do not resolve after 12 hours, and as soon as possible if you develop a fever or flu-like symptoms.
Blocked ducts and mastitis often go hand in hand, but you can get one without the other. Mastitis can result from infrequent or inadequate emptying of the breast or a blocked duct, leading to milk stasis. The pressure of the built-up milk can force it into the surrounding breast tissue and cause inflammation, resulting in a warm or hot reddened area.
Mastitis symptoms can come on very suddenly and you may feel like you have the flu – lethargic, shivers and achy. Go to your doctor. Rest is important and you won’t feel like doing much anyway.
Infection often follows the initial inflammation, especially if you also have damaged nipples. It can sometimes be prevented by recognition of early symptoms and optimal management, but if your early symptoms do not resolve in the first 12 hours, you should see your healthcare provider as you may need a course of prescribed antibiotics. Most suitable antibiotics are compatible with continued breastfeeding.
It is most important to keep your breasts as well drained as possible, by feeding or expressing every two hours if you can, especially the affected breast. This will help reduce the inflammation and if started early, may prevent it progressing to infection. Frequent emptying will also help maintain the milk supply in the affected breast. This is not the time to wean or to worry that removing milk will encourage your breasts to make more milk. Most women notice a drop in supply in a breast that has been affected by mastitis, but this can be minimised or prevented by frequent feeding or expressing. The milk from a breast with mastitis will not harm the baby.
Some mothers find their milk seems more fatty or stringy, much like when a duct is blocked. Swelling can be more intense than with a blocked duct and red streaks may be seen around the affected area. Your milk may also taste saltier and your baby may fuss or temporarily refuse to breastfeed on that side.
If your baby is refusing, it is very important to express when baby would have been breastfeeding, to ensure that your milk is being drained regularly. Your baby can have your expressed breastmilk for those feedings or as a top-up after feeding from the non-affected breast.
If you think you have mastitis:
- Follow the suggestions above for a blocked duct.
- If your early symptoms do not resolve in the first 12 hours, see your healthcare provider; you may need antibiotics.
- Breastfeed or express your milk frequently, every two hours if you can. Keep the affected breast will drained.
- Early and optimal management will mean a faster recovery and may prevent progression to a full infection.