Navigating a Clogged Milk Duct

Let's talk 'all things' clogged milk ducts, shall we?

Because, as much as you want to hope you will never face this scenario in the time you spend breastfeeding your baby, the unfortunate chances are that you might & when you do, it is hardly anything fun to endure.

According to Medical News Today, "a 2011 study of 117 breastfeeding women found that 4.5 percent experienced clogged ducts at some point during the first year of breastfeeding." And furthermore, that 10-33% (varying research and studies results) of moms will deal with mastitis - a breast infection during the time frame they spend breastfeeding.

Frankly, I found the clogged duct statistics surprising - in that, this is a commonly sought out topic when a mom contacts me in my lactation nurse educator position because of how frequently women are finding themselves dealing with one.

So- let's talk about why you may come upon experiencing this breastfeeding speed bump, how you identify one and what you can do to get rid of it and ensure you don't contract mastitis along the way!

Normal vs Abnormal
Within a woman's breast are approximately 15-20 lobes that encircle the circumference of each breast. And within those lobes, there are lobules which are the carriers of the bulbous ducts that hold milk until the milk is utilized by a baby's sucking ability to remove what is needed from the breast. With the help of hormones within a mom's brain - specifically Prolactin and Oxytocin, these brilliant components of a mom's breast are able to supply what is needed based off of the demand requested via baby's amazing ability to ask those receptors to make as little or as much milk as is needed during the age, stage and developmental portion of life the baby is currently in.

The caveat to a regular, healthy working breast is that there are many things that can get in the way of this system working properly - which is usually the beginning of a clogged milk duct. Though this is painful for mom and frustrating baby, it is manageable should you identify it early enough and have the tangible information and resources to make it better before it worsens.

What am I looking for??
Clogged ducts are hard to miss and definitely difficult to ignore once symptoms have arrived. The more challenging aspect of figuring things out is when you are trying to differentiate between a clogged duct versus a developing breast infection that develops too quickly and before you can do much to reverse it.


Symptoms you might notice are:

• pain in a specific area on the breast
• a swollen, tender lump in the breast 
• often feels like a pea is lying underneath your skin
• slower milk flow on one side 
• recognized by you OR baby
• a small white dot on the nipple 
• not to be confused with Montgomery Tubercles 
• this is called a 'milk bleb'

It is important to realize that once you begin to experience or recognize these symptoms, you have limited time to improve the clog before it turns into a more difficult problem to fix. The positive news is that - if you catch it early enough, you can usually correct a clog within 24-48 hours, if remaining persistent with interventions until resolution occurs.

Why do clogs usually form?
Clogs are known to show up at different but definitive times in a mom and baby dyad's time spent together breastfeeding. The most important motto to remember when providing breast milk for your baby is that - an empty breast supplies milk more plentifully and effectively than an overfilled, engorged or underutilized breast. This means that the more frequently and reliably you provide or express milk from your breasts, the more diminished chance you have in allowing milk stasis to complicate your breastfeeding process.

1) Engorgement or inadequate milk removal can happen at a couple different times. 

• Upon initiation of and during the beginning stages of breastfeeding- immediately after delivery and while supply is becoming established and regulated, it is very difficult for a newborn to completely and adequately remove milk according to what is needed for the body to not have underutilized milk sitting within the breast for an extended amount of time
• When feedings are becoming more spread out due to growth and development needs/changes, baby begins to not need as much as was being utilized before. Even with the most intentional efforts being put forth to slowly taper and regulate into the next stage of milk demand for your baby and your baby, it is all too common for the body to not properly regulate and instead cause a clogged duct to develop

 2) Infrequent, missed or inadequate feeding times

• The most common times that this may occur are:
• When baby begins to sleep through the night
• When mom returns to work and is unable to achieve proper pumping times throughout the work day

It is essential that you find ways to regulate your supply and incorporate proper pumping sessions or removal of milk at regular intervals so that milk does not become clogged.

In regards to baby learning to sleep through the night, it is a good idea to work towards slowly tapering the amount needed by incorporating a dream feed into your schedule or pumping to relieve pressure for some nights in a row until your body catches on to the diminished demand.

