Breastfeeding: Plugged ducts
I have a four-month-old son who has been exclusively breastfed since birth. I have had continual problems with plugged ducts. Nothing seems to be working and now I am having a very painful plug in my left breast(inner quadrant). The plug usually takes five feedings to go away. My son is now frustrated on that side and does not feed well, causing more problems. I am thinking that my only solution at this point is to wean him completely. The idea breaks my heart, but I don't feel I can be a good mother when most of the time I am in pain. Do you have any advice on weaning in this situation? Or is there an alternative?Question:
Repeated plugged ducts can be very painful. I'm sorry you're having such difficulty getting rid of them for good. As you have said, you probably have tried most of the common hints for treating a plugged duct, but I will go through them with you to make sure you have all your bases covered:
- Apply moist heat in between and during feeds. Wet compresses can be warmed in the microwave, 15 seconds at a time until the proper temperature. (Be careful!)
- Try a warm salt water soak.Soak the affected breast for around 20 minutes, prior to nursing, in a basin of warm water. Use at least 1/2 teaspoon of salt for each cup of warm water.
- Massage.A firm, circular massage can be used during the soak and while nursing.
- Nurse frequently on the affected breast.
- Don't forget the basics. Proper positioning and attachment is very important in assuring adequate breast drainage. Some moms have luck using a rather unusual position. Place your baby on the bed and nurse from above, with your breasts hanging freely. You can also do some breast massage over the area of the plug as your baby is nursing. Obviously, this isn't an everyday position, but it may help with the more stubborn plugged ducts.
- Try a cabbage compress on the affected area. Use a small piece of cabbage (only a bit larger than the area), crinkling the veins in your hand, and warming slightly in the microwave (be careful). Apply to the area, using your bra to hold it in place. Replace about every two hours.
- Make dietary changes. Try adding salt to your diet. Lecithin can also be added as a dietary supplement -- one tablespoon a day (Lawrence 1994). Limit polyunsaturated fats (Lawrence 1994).
- Rule out the possibility of ductal yeast. Have you or your baby had any problems with candidiasis? Have you taken antibiotics or steroids? If you or your Health Care Provider feel this could be impacting the situation, a systemic antifungal would need to be used to treat thrush within the milk ducts.
- Take a closer look at your wardrobe! Could your bra (or its underwire) be constrictive? How about the bra straps? Are they digging into your shoulder? Do you use breast shells, or thick bra pads? Are you wearing a tight bathing suit? Put away all of your constricting clothes for the time being.
- Other factors can be playing a role. Sleeping position (lying on your stomach), the type of baby carrier or sling used, seatbelts, etc. can cause pressure on milk ducts, which can be problematic in moms susceptible to plugged ducts. Excessive upper arm exercise has also been implicated in recurrent plugged ducts.
Your baby's fussiness at your breast could be more than a difficulty in getting milk from that side. You may have developed a case of mastitis. With mastitis, the sodium content of your milk rises and most babies are not thrilled at the taste of salty breastmilk. You can express a bit of your milk and taste test it yourself to see if it is sweet, as it should be, or if it has a salty taste. (If it does taste salty, it is important to discuss this finding and the possibility of mastitis with your Health Care Provider.) If you begin to develop a fever or flu-like symptoms, have a reddened area on your breast or are unable to free up a plugged duct on your own, you need to have your condition evaluated by your Health Care Provider.
It really shouldn't be necessary to totally wean your baby from your breast, even if you are unable to resolve this condition. You have the option of weaning on only one side, since your plugged ducts seem to be occurring only in your left breast. Cut back feedings gradually from the "weaning breast" (about one every three or four days) and use full-sized cabbage leaf compresses on that breast, changed every two hours, only until you milk supply diminishes to a comfortable level. In between feeds, express just enough milk for comfort. Best wishes for pain-free feeds!Answer: