Breastfeeding And Plugged Ducts

GENERAL INFORMATION:

What is a plugged duct?

• A plugged duct is a milk duct that is blocked. Things that can block your milk ducts include milk that gets thicker, scar tissue, or something pressing on them. The blockage can decrease or stop the flow of your breast milk in one part of your breast. It can make your milk build up inside and cause your breast to swell. Milk ducts are pathways where milk flows from milk producing areas in your breast down to your nipple. When you have plugged ducts, you may get a lump in the breast that is warm and tender to the touch.
  
  
• Plugged ducts are a common problem while breastfeeding. Having this condition can lead to you getting a breast abscess (area of infection in your breast) or mastitis (breast infection). Your breast with the plugged ducts may swell and become painful. Having an infection or pain may make you want to decrease how often you breastfeed your baby. If you breastfeed less often or stop completely, your baby will not get all the good effects from breastfeeding. Treating plugged ducts will relieve the swelling and pain in your breast, making breastfeeding more comfortable for you.

How do breasts make milk?

• Your breasts change during pregnancy to prepare for making milk. Your breasts contain milk glands and milk ducts that increase in number, causing your breasts to get larger. Milk is made in small sacs called milk glands or mammary glands. The milk glands are arranged side by side in small grape-like clusters. The milk gland clusters connect to milk ducts, which are pathways for milk to travel through before reaching your nipples. These small ducts join other ducts and form bigger ducts as they get closer to the nipple. Breast milk flows from the ducts into the sinus (collection area) behind the nipple. It then comes out through 15 to 20 small openings on your nipples.
  
  
• During the later part of your pregnancy, your breasts start to make and store colostrum. Colostrum (KO-lah-strum) is a yellow, creamy fluid made by the breasts before they start making milk. It contains protein, vitamins and minerals, and sugar, plus antibodies (substances that protect against infection). Your baby will receive colostrum during breastfeeding before your breasts start making milk. Your breasts will start making regular breast milk 2 to 4 days after your baby's birth. Colostrum may continue to be in your milk for up to two weeks after your baby is born. Your milk glands make milk continuously while you breastfeed and removing more milk increases how much you make. Milk is removed from your breast during feeding when your baby suckles it or by expression (milk removal by hand or pumping).

What can increase my risk for having plugged ducts?

• Breast infection: Having a breast abscess or mastitis can cause your breast to swell. The swelling can pinch off your milk ducts and decrease or stop your milk flow. When milk cannot be drained out of your breast, it will build up inside your breast. Too much milk that has built up inside your breast will trap even more milk and can be painful. Ask your caregiver for more information about mastitis.
  
  
• Not having a good milk flow or not completely emptying the breasts: Things that can cause this include:
  
  
  • Being in an uncomfortable position during breastfeeding: How you position your baby and breast for feeding can affect how well he is able to latch-on. Your baby may have a hard time suckling when he is uncomfortable. Being uncomfortable can also make you anxious, and decrease or stop your milk flow. Your breasts may not empty completely and a lot of milk may still be left inside. Ask your caregiver for more information about how to hold and breastfeed your baby.
    
    
  • Leaving milk in your breasts when you breastfeed: There are many things that can result in milk not being completely emptied from your breast. Cracked, bleeding, or painful nipples can make you want to breastfeed less often. Feeding problems or medical conditions may make your baby not able to breastfeed often. Feeling tired or stressed, or doing too many things can lead to less breastfeeding. Hurrying through breastfeeding sessions with your baby may not let your breasts empty completely. When your baby gets older, he can get distracted easily and may stop suckling sooner than usual. He may look around more instead of feeding or want to sleep more. Your breasts may still have milk in them after your baby is done feeding.
    
    
  • Pumping to express milk: Pumping may not be as effective at removing milk from the breast as breastfeeding. How well your pump removes milk depends on the type of pump you are using. Hospital grade ones work the best. Ones with weak battery power or those without a power source may not work as well.
  
  
• Pressure on your breasts: Carrying heavy diaper bags, infant carriers, purses, or wearing tight clothes can squeeze your chest and your breasts. This may pinch your milk ducts and trap milk inside your breasts.
  
  
• Scar tissue from breast surgery or nipple piercing: If you have had breast surgery, or one or both of your nipples pierced, you may have scar tissue in your breast. The scar tissue can pinch and block your milk ducts. Breast surgeries includes breast biopsies, partial mastectomy (part of breast removed), and breast reduction, augmentation (make larger), or reconstruction.
  
  
• Things associated with having a higher risk for getting plugged ducts:
  
  
  • Breastfeeding history: Having had plugged ducts or mastitis before increases your risk for getting plugged ducts. Having had early or severe (very bad) engorgement (breast too full of milk) also increases your risk. Any of these can damage and scar your ducts. Other things are associated with getting plugged ducts. These include milk leaking from your breasts between feedings. If you have milk spraying from the free breast when let-down happen, you may be at risk. Having breast milk that seems to be more thick than usual is also a risk.
    
    
  • Using certain breast care products: Nipple devices and ointments can increase your risk for having plugged milk ducts. Nipple devices include nipple shields and shells. Nipple shields are made of thin, soft silicone, shaped like your nipple with holes to let the milk pass through. They cover your nipple and areola to protect or help shape your nipple during breastfeeding. Nipple shells are small, round, plastic devices placed over your nipples. They are used to make inverted or flat nipples longer to improve latching-on. They may also be used to protect sore or injured nipples from rubbing against clothing. Ointments such as lanolin are used to protect your nipples from getting too dry.

