Expert: Sally Wendkos Olds - 2/9/2007

Question
Hi, I have just stopped bf my almost 13 month old son, and now I think I may have a plugged duct in my right breast (it feels like there is a bruise there).  So, I am wondering how can I take care of this without having my son nurse?  And how can I ensure that my milk dries up without any more bouts of plugged ducts?

Answer
Dear Beth,

First, congratulations for giving your son the best start in life by breastfeeding him!

I am so sorry to hear about your present problem with the plugged duct. I suffered this myself many years ago, and you have my sympathy. I rarely hear about this condition from someone who has already weaned -- especially if she has weaned gradually.

If you have not totally weaned your son, you may want to resume breastfeeding just long enough to wean him gradually. I discuss plugged ducts in my book (see below) and I am adding an excerpt from the book to this message. To ease your discomfort and pain, I would suggest that you follow my suggestions for mastitis.

If your plugged duct has lasted longer than three days, call your obstetrician, just to rule out infection or any other medical problem.

If you wean gradually, cutting out one feeding at a time over a period of a few weeks, your milk will dry up. I can't ensure that you won't have any more plugged ducts, though. Unfortunately, some women do get them on a recurring basis, and you may be among this group. If so, your doctor should be able to help.

Good luck!

Sally

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.
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  CLOGGED DUCT
  (PLUGGED DUCT; "CAKED" BREASTS)
In this condition, which can occur any time during nursing, one or more of the 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 you should take immediate measures, as suggested in Box 15-4.
  
  BOX 15-4  TREATING A CLOGGED DUCT
  * Be sure your bra (or other clothing, like a tee shirt or sweater) is not so tight that it is pressing on the milk ducts. You may want to get 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.
  * 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 wash cloth, or tub bath or shower). Follow this with gentle massage on the area of the clogged duct.
  * Get extra rest.
  * Do not wear a nipple shield, which will make it even harder for your baby to drain your breast adequately.
  * Do not sleep on your stomach, which puts pressure on your breast.
  * Continue to nurse. If you stop suddenly, your breast is likely to get too full, the condition will worsen, and infection may result.
  * 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 the lump remains for more than three days, see your obstetrician. While the lump is most 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.
  END OF BOX
  
  BREAST INFECTION
  (MASTITIS)
When breast infections occur, they usually show up between two and six weeks after birth, but they may appear earlier or much later. A breast infection may be a complication of a clogged duct or the result of an infection carried from the baby to the mother or picked up elsewhere. Symptoms tend to appear suddenly, and may include some of the following: headache, an intense localized pain, engorgement with the breast hot and tender to the touch, redness, fever, a cracked nipple that looks infected, red streaks on the breast, and a generally sick, ache-y, flu-like feeling. If you see any of these symptoms, begin treatment right away. If you still have fever after 24 hours of treatment, call your doctor.
  Mothers with breast infections used to be told to stop nursing immediately. We now know that breast infections clear up more quickly and with fewer complications when the mother continues to nurse, and nurses frequently, from the affected breast. There is no danger from the baby's becoming ill from nursing at an infected breast; he probably harbors the same germs in his mouth and nose that may have caused the problem in his mother's breast. Occasionally a baby may not nurse well at an infected breast because the milk tastes salty. If this happens, express or pump from the infected breast and nurse from the unaffected one.
  It is important to treat a breast infection right away, as suggested in Box 15-5. With treatment, the fever should drop within 36 to 48 hours, and the soreness and hardness will go away soon afterward. If symptoms do not disappear within three days of treatment, call your doctor.
  
  BOX 15-5  TREATING A BREAST INFECTION
  * Go to bed immediately and stay there as much as you can. If you can't stay in bed, rest as much as possible.
  * Apply moist heat to the infected breast, with one or more of the following: moist-heating pad, hot water bottle, hot wet towel, soaking in basin of warm water, warm shower, or warm bath. Nurse soon after application of heat.
  * Do not apply an ice pack.
  * Nurse frequently, as often as every two hours around the clock. This will keep your milk flowing and will avoid engorgement. Be sure your baby is well positioned, and change positions so your baby is not always putting pressure at the same spot on your breast.
  * Offer the sore breast first at each nursing so that it can be drained more completely.
  * Be sure your bra is not too tight. You may want to get one 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.
  * Drink plenty of fluids.
  * Do not wean suddenly if you can help it, since this can contribute to an abscess, a serious and painful infection that may require surgery and temporary cessation of nursing from the affected breast.
  * Call your doctor immediately upon development of symptoms of mastitis. The usual treatment for mastitis is the administration of an antibiotic for a course of from 10 to 14 days, in addition to other treatment, as indicated above. This will be safe to take while you continue to nurse. Once prescribed, the antibiotic should be taken for its full course, even if your symptoms have gone away before then.
  * If you suffer repeatedly from breast infection, see your family physician, your obstetrician, or a breast surgeon, especially if a lump is not reduced in size after three days of treatment, if the mastitis keeps reappearing at the same place on your breast, and/or if you have dimpling on the breast. Breast cancer is extremely rare in lactating women, but it does occasionally occur and must be ruled out.
  * If you have been checked out for repeated breast infection and reassured that it is not caused by a malignancy, check for other factors that may be causing the mastitis -- allowing your breasts to become too full, not alternating them, improper positioning of your baby, inadequate washing of your hands before nursing, using an unclean breast pump, or not getting enough rest. Change what you can and seek help at the first sign of infection.
  END OF BOX



the following measures (see below). Your milk supply will dry up