Tag Archives: mastitis

Chronic Plugged Ducts and How I’m Fighting Them

I think it’s finally time to admit to myself that I’m having an issue with plugged ducts. A plugged duct is when one of the milk ducts becomes blocked and milk can’t exit the breast.  A hard, painful lump can form as the milk backs up.  If the milk isn’t removed, a plug has the potential to develop into mastitis, which is an infection of the breast.  Think fever, chills, nausea, etc.  Plugged ducts are not fun.

I’ve had six instances of plugged ducts in the last month and a half, which is more than I had the entire three and a half years of nursing Gabi.  Twice now, the plugs have been especially exciting because I’ve gotten a bleb along with them.  A bleb is a hardened bit of milk that forms a blister right at the nipple. Once, I got a mild case of mastitis and ended up missing work because of it.  Obviously, there’s something going on.

I brought it up the last La Leche League meeting, and I got some great help.  We really thought together about what kinds of things I notice before a plug occurs.  Here’s what I came up with.  My plugged ducts coincide with:

  • Juan travelling for work
  • Eating fast food
  • Especially wakeful periods for Katie
  • Missed pumping sessions at work
  • Feelings of stress, anger, and disconnect
  • Allowing Katie to roll her lips in for a lazy latch

In doing some online reading, it seems like these items play into the risk factors for developing plugged ducts: sleep deprivation, stress, poor diet, bad latch, failure to remove milk.

Priority number one with all of this is to clear the plug and remove the milk.  Easier said than done.  My old stand-by trick is to lay the baby on her back on bed, turn myself around so that her chin points at the plug, and nurse over her so that her suction and gravity can clear the plug.  Trouble is, that hasn’t worked the last two times.  The resulting let-downs from the nursing just seemed to make the plug worse.

At this point, hand expression seems to work best.  I express most of the milk out (or have her nurse for a while).  Then I start hand expressing very gently over the area.  If you don’t know how to hand express, here’s a YouTube video.  This is an incredibly valuable skill.

Once I get to the point where I can look really closely and see the pore that is clogged (I typically see a bit of white that just isn’t coming out), I gently squeeze on the nipple to work that bit out.  A warm wet washcloth or even getting into a warm bath really helps with this.  Typically, that bit will come out with a POW! and I’ll be able to very easily hand express the backed up milk out.  Massaging at the front of the plug, instead of trying to push it from the back), can also help loosen things up and get it moving.

If you have a clog that you just can’t get out, get help!  Find a lactation consultant.  Ask for help from (dare I say?) your husband.  Don’t let it sit around.  Having a plug long-term is not only really painful, but it can lead to mastitis.

At this point, I’ve got my plug clearing routine down.  But how do I keep from getting them in the first place?

Here’s what I’m doing to try to prevent plugs from forming:

  • Removing milk often (as in, no more skipping pumping sessions)
  • Taking a lecithin supplement
  • Trying to eat healthier, whole foods
  • Paying careful attention to Katie’s latch
  • Taking a few minutes each day to relax and have some time for myself

So far, this seems to be helping, but I think to a certain extent, the occasional plug may just be part of my landscape right now with my oversupply.  I’m okay with it happening once every few months, but I’m looking forward to a few plug-free weeks.

Here are some more resources that I found on plugged ducts.

Have you had plugged ducts?  How did you deal with them?  Do you have any tricks for getting rid of them?

Breastfeeding the Second Child Part 1: Not as Easy as I Thought

I thought it would be so easy.  I mean, it’s not like I haven’t nursed a baby before, right?  Three and a half years of nursing should make me an old pro, right?

Wrong!

This journey, while not quite as difficult as it was learning to breastfeed Gabi, has been incredibly difficult.

Katie latched on almost immediately after birth.  It was fantastic.  I thought we had it made.  But by day three, the pain was starting to get intense.  Note that I said “pain” and not discomfort.  Breastfeeding shouldn’t be painful, but this was.

She was born on Tuesday, and we took her to see her pediatrician on Friday.  He checked her for a tongue tie, but didn’t see one.  He encouraged us to meet with an IBCLC, Rhonda (not her real name).  We called her and scheduled an in-home visit.  Good thing, too, because by the afternoon I was in tears every time she latched.

She came and helped us to latch correctly.  Things got better for a few hours, but in the night it got much worse.  By morning, I was a bleeding, crying mess.

Saturday, I called her in tears because I was reaching the point where I just could hardly stand to bring her to breast anymore.  She recommended pumping and syringe feeding until my nipples healed.  I did not want to do that, so I called my midwife who came right out to the house and helped me learn a new position to nurse Katie in.

I still wasn’t healing, though, and the pain and bleeding were getting worse.

Monday, I went to a group meeting that Rhonda leads.  She helped me latch on there as well, but the meeting made me very uncomfortable.  Believe me, when you’re a deeply attached parent, hearing other parents talk about night weaning 5 month old babies through is not something you need to hear at 6 days post-partum.  Most of my tears were from the pain of nursing, but some were from grief for those poor babies who just needed their mommies at night.