What are the signs and symptoms of plugged ducts?

• A lump in your breast that is tender to the touch.
  
  
• A small, white bubble at the nipple of the breast with the plugged ducts.
  
  
• An area of bluish color over the blocked area of your breast.
  
  
• Decreased or no flow of breast milk.
  
  
• One or both of your breasts are swollen.
  
  
• Pain in your nipple or short, shooting pains in your breast.
  
  
• Redness or warmth over the painful area.

How are plugged ducts treated?

• Get the milk in your ducts moving.
  
  
  • Apply warmth to your breasts before breastfeeding. Put a warm wet cloth on your breasts or take a warm shower or bath. You can also lean over a sink or basin of warm water and place your breasts in it. Doing this can help remove the blockage and increase your milk flow.
    
    
  • Breastfeed or pump more than eight times a day, and breastfeed as often as your baby wants. Your baby can feed 8 to 12 times a day, or even more. Frequent breastfeeding often can remove the blockage in your milk ducts. Breastfeed at least every two hours during the day and every 2 to 3 hours at night. To help remove excess milk, give your baby the breast with the plugged ducts first. Use a breast pump after your baby is done feeding to drain left-over milk and help prevent breast swelling. Ask your caregiver for more information on how to use a breast pump.
    
    
  • Express or pump milk from your breasts. You may also need to do this right before you put your baby to breast. Expressing or pumping out some milk can make your breast less swollen and your nipple a better shape for latching-on. If your baby is not emptying your breasts fully when he feeds, expressing or pumping can also help. Ask your caregiver for more information about expressing, collecting and storing breast milk.
    
    
  • Massage the breast with plugged ducts before and during breastfeeding. You may also do this while taking a hot shower or bath. You can usually feel a lump on the breast with plugged ducts. Massage your breast in front and behind the lump, using firm stroking towards the nipple. You may be able to massage out white clumps of milk causing the blockage. Watch the area for several days to check if the lump or swollen area is getting smaller.
    
    
  • Use comfortable breastfeeding positions for you and your baby. Hold your baby in a position where he can suckle at your breasts easily and comfortably. When you are relaxed, your milk flows easily. Make sure your baby is relaxed during breastfeeding. This lets him empty your breasts completely. Hold your baby so that his nose is pointing towards the painful or swollen area of your breast. Hold your baby in different positions each time you breastfeed. This helps remove breast milk from all the milk ducts in your breast. Ask your caregiver for more information about how to hold and breastfeed your baby.
  
  
• Take pain medicine if needed. Ask your caregiver about what medicines you can take for breast pain. You may be able to take over-the-counter (OTC) medicine such as acetaminophen. Follow your caregiver's advice on how to take them.
  
  
• Visit your caregiver if you often have plugged ducts. You may need other tests and treatment if you often get plugged milk ducts. He will check for problems that can pinch on milk ducts, such as an infection or a tumor.

How can I prevent having plugged ducts?

• Avoid pressure on your breasts. Sleeping in a face down position may squeeze your breasts and block milk ducts. Do not wear underwire bras, and avoid wearing bras that are too tight and clothes that are tight over your breasts. Avoid wearing or carrying items that can squeeze or press on your breasts. These include big purses, baby carriers and slings, and diaper bags.
  
  
• Breastfeed or pump at least eight times a day, and breastfeed as often as your baby wants. Your baby can feed 8 to 12 times a day, or even more.
  
  
• Breastfeed so that your milk flows and both breasts are emptied. Have your baby breastfeed on both of your breasts at each breastfeeding session. Be sure your first breast is completely empty before you let your baby suckle from your second breast. Make sure that your baby is well latched-on and is suckling on a mouthful of your breast, and not just on your nipple. Your baby will suckle easily and get the right milk flow when he is well latched-on.
  
  
• Rest and relax. Rest and relax as much as possible. Ask family members and friends for help doing your usual activities at work or in your house.

When should I call my caregiver? Call your caregiver if:

• Your breast is very swollen and painful.
  
  
• You feel sick and you cannot breastfeed your child.
  
  
• You feel that your baby has trouble suckling or is not getting enough milk.
  
  
• You have a breast lump or a swollen area on your breast that feels warm.
  
  
• You have a fever and chills.
  
  
• You have bleeding from one or both of your nipples.
  
  
• You have redness and pain in your breast or at the nipple and areola area.

Where can I get more information? Ask your caregivers for more information about breastfeeding. Join a breastfeeding class, or a support group with other breastfeeding mothers. Ask your caregiver for the name of a Lactation Consultant. This person is specially trained to help women breastfeed their babies. Contact any of the following:

• La Leche League International
  1400 N. Meacham Rd
  Schaumburg, IL 60173-4808
  Phone: 1-847-519-7730
  Web Address: http://www.lalecheleague.org
  

• The National Women's Health Information Center
  Phone: 1-800-994-9662
  Web Address: http://www.4woman.gov
  

CARE AGREEMENT:

You have the right to choose how you are going to feed your baby. To help with this plan, you must learn as much as you can about breastfeeding. You may ask your caregiver for more information or join a group with other breastfeeding mothers. You and your caregiver can work together to plan the best way to feed your baby.

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