Plugged ducts: Dealing

I've had 3 episodes of plugged ducts since I started breastfeeding. It doesn't get easier to deal with, but at least the accumulating experience makes me confident that I can fix it before infection sets in. I've heard some scary stories of mastitis from friends and these were enough to scare me into acting quickly as soon as I suspect a plugged duct.

Lately I've been prone to these. I started working again and my unpredictable schedule makes it hard to schedule regular pumping sessions. One is prone to plugs when the breasts are not emptied out regularly, they get engorged and milk solids block the ducts so that even after pumping or nursing a part of the breast remains full. It can be painful, you will be able to feel a lump on your breast, it will be tender like there's a bruise, sometimes there's a redness on to the skin and it feels warm.

Moms who plan to breastfeed should have small hot/warm compresses handy. These are useful for a lot of things, faster letdown, soreness, mastitis, and plugged ducts. A lot of websites say it helps to take a hot shower and let the water run against the part of the breast with the plug. In the Philippines though not all homes have hot showers, so warm compresses are a must. A low-cost option is to put some uncooked rice in an old sock and sew it closed, then microwave for 30 seconds at a time until warm, you can use this indefinitely but make sure you don't get it wet!

Place the warm compress on top of the breast where the lump is, massage the lump from the outside of the breast toward the nipple, do this for 5-10 minutes then start pumping or nursing. Nursing is better, especially if you have an older baby, because his suction will be stronger than a pump. What you are trying to do is soften up the milk solids plugging up the duct, then suck it out (literally). Joke all you want about getting your husband to suck out the plug, but don't do it, your baby has a stronger suck I promise. If you're pumping, keep the warm compress on while pumping.

The plug might not go the first time, repeat the process every 2 hours until the plug is gone and you can feel the duct drain off the milk. Soreness may stay for another couple of days, but you'll know the duct is clear if the lump is gone.

So remember, as soon as you feel that lump do the warm compress thing, don't wait for more milk to accumulate in there because it will get more painful as that happens and then infection is next.

For more: Dr. Sears on Plugged Ducts

Stuff that Helped me Breastfeed

Ok so as I said before, I needed a lot of gadgets to help me get through all the challenges that nursing my tenacious little infant presented. Below is a list of the ones that helped the most and where I got them. 

1. Nipple shields. The ones I used often were Avent brand that my mother-in-law found at SM Megamall (around P800 for a pair). I’ve also seen them at the Hypermarket in libis and in Rustan’s. They were recommended by the midwife at the hospital when she noticed that baby J just couldn’t latch on properly. Frustrated and scared, I asked my mother-in-law to find me nipple shields so these were sort of an emergency purchase, no time to read reviews or comparison shop. Eventually I found a better kind, Medela brand available at Rustan’s (I think 1,200 a pair), but by then the baby wasn’t using them as much anymore. Take note that these things have sizes! I made the mistake of buying smalls and ended up never using them, buy the mediums to be safe.

I used these not so much to prevent soreness, they don’t do a good job of that, but to help baby latch. For latch these are great. You place them on top of the nipple and the baby’s suction will pull your nipple into the shield’s shape. For us the problem I think was that my nipples were flat and almost inverted, then the baby’s mouth was too small. So I credit these shields for my success in nursing, used them until he was about 3 months old. There are certainly downsides to these, including inefficient milk transfer (see kellymom for a full discussion), but women like me just cannot nurse without them. Just wean as soon as you are able, when baby is big enough to learn how to nurse without them.


For more see: Medela site on nipple shields

2. Breast shells. Great invention these things. Also used Avent brand since these were cheapest at Amazon when a friend was able to bring them home. I have seen them at SM stores as well for P1200, really expensive considering they were $12 on Amazon. When nipples get sore from friction with the baby’s tongue as he nurses, the pain sometimes gets worse when it then chafes against your bra or top. The shells protect your boobs from friction against clothing, giving them time to heal up and you some freedom to move around without pain. Put on some Lanolin (available at most baby sections in department stores and possibly Mercury Drug) after nursing then wear the shells.

3. Manual breast pump. I had an expensive brand electric pump which I used at home, a Medela that a friend gave me, that one is for the everyday pumping. For travel and overall mobility, have a manual pump. I bought a cheap one at Shopwise (P700), it doesn’t even have a brand, but it works well. These actually feel like they have more suction than the electric pump. You will need it for when you’re on road trips, on weekends out of town, for dealing with plugged ducts when you need stronger suction.

4. Warm compress. Warm wet heat is best for dealing with plugged ducts and mastitis. Believe me these are a b*tch to deal with and you want to make sure you are vigilant about checking for them and getting to fixing them before they get infected. If you don't feel like spending, make your own: put some bigas (uncooked rice) in a couple of socks, sew up the open ends, microwave for 30 seconds until warm. 

Some of these are tricky to find the Philippines. If you are not in a terrible hurry I suggest going online and checking if you can find these on the many mommy sites on multiply.