A plugged or blocked duct is a milk duct that has obstructed milk flow. The obstruction could be at the nipple, or back further in your milk duct. It can be caused by something pressing on your duct (like an underwire bra or your diaper bag or even your arm when you sleep), dried/thicker milk blocking the pore/opening on your nipple (you can see this blockage on the nipple as a white spot), engorgement (from oversupply, incorrect latch, not emptying the breast completely at each feeding), infrequent feedings (from a sleepy baby, or one who is being put on a strict feeding schedule – DON’T DO THIS IT’S NOT GOOD FOR YOU OR BABY), yeast infection, or stress and not enough sleep (hello, new mommyhood!).
You can tell you have a plugged duct when you have tenderness (usually) only in one breast – in one area. In my experience, I was able to recognize a plugged duct when I’d feel a generally uncomfortable area of the breast, or an overfull/engorged feeling, that didn’t go completely away after a full nursing. The tender area becomes more swollen, firmer – like a wedge shape – warm, and painful to the touch as time progresses, and is not fully relieved after nursing. You may have a low fever and feel generally tired. If you experience a high fever, or suddenly feel very ill (flu-like symptoms), it is important to call a doctor, as you may have an infection - mastitis, which can be treated with antibiotics.
The good news is that plugged ducts are normal, they don’t require that you stop or even pause breastfeeding – in fact, you should nurse MORE and more often – and they can be fairly easy to clear up. Over my nearly 6 years of breastfeeding experience (my youngest son is still occasionally nursing), I’ve had several plugged ducts, and one case of mild mastitis. I believe mine were mostly caused by oversupply (I was tandem nursing), preterm baby who didn’t like to linger at the breast, combined with adjusting to mothering two children, and returning to work. Time, taking better care of myself, and early detection and mitigation helped me through my recurrent plugged ducts. Over time, I’ve tried pretty much everything.
If you determine that you have a plugged duct (ouch!), here are my suggestions for what to do:
1) Breastfeed. Breastfeed. Breastfeed some more. It is so important not to stop nursing when you have a plugged duct, even though it is uncomfortable. Baby is the best tool to relieve the plugged duct. Make sure baby is well-latched, is draining the breast effectively, and nursing frequently. If baby is falling asleep while nursing, or isn’t interested in nursing as often as you need to in this time, you can pump, or hand express.
2) Breastfeed in different positions. Try to point baby’s chin towards the swollen area – this may mean some creative positioning, but baby’s suction is extremely effective at loosening/dislodging the clog. You can also try lying baby on the bed, and dangling your breast down for nursing – use the benefits of gravity to help dislodge the clog.
3) Use Heat. I had a microwavable rice bag that I’d warm (not super hot – you don’t want to burn yourself, it hurts enough already!), and place directly on the swollen area while nursing. A hot shower with water directed on the area (though this can be painful as well) can help to soothe and loosen up the clog.
4) Rest. You must rest, and take care of yourself. Nap with baby while nursing in side-lying position, or, play the “sleeping game” with toddler on the floor. Ask someone to help you with the housework for a few days. Whatever you can to take it as easy as possible to allow your body to heal, do it.
5) Pump. When baby doesn’t want to nurse, you can pump to keep the milk moving. I found as long as my breast felt as “empty” as possible, the plugged duct was less painful. Pumping in the shower was helpful to me as the heat was relaxing, and pain relieving.
6) Nurse a Toddler. You may not have this option, but I was lucky enough to have my toddler available and willing to nurse when baby was sleeping. A toddler may be willing (& actually think its funny) to nurse in strange positions in order to dislodge the clog.
7) Pressure massage. I found this method to be extremely painful, yet super effective. You use the heel of your hand to apply strong pressure to the swollen area to move the plug out and down. Dr. Sears very clearly illustrates just how to do this, and I’ve followed it to the letter with success, so I’m copying directly from his website:
To do pressure massage, start at the edge of the lumpy area closest to your chest wall. Apply pressure to that area 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.
8) Use a Needle. If you actually see a white “blister” on the nipple, it can be dried milk plugging the opening on your nipple, which can block milk flow and cause a swollen duct. Sterilize the needle, then gently insert into the blister to pop it. Follow with a pressure massage and breastfeeding and/or pumping.
9) Take Soy Lecithin. Once I started taking daily lecithin, my plugged ducts stopped recurring. The recommended dosage is 3,600 – 4,800mg/day. Soy lecithin is a fatty acid which acts as an emulsifier. There are no known contraindications to use while breastfeeding.
10) Vitamins. Up your infection-fighting vitamins & herbs, like: Vitamin C, Vitamin D, Echinacea, Garlic, Elderberry, and Probiotics.
11) Pain Relief. Take an anti-inflammatory pain reliever like ibuprofen which will help with swelling and pain.
11) Read up on plugged ducts:
KellyMom.com – Plugged Ducts & Mastitis: http://www.kellymom.com/bf/concerns/mom/mastitis.html
Dr. Sears - Plugged Milk Ducts: http://www.askdrsears.com/html/2/t022100.asp
Dr. Jack Newman – Blocked Ducts & Mastitis: http://www.breastfeedingonline.com/22pdf.pdf