Expert: Sally Wendkos Olds - 9/12/2010

Question
I exclusively pump.  My left breast is very sore and I am only getting a little bot of milk out of it.  It is sore on the bottom of the breast.  Could this be a blocked milk duct?  I have read to have your baby nurse off of it and I tried that today but my son will no longer latch on.  Thank you!

Answer
Dear Erika,

First, congratulations for giving your son the best start in life by giving him your good breast milk!

Yes, your pain could come from a blocked milk duct. I'm attaching an excerpt from my book (see below) with some suggestions for dealing with this. If these don't work within a few days, go to see your obstetrician just to be sure there's no medical problem.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and soon available in most public libraries, bookstores & La Leche League chapters.

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Clogged Duct (Plugged Duct, “Caked” Breasts)
In this condition, which can occur any time during nursing, one or more milk ducts are blocked so that the milk cannot pass through them. If you develop a clogged duct, you’re likely to find a small reddened lump on your breast that’s painful to touch. If not treated, this condition can lead to a breast infection, so take immediate measures, as suggested below.
• First, continue to nurse. If you stop suddenly, your breast is likely to get too full, the condition will worsen, and infection may result.
• Be sure your bra (or other clothing, like a T-shirt or sweater) is not so tight that it’s pressing on the milk ducts. Try a bra in the next larger size. Or try going without one, at least while you’re nursing. Also check other items that may be putting too much pressure on your breasts, like a baby carrier or a shoulder bag.
• Breastfeed more often and for a longer period of time, so that your baby can help you empty the breast, release the lump, and unclog the duct.
• Change your position with every feeding, so that the pressure of your baby’s suckling will hit different places on your breast, exerting pressure on different ducts.
• Express or pump milk from the affected breast after each feeding if your baby has not nursed long and vigorously, to get out as much milk as possible.
• If dried secretions seem to be covering your nipple openings, wash them off very gently after each nursing with a piece of cotton saturated with warm water.
• Offer your sore breast first, so that your baby will drain it more thoroughly.
• Apply moist heat several times a day (with a moist-heating pad, a hot water bottle, hot wet towel or washcloth, disposable diaper filled with hot water and squeezed out, or tub bath or shower). Be careful not to burn yourself!
* Gently massage the area of the clogged duct, especially after moist heat treatment.
* Try ultrasound at a physical therapy office or sports medicine clinic for one or two consecutive days. Sometimes spontaneous milk ejection occurs during scanning, especially if the breast is full of milk or the device used in the procedure stimulates the nipple, triggering the release of oxytocin. If the therapist is not familiar with this use of ultrasound, ask your lactation consultant to recommend the dosage.
• Rest as much as you can.
• Don’t wear a nipple shield, which will make it harder for your baby to drain your breast adequately.
• Don’t sleep on your stomach, which puts pressure on your breast.
• If your baby refuses to nurse on the breast with the clogged duct, see your obstetrician. There may be a changed taste in the milk from that breast, which may be a sign of an infection or other problem.
• If a lump remains for more than three days, see your obstetrician. While the lump is probably related to breastfeeding, it may not be and must be looked at promptly.
• If you repeatedly suffer from clogged ducts, consult a lactation specialist to reevaluate the way you’re holding your baby or the way your baby is suckling.