As for returning to work, it is important to remind your workplace that your first and foremost job is to continue to provide for your baby and remind them of the laws set in place to allow a mother to continue provide for her nursling - even in the most demanding of work settings. Another consideration in order to allow proper milk removal to occur at regular intervals is to invest in a hands free pump as is in high demand these days in the breastfeeding world.

3) Tissue injury related to inflammation
Without healthy tissue to continue generating the liquid gold your body is so used to making, it is difficult to maintain the best environment possible for milk production. A teething baby that bites your nipple can introduce bacteria or improper flora back into your milk glands which can then produce an unhealthy place for milk to flow through. Yeast and thrush from recent antibiotic use can increase your likelihood of developing a clog. And lastly, considering the tightness of your sports or nursing bra can damage proper blood flow and milk production in your ever important ducts.

Help me... I'm in the thick of it!

So you've developed a clog and you want out - QUICK! Tell me about it, that annoying phrase 'been there, done that' - well... I'm here to tell you personally, 'BEEN THERE, DONE THAT' and... definitely would love to never go back. Its painful, its annoying and it is extra steps incorporated into your daily breastfeeding life that make things a little more complicated than anyone wishes to deal with!

I'd love to share some tried and true advice that I know will help you to face it head on and fix it before it gets any worse!



Haakaa or Bust!
In some other posts, I know you've read about the Haakaa pump. And here to say it again - run, get one, don't look back, it's worth it! This $12 Amazon purchase will help you from start to finish with all the different parts of breastfeeding and its phases. And no- they aren't paying me to say it, it's just that good! This silicone hand pump that suctions to your breast once you squeeze and apply it to your skin, helps to relieve any extra pressure pent up in your milk ducts. Relieving pressure means relieving milk that has been sitting in there a bit too long which is the concept in getting that clog out and preventing complications in the long run. You can fill your Haakaa with warm water and epsom salt to provide the moist heat environment needed with an antibacterial component to it from the salt, so that its quick to be sucked out while baby does the important work on the opposite side to stimulate the let down reflex needed to allow that clog to flow down and out on the side your Haakaa is applied to. And - don't be worried if you see strains of yellow, thick, stringy substance coming out! That means you've done it mama... that's the clog, so no need to be alarmed! Oh and... don't have a Haakaa? Use a bowl or basin with warm water and epsom salt 15min before a feeding and watch it work its magic!

LaVie Lactation Love!
Our world and medical technology gets cooler by the moment and that is one of the reasons I love being a nurse so much in these present day times. LaVie is a company that is all about providing up to date and easy to use tools to get those clogs out before you have a whole other scenario on your hands. The massage roller to the left is under $20 and can be utilized while breastfeeding to break up those pesky ducts that are clogged and difficult to massage while you're holding baby too. You gently roll it from the top of your chest wall, down towards your areola and nipple while feeding to loosen up the built up milk and get it flowing again. And the lactation massager to the right is under $35 and provides vibration to your breast and the affected area to loosen it up in a more technologically advanced way. Whichever suits your budget - I'd be all about stashing that little helper until a rainy, unexpected day full of clogged milk arrives!

• If neither of these suit your budget, a vibrating toothbrush or handheld back massager will do the trick too!

Baby is your best pump.. truly.
Every mama seems to be quick to jump to the pump whenever a clog is identified. For some reason, because of that technology based mindset we all tend to have in this day and age- we tend to think the pump is better than our own baby's ability to suck harder and stronger when they sense a clog. Can they really sense a clog? Yes- they sure can! So when you feel that bump, have all the symptoms and notice a frustrated baby at the breast... they are trying to work hard for you and their milk in breaking it up the best way they know how. So keep them breastfeeding - frequently and for long periods of time. It will help, even though it may hurt in the moment.

• And also, wherever the clog is located, have your babies chin point TOWARD the clog. Their mouths greatest point of suction is wherever their chin is pointed towards. So if you have a clog on your right breast but towards the middle of your body/chest, cradle hold is right where you need to be! But if you have a clog in your lower breast on the left side, a football hold will be much more effective in removing that clog.  
•  

Comfort measures are a beautiful thing.
So remember to not give misery it's greatest company. Fix the discomfort so that resolving the clog is more manageable for you to do and cope with along the way!

