Expert: ruth kraft - 3/14/2009

Question
QUESTION: I have a 8 week old baby which I'm breastfeeding exclusively.  one of my breasts produce a lot more milk than the other one, and I have had several incidents of blocked ducts and milk blisters which this breast.  It also tend to get engorged/lumpy very fast.  I have to breast feed every 2-3 hours or else it becomes achy/lumpy and I get worried that I will get another blocked duct if I don't empty it.  The baby is gaining weight fine, but I'm trying to get more sleep at night and my breast won't cooperate since it gets uncomfortable so soon.  In fact, it's not uncommon for me to empty the breast, switch to the other one, then 10 -15 minutes later, have the first breast be hard/full again!  It's a little scary because I don't think the baby can keep up with this pace and I don't want to pump because I don't want to stimulate the breast to produce more milk. so my question is this:

1.  how can I get the breast to produce enough milk for the baby but not do it so fast that it causes engorgement/blocked duct problems?

2.  how do I get my breast to synch up with the baby's sleep pattern so it can go several hours without engorgement problems so I can get more sleep at night?

3.  right now I'm waking the baby up to feed because of the breast being engorged, is this bad for the baby?  I'd rather have her sleep as long as she needs instead of have her sleep pattern be dicated by my breast engorgement schedule.

I'm taking lecithin to  thin out the breast milk a bit, and I'm not sure it's helping that much.

Thanks,

Debby

ANSWER: hello!  First I will say stop emptying that breast. every time you empty it, it fills up because you are telling it that the baby needs that much milk. if you get engorged you should only pump until the pressure is released. Breastmilk is supply and demand. so if you constantly feed and pump, your body thinks you need twice as much milk.

your baby will sync your breasts automatically. there isn't anything you can do. other than honor your babys routine that works best for him.

its not bad for the baby at 8 weeks, however over time it will become not such a good thing as sleep must be honored for your baby good brain development.

I am going to suggest three things that should help you get that under control in side that is over producing.

1. pump ONLY to relieve pressure. never empty. this should be about 1 or two letdowns. maybe three. using a warm compress first.  not to empty as this will tell your body that you need to make that much more.

2. go to the store and buy a fresh head of cabbage with whole leaves on it. take one leaf and place it inside your bra , next to your breast when its full, and leave it there till it wilts. do this about once a day until engorgement is gone.

3.  drink 1 cup of sage tea  a day and then do  1 20-minute warm compress treatment using hot sage teabags wrapped around each breast... Within 24 hours the engorgement should be almost gone or at least allot better. if not , do it again for the next two days and see if that helps.

another note, do not do all of these together. only pick one which you like the best and use that one. if your body doesn't react, try another. there is a chemical reaction in the body  with these two last things that can be very helpful. but don't over do it as you can decrease your supply too much and have the opposite problem.

hopefully those will work, if not, e-mail me back and let me know what goes on with each and where you are...

Ruth Kraft
www.honoringwomen.com

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

QUESTION: Hi Ruth,

Thanks for your response.  I had a blocked duct (hard, wedge shaped mass on breast which doesn't resolve with feeding) several days ago and it took about 12 hours to resolve.  I tried doing all of the following:

1. cold compress between feedings
2. cabbage leave on breast
3. ibuprofin
4. lecithin supplement
5. hot compress shortly before nursing

The blockage did resolve after doing all the things above, but I'm wondering if there's anyway to prevent this from happening?  I'm getting this condition at least once a week, which is very stressful.  I've heard of ultrasound treatment for recurrent blocked ducts , does this prevent future blockages or can it only be done to treat a duct which is currently blocked?  Anything else you can suggest?

Also, I always have to do breast compressions while nursing because my baby seem to slow down/fall asleep a lot while nursing, if I don't do this then it can take HOURS for her to finish.  Can the breast compressions cause inflammation of the ducts and contribute to the blocked duct problems?  Is it OK to always compress the breast while nursing?

thanks,

Debby

ANSWER: I am not familiar enough with t he ultrasound to tell you if it would work to prevent them again. My guess would be no though, as to do that would mean your taking away the natural aspect of the duct to enlarge and close up with milk.  

Are you getting the clogged duct in the same place? or different places? my guess is if its in the same place, maybe its not being completely relieved it just mostly is. or there is a back up of milk or infection in that area. ( clogged ducts could go on to create mastitis so you want to get it taken care of as soon as you can when you notice it happening. )  if its in the same place, then when you are pumping or feeding, do the warm compresses first and then while you are doing your compression on the breast to encourage feeding, make sure you rub downward, towards your nipple on that area specifically so that it encourages that are to release always. using a little olive oil on your fingers will help ease any friction of skin.

In fact, I would do this on every feeding while you are doing compression just to keep it empty.  Doing compressions should not encourage a duct unless you are pressing so hard into your breast for a long period of time. notice when you hold your breast, if your fingers are right by the end of the clog. if this is true, then you need to move your compressions around . starting by compressing/massaging that always clogged area will help this. I don't see this very often but it is possible.  

you shouldn't have to do the compressions much longer. at 8-12 weeks the baby should be able to nurse without falling asleep all the time. unless she was preemie. then it might take longer.

Yes, its ok to compress while nursing. Only do it while she is sucking though. not inbetween.

I hope that helps!

Ruth Kraft
www.honoringwomen.com

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

QUESTION: Hi Ruth,

What do you mean by only doing compression while the baby's sucking, not in between?  I compress/massage the breast when she slows down or is not longer drinking - is this what you mean?  

Also, my baby takes anywhere between 40 minutes to over an hour per feeding session, which seems like a long time.  This is with frequent breast massage/compression - else it may even go on longer.  Since I have an oversupply problem on the right breast, I usually let her feed on this breast first, to get it at least somewhat soft, then switch to the other side , then switch back to the first one.  I try to get the oversupply breast drained as much as possible without neglecting the other breast.  I have to wake her up at least once during the feeding session to do this.  Does this sound right?  Will the feeding time shorten as she gets older or is this just the way it is?

I talked to a lactation consultant about my oversupply problem and she suggested not draining the breast completely at every feeding session to tell the body to reduce the amount of milk being produced in this breast, does this sound right to you?  I worry that if I don't drain the breast completely, then I'd get a blocked duct.

Answer
If you go to  drjacknewman.com he talks alot about breast compressions. and when to do them. usually he suggests to do them while the baby is sucking. this teaches baby you have to suck to get milk. if you do it inbetween, the baby gets lazy and assumes it can be at the breast and let milk fall into its mouth with no effort. so essentially you are teaching the baby you will do the work. when the baby shoudl be doing it by itself.

It doesnt sound abnormal to nurse for that long. Some babies are snackers and slow eaters. It very well could be the babys personality. yes, feeding will get shorter as she matures as food will no longer be the primary source of excitement. 6 months from now youll wish you could get the baby to sit still and eat :)

I would agree with the lc to not drain it completely. otherwise you will compound the problem.  While you are pumping and nursing and doing compressions, use the massage I was sharing with you. that should eliminate the clogged ducts .

Hope that helped!
www.honoringwomen.com