Dealing with a Plugged Duct or Mastitis

Sara Walters
Carmarthen Wales UK
From NEW BEGINNINGS, Vol. 24 No. 2, March -- April 2007, pp. 76-77

Ouch! The soreness of a lump in the breast can be painful for a nursing mother. It's at times like these that your commitment to breastfeeding your baby can be truly tested, especially when putting your baby to the breast may be the last thing you feel like doing. If the blockage has become infected and turned into mastitis, then it's possible that you may have been told to wean. But is weaning really necessary?

The short answer to this question is, "No, you do not need to wean." In fact, weaning may make the problem even worse. Generally, in the case of a plugged duct or mastitis, there are three steps you can take to help you recover quickly: apply heat, get plenty of rest, and nurse frequently. Plugged ducts happen when the milk duct has become inflamed because the milk is unable to flow through easily. You may notice redness, or feel a tender spot or a sore lump.

What causes plugged ducts?

There are many causes of plugged ducts, including not having your baby well positioned at your breast; too big of a gap between nursing sessions; giving "top-up" bottles after breastfeeding or overusing a pacifier; and wearing a bra that is too tight or other tight clothing. I've even heard of a mother getting a plugged duct after lying on her tummy for a back massage!

What can I do?

Take action promptly. Your best move is to take your baby to bed and stay there for as long as possible. If this isn't possible -- especially if you have other children -- then try to rest as often as you can. Often, a plugged duct is a sign that you are doing too much. It is important to try and lie down for a while and nurse your baby.

Nurse frequently on the affected side. Even during the night, you should try to nurse every couple of hours. It's only by nursing that you will be able to clear the blockage and get the milk to flow freely again. You may have to alter your nursing position -- it helps if you can get your baby's chin pointing toward the plugged duct. This may involve some nursing gymnastics on your part, such as leaning over the baby on your hands and knees and letting your breast hang loose.

Check your baby's position at the breast. He should be on his side facing you without having to turn his head to get a large portion your areola in his mouth.

Apply heat. Take a warm shower, or apply a heating pad or hot water bottle. Gently massaging the area while it is still warm and then nursing your baby or hand expressing some milk immediately afterward will help to clear the blockage.

Take off your bra. Your bra may be a cause of the problem.

What should I do if I get mastitis?

Mastitis is another name for a breast infection, and this happens when the plugged duct doesn't clear and gets infected. You will know that you have mastitis because in addition to the symptoms of a plugged duct, you will also feel ill with a fever, or flu-like symptoms.

Treat mastitis as you would a plugged duct. Remember that it is perfectly safe to nurse your baby. Antibodies in your milk will protect your baby from any infection. Suggestions that you wean from the infected side may make matters worse. (See "Breast Abscess and Breast Lumps"). Frequent nursing will help the infection clear up more quickly. And again, take yourself off to bed. You're ill, and it's where you need to be!

If the fever persists, or you continue to feel ill, then you may want to contact your doctor, who will probably prescribe antibiotics. Many antibiotics are compatible with breastfeeding, so make sure that your doctor prescribes one that is. You should also complete the course of tablets even if you feel better before you have finished. It is important to continue to nurse frequently and rest.

If an infection reoccurs shortly afterwards, it is a sign that the original infection did not clear up. If you find that you frequently suffer from plugged ducts or mastitis, talking with a La Leche League Leader may help you pinpoint the source of the problem.

Breast Abscess and Breast Lumps

A breast abscess is very unusual, but it can occur if mastitis is not treated quickly or correctly. It is a very painful, localized infection containing pus and must be treated immediately. This is done by surgically draining or aspirating the breast. You can continue to nurse on the unaffected side, and may even nurse on the affected side, especially if the abscess was treated by needle aspiration. If, however, the abscess was surgically drained, it may be painful to nurse, especially if the incision is close to the areola. If this is the case, then you may need to hand-express for a day or two. Keeping the breast empty will help the breast to heal.

Most women worry when they discover a breast lump, and obviously breasts feel very different when a woman is lactating. However, if you discover a lump that does not go away after a week, even after careful treatment of a plugged duct, you should consider consulting with your doctor. In many cases, breast lumps are benign tumors (fibromas) or milk-filled cysts (galactoceles), all of which can be diagnosed and treated while you continue to breastfeed. It is very rare that a lump is a sign of cancer. But be sure to consult your doctor if the lump continues to grow, does not move, is firm and hard, or there is dimpling of the skin.

Care Plan

If:

You see red patches on the breast,
You feel a hard sore lump in the breast,
You feel achy and run down,
You have a low grade fever (less than 38.4°C [101°F]),

Then:

Continue to feed the baby eight to 12 times each 24 hours from both breasts.
Rest, drink plenty of fluids, and increase your vitamin C intake.
Hand express or pump the affected side if the baby does not thoroughly drain that side.
Use alternate massage (massage and compress the breast and hard area with your fingertips each time baby pauses between sucks).
Apply heat prior to feedings to promote drainage.
Ask your health care provider if you can use a medication such as ibuprofen to reduce the inflammation.