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The Step-by-Step Holiday Guide to Plugs, Blebs and Mastitis

As parties, preparations and push-up bras work their evil magic...

Ho! Ho! Ho! and Go! Go! Go! grinds to a halt.

This is the day you don't feel so good and that throbbing pain in your breast may need medical attention today. Yes, TODAY! The day of all days that you can't afford to waste a single minute, let alone cross the whole day off your calendar and go to bed. Here is a step-by-step guide to moving milk and getting back in the game.

Plugged (clogged) Milk Ducts

Plugged ducts happen when milk stagnates in a section of your breast either from compression or inefficient milk removal. It could be a baby who isn’t latching well, or a few days when you are busy and delay nursing, or it could be from clothing that compresses an area of your breast- like an underwire or too tight bra.

The stagnant milk curdles into yogurt and then cheese. This solid milk creates a plug - a tiny string cheese, the thickness of angel hair pasta - which causes a back up of milk inside your breast. The painful lump is not the plug. The lump is a reservoir of milk BEHIND the plugged milk duct. If you start massaging on the lump, you are pressing milk into the plug and increasing the pressure without moving any dried milk out.

If you don’t move the plug and get the milk flowing again, you can develop mastitis.

Start self care immediately. It would be a good idea to call in sick to work and/or get help if you have children who rely on you for everything. Continue breastfeeding and pumping as often as possible. To work on getting the plug out, you may want to take a pain reliever, like Motrin, and give it some time to get into your system. You may not. Everyone has different pain tolerances, but working out a plugged duct is painful, even though it also feels good in a certain way.

It’s easier if someone can take care of your baby while you work on this.  If that isn’t possible, try when the baby takes a nap.

  • Breastfeed or pump, so your breast is less full. Either work in a big bowl of warm water or in the bathtub, with the water high enough that you can comfortably lean over and soak your breasts.  Soak them for a few minutes, to let the heat expand the ducts and soften the skin of your nipple.  
  • Grasp the nipple and pull it down away from the breast. Press it between your fingers and roll it, to your pain tolerance. It doesn’t have to be vigorous. All you are trying to do is work some dried milk out and reshape the curdled milk in the duct, so liquid milk can help to wash it out. You may start to see a white dot or a tiny string cheese on the tip of your nipple.
  • Move back about 1/2 inch and repeat, pulling the nipple down and away from your breast. Then, move back another 1/2” pinching and rolling any lumpy areas down, moving milk down to the plug. You may feel stringy lumps like spaghetti, inside your breast while you are massaging. This is dried milk. Massage any sore areas towards the nipple tip. You may use olive or another massage oil to keep friction to a minimum if you are not working in water.
  • When you are working the thickened milk out, it feels painful, or at least uncomfortable, and when the plug releases it feels immediately better. Sometimes you see the breastmilk string cheese in the water. If you don’t, that’s OK. Your baby may remove it while breastfeeding. It won't hurt your baby to swallow it. It’s just breastmilk cheese and still has all the antibodies and nutrients of your milk.

Breastfeeding with a plugged duct

Because a baby’s tongue massages your breast when they breastfeed, try changing up positions when you nurse. Try to line up their nose or chin with the sore spot and breastfeed. Some mothers swear by “dangle nursing.” Get on your hands and knees with the baby beneath you and breastfeed.

Be persistent and stay on top of milk removal. Try to figure out the cause and prevent that from happening. Some women have overabundant milk and their baby can’t remove it fast enough. If their baby oversleeps one night, they develop a plug. Some women are so exhausted they sleep in one position for 5 hours compressing a spot on their breast. Babies go through teething, a distractable phase, or have stuffy noses and leave breasts half-full. And, don't forget the above-mentioned parties and bras.

If you don't work out the plug you may develop a....

Nipple Bleb

A bleb is a milk pimple. It starts when milk sits in the nipple so long that it skins over. The treatment is the same as for plugged ducts. If nursing, massage or gentle exfoliation doesn’t open the skin, you may need to see your doctor to have it lanced. It sounds awful, but it is less painful than a bleb and brings immediate relief. Once the skin is opened, diligent and persistent plugged duct treatment is needed, or it will re-form. Both plugged ducts and blebs can also be a symptom of poor latch and tongue tie.

If you ignore blebs and plugs, you may develop...

Mastitis

Mastitis is an infection inside your breast. It happens when milk stagnates in a section of your breast and you are exhausted. Milk stagnates when there is incomplete removal of milk either from compression or a baby who isn’t latching well. 

Mastitis starts with a plugged duct and a lump in breast which you may or may not notice until it becomes infected. The first sign many women notice is an overnight decrease in milk production on one side. If nursing, pumping and massage don’t move the plug and the milk behind it, a pink or red patch will develop on the skin. Over time the red patch will grow, often into a stripe from nipple to the lump and into the armpit. You will become feverish, often engorged in one breast and feel awful. Mastitis has sudden-onset, flu-like symptoms: fatigue, aches, fever, chills and a sore or throbbing breast.

Mastitis can come on suddenly, in a matter of hours. It is a serious condition, that if untreated, can lead to breast abscesses or hospitalization.

There are two components of treatment.

The first is to get the milk flowing and the second is to address the infection. Getting milk moving is addressed in the section above on plugged ducts.

To treat the infection, you are going to have to decide how sick you are and what your treatment options are. It's not easy to decide to go to the emergency room when it's an hour away and you have 2 sick kids and a baby. Or, you've been fighting a yeast infection for months. Or this is your third round of mastitis in the past few months. Or, maybe it's Saturday night and you can go to the Urgent Care doctor in 12 hours.

If you can get the milk moving within an hour or so, you may start to heal with self-care alone. Your first action should be to massage the plug out and use your normal home remedies for sickness. Some people take vitamins, garlic, herbal teas or tinctures, zinc, chicken soup - whatever your favorite healing remedy is - take the time to massage your breast, get the milk flowing and go to bed. Your routine for the next few hours or 1/2 day should be sleep, nurse the baby, hand express/pump and massage the plug out. 

If you have done self-care for 12 hours and you are not getting better, or feel worse, it's time for medical attention.

If you know you are too sick for self-care, call your primary care, midwife or obstetrician, go to urgent care or the emergency room. They will prescribe an breastfeeding-friendly antibiotic which usually clears up the infection in a day or so. They may also take a culture when they examine you. You still need to unplug the duct but it will be easier when the infection is reduced. 

Mastitis is almost always a sign that you are trying to do too many things without enough rest. An exhausted mom will take not time to attend to make sure every latch is perfect, every feed complete. Because she is tired, it seems overwhelming to unplug yet another plugged duct. Mastitis is a call to simplify, to let go of something, so that you can take care of the most important person in your family, YOU.

If you need help resolving your plugged ducts, call or text Donna Bruschi, IBCLC at (845) 750-4402 for an appointment.