Expert: Sally Wendkos Olds - 10/1/2009

Question
QUESTION: Help!  I am on day two of weaning my 15 month old.  My breast are very engorged and so I was expressing in the shower.  While I was expressing blood came out of one of the ducts. Prior to becoming pregnant I had spoken with a surgeon about a clogged duct I had but he said that it would go away with surgery or nursing.  I am wondering if I should continue weaning my baby or if i should start nursing again to help the problem?  I do not want surgery and i also do not want to start nursing again as yesterday was really hard on me and my daughter... What should I do? Do u think this is a clogged duct again or something due to the weaning?

ANSWER: Dear Cassandra,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

I'm sorry to hear about your present problem. It's very unusual to have blood come out of your breast at this stage of weaning, and it's hard to tell at a distance what the cause is of your bleeding. Whenever there's an unusual symptom, it's best to check it out to be sure there's no medical problem, so I suggest that you see your obstetrician as soon as possible. Your doctor may refer you to a breast specialist, but not necessarily a surgeon.

Meanwhile, this does  not sound like a clogged duct. I think that you can continue to wean your daughter and you don't need to go back to nursing -- but remember, I am not a doctor. The best course for you is to be examined by a physician.

Good luck!

I would appreciate your updating me on what the doctor says and how you are.

Best regards,

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.



---------- FOLLOW-UP ----------

QUESTION: Sally,

I went to the doctor and it turns out that they are pretty sure that I am going threw mastitis again.  She said that I should avoid being engorged at all costs, I did not have presence of mind to ask her whether I should consider stopping weaning??? If I am not supposed to get engorged and that is basically what happens when you wean. My pump is broken and I cannot afford a new one especially if I will only be using it for a few more days... HELP... What should i do?

Answer
Dear Cassandra,

Sorry it's taken me so long to answer your follow-up question -- I consulted Dr. Marks and a couple of other people.

Basically, we all suggest that you continue to wean -- but that you do it gradually, nursing just enough so that you don't get engorged. Apparently your engorgement is what led you to develop the mastitis. I know you're ready to wean, but your breasts are not. So continue to nurse, but eliminate one feeding at a time -- preferably the one your daughter is least intrested in, and don't drop another feeding for at least several days, and up to a week. You can give her bottled whole milk for that feeding. If you feel your milk coming in before you're ready for the next feeding, hand-express to relieve the fullness. It will take longer to wean this way, but it should relieve your engorgement, help to prevent infection (mastitis), and stop the bleeding. Also, I'm attaching some suggestions from my book to help with engorgement, and I hope that some of them will help.

Good luck!

Sally
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Ways to Relieve Engorgement
The most important and effective way to relieve engorgement is to remove as much milk as possible from your breasts, as frequently as possible, either by nursing your baby often or by using a good breast pump. Some of the following remedies may help.
• Express or pump a little bit of milk just before feedings to soften your breasts and make the nipple easier for your baby to latch onto.
* The technique of reverse pressure softening (RPS) is sometimes helpful in the first two weeks postpartum using gentle pressure to relieve some of the congestion in the breasts. Ask your lactation specialist to teach you how to do this.
• If your breasts are severely engorged, massage them once or twice a day before feeding, starting gently at the outer edges with your fingertips and going toward the nipple area. A mild cream may make the process easier, but don’t get any on the areola, because that would make it harder for you to express milk. It may help to do the massage in the shower.
• Apply warm, moist compresses about ten or fifteen minutes before a feeding (and before a massage). Between feedings, apply cold compresses. The warm compresses aid the let-down reflex, and the cold packs relieve swelling and pain. Apply cold in an ice pack, a bag of frozen vegetables, or a blue freezer pack wrapped in a thin towel. Apply heat in a moist-heat pad, a small hot water bottle wrapped in a towel, a towel soaked in hot water, or in a hot shower. If you use a heating pad, be very careful not to burn your skin.
 • Wear a firm bra for support. Be sure it’s not too tight, since this can make you more uncomfortable and also cause other problems. If you use breast shields (see below), wear a bra that has enough room to insert the shields. Try taking off your bra while you’re nursing, to be sure it’s not constricting your milk ducts.
• Apply fresh cabbage leaves to your breasts. This simple home remedy seems to help some women. Pull two outer leaves from an ordinary head of cabbage, strip out the large vein in each leaf (or alternately, leave this in and crush the leaf as if you were crumpling paper into a ball). Then cut a hole for your nipple and wash the leaf to get rid of any chemical residue. Chill them for about ten minutes if you want to. Then wrap the leaves around the irritated areas of your breasts. They’re convenient, cheap, not injurious, and disposable, and some women report that they relieve pain. You might try it if you don’t mind staining your bra—and smelling like dinner.
• Wear a silicone breast shield (also known as a milk cup, breast shell, or Woolwich shield) inside your bra for 30 minutes before feedings to soften your areola and bring out your nipple.
• Take a pain reliever—either one of the over-the-counter agents listed in the box on page tk (Chap. 10), or something your doctor can prescribe that will not affect your baby or your milk.
• If only one breast is engorged because your baby is consistently not suckling from it, this may be a sign of a possibly serious medical problem. To rule this out, see your obstetrician.