A few of note to utilize in the time of greatest need are:

• Begin each nursing session on the affected side as baby sucks strongest at the beginning of each feeding & will work harder to remove the clog present
• Moist heat 15 min prior to feeding
•  (Especially the shower, but a wet & warm washcloth is great too)
• Ibuprofen and Tylenol
• A loose but supportive sports or nursing bra
• Ice after completion of feeding to decrease inflammation and soreness
• Hydration

I tried.. but now I think I have mastitis.

 It's such a bummer but - it happens.

And sometimes, despite your greatest efforts you still find yourself with a breast infection that is painful, frustrating and that much more to overcome before returning to normalcy.

Mastitis develops as a result of the milk stasis causing a clogged duct spreading into the surrounding tissue and causing bacteria to multiply and further compromising the usual healthy environment milk travels through to your baby. Again, unfortunate but manageable when recognized and dealt with accordingly!

So let me leave you with what to look for, how to manage and how to prevent it from becoming a chronic problem.

Signs and symptoms: 

• Hard, reddened and painful area on breast
• Fever, chills and body aches
• Decreased milk supply in affected breast
• Shooting or stinging pain during feeding 

Mastitis is a breast condition that can develop and further become complicated if left untreated. Contact your OB/Gyn or family care practitioner to ensure you receive antibiotics.

According to the American Academy of Breastfeeding Medicine (2014), "the most common pathogen in infective mastitis is penicillin-resistant Staphylococcus aureus" and "the preferred antibiotics are usually penicillinase-resistant penicillins, such as dicloxacillin or flucloxacillin 500 mg by mouth four times per day." It is important as a mom to advocate for yourself if the provider is unfamiliar with breastfeeding infection protocols, to ensure that this is the antibiotic given to you for treatment of mastitis, unless otherwise indicated based on their clinical judgement in direct regards to your specific health history.

Supportive measures can be taken to endure the infection until the antibiotics kick in and begin to allow you to feel improved affects from the symptoms that usually arise with worsening infection. These comfort measures look very similar to the interventions used for a clogged duct - however, it is very important to remember that continued nursing remains essential to maintain supply and ensure the infection improves. Research shows that this is safe with the previously discussed antibiotic regiment and is beneficial to a continued adequate supply and long lasting nursing relationship as mom desires.

Dangle Feeding
Dangle feeding is an added nursing position that can and should be utilized to help baby to remove the clogged and infected area while recovering from a clog or mastitis. In this position, you can lay your baby on a bed or flat surface that they will be comfortable nursing upon while you position your breast and yourself directly over them to allow gravity to aid in moving the milk down and out the ducts affected. Keeping in mind the placement of babies mouth and chin as previously discussed so that the strongest point of suction can work towards the greater cause too!

 

Last things, last!
Sunflower lecithin is an extremely valuable supplement to keep around so that it can be utilized to thin out the sticky/thick component to your milk that baby thrives upon due to the protein and other important substances that provide the thickness to their nutrition. This supplement is essentially crushed up sunflowers and work to thin your milk so that is does not actively or frequently stick to the walls of your milk ducts.

Direction in dosing should ultimately be referred to your healthcare provider - however, general rule of thumb with consuming this supplement is that you can take 1-4 capsules per day (despite instructions on the back of the bottle) to help with a clog or mastitis.

Should you find yourself with recurrent and unexplained clogged milk ducts or chronic bouts of mastitis, it is important to reach out to your OB provider to consult a breast specialist for further guidance and investigation into specific reasons as to why it may be recurrent!

Always seek out and utilize resources in order to help yourself and protect the precious nursing journey you've worked so hard to establish and maintain!

Keep calm and nurse on, mama. 

Help is always just around the corner!

References:

kellymom.com - Plugged Ducts and Mastitis (Jan 23, 2018) and Recurrent Mastitis or Plugged Ducts (Apr 8, 2020)

medicalnewstoday.com- Mastitis and what to do about it (Dec 19, 2017) 

Cleveland Clinic website

Academy of Breastfeeding Medicine - Protocol #4 (Jun 1, 2014)