Monday night, I went to a second meeting, where I met two angels: Shirley (not her real name) and Paris (this is her real name and here is her awesome blog!).  Both are IBCLCs for one of the hospitals here (NOT the hospital where they tortured me).  Paris taught me a 3rd way to nurse Katie, and it didn’t hurt!

Unfortunately, by the time I left the meeting at around 7:30 PM, I was shaking.  As I drove home, the shaking got worse and worse.  When I got home, I took my temp and it was 102 degrees.

Mastitis.

Juan ran to the pharmacy to get my antibiotics (God bless my midwives for acting fast and calling it in immediately), and I had to pump after every feeding so that the milk didn’t sit and grow bacteria.  It was a long, brutal night.

36 hours later, I was feeling much better.

It was Thursday, and we had an appointment to meet with Shirley.  She helped us again with Katie’s latch and taught me to tuck her little hips in against my body.  This is a natural way to get a baby to extend her neck a little more and to keep her from tucking her chin.  It worked!

But I had a suspicious tingle in my nipples and Katie’s mouth was coated in white.  We walked a block over to the pediatrician who took one look at her and diagnosed thrush.  I asked him to look in her mouth again for a tongue tie, but he very confidently said, “This babe is definitely not tongue tied.”

So after a week of Katie taking Nystatin and me taking Diflucan, we were ready to move forward.

But something still wasn’t right.  She was growing slowly and her lips were blanched after every feeding and full of blisters.  She also clicked and lost suction as she nursed.  Nursing wasn’t bringing me to tears anymore, but it wasn’t very much fun either.

What was going on?

Stay tuned for Breastfeeding the Second Child Part 2: Tongue Tied or Not?

 

World Breastfeeding Week – What am I doing to prepare to breastfeed the new baby?

Gabi and I did not have an easy start to our breastfeeding relationship.

My milk was slow to come in (thanks pitocin).  She struggled with latch due to flat nipples.  I got engorged.  Then I got mastitis because she wasn’t able to latch to remove the milk.  I didn’t know enough about pumping and thought that the milk I was pumping was “not real milk” because of the whole not-coming-in thing so I dumped what little I did pump.  Gabi got dehydrated (no poops, no wets over a couple of days)  so we supplemented with formula through a bottle and then through a supplemental nursing system via finger-feeding.

Then, right as she was starting to latch, I got thrush, which took forever to figure out because Gabi never showed signs.  It was all in me.  By then, my milk supply was almost gone, so I essentially had to relactate.  The Boppy nursing pillow that I got was sliding all over God’s creation, so I was trying to hold the pillow in place, hold the baby, deal with the stupid nipple shield, get the baby latched, keep the baby latched, ignore the agony in my back (thanks epidural), and just fight fight fight fight fight.

Meanwhile, the “help” I was getting from hospital “lactation consultants” was vague and not helpful.  We could manage to nurse in the office, but not once we got home.  And when I would call for help they wouldn’t call me back.

It was a really difficult time.

Finally, we managed to turn the corner at around six weeks.  I ditched the Boppy for the My Breast Friend pillow (they’re WHO code compliant and the BEST nursing pillow on the market!), I threw the nipple shield across the room, I found the kellymom.com forums where I could get some real help, and suddenly Gabi was alert enough and started latching and nursing.  I also dropped in to a local baby shop that had an IBCLC on staff, and she proved to me that I actually had milk by doing pre- and post-feed weighs.  Having this confidence is what ultimately saved our nursing relationship.

Gabi’s latch was never great.  I think the nipple shield had a lot to do with why.  But we managed.  She was exclusively breastfed from 4 and a half weeks until she was a little over 8 months old.  As she grew older, her perpetual bad latch became worse, but she got enough.  I’m so proud of the fact that I managed to nurse her for 3 and a half years, and I’m so grateful that those resources (seriously! the pillow ruled!) all came together at the same time.

I was so lucky.

This time, I don’t intend to leave things up to luck.

What am I doing differently this time?

Unlike last time, I have developed a network of support.  I co-founded a Lactation Support Group at my workplace, and I know that I can reach out to my co-leaders for help if I need it.  I’ve also become an active member of the Kellymom.com forum community.  I cannot say enough good things about this community.  If you’re interested in nursing or plan to nurse or are thinking about it, join this group.  This–and the Kellymom.com website of course–is hands down one of the best resources out there.  Don’t bother buying a book.  Go to Kellymom.  The information, compiled by Kelly Bonyata, BS, IBCLC,is accurate, carefully vetted and moderated, and evidence based.  It is truly second to none.  

I’m also planning an unmedicated birth.  The IV fluids and pitocin were both, I believe based on several years of reading up on it, at least partly responsible for my severe engorgement and the delay of my milk coming in.  The terrible back pain I suffered was, in large part, from the epidural.

I know now, having observed the way my body reacts to these interventions, that they are harmful to my ability to breastfeed.  To promote the gentlest and least invasive birth possible, I’m using the Hypnobabies childbirth method and birthing at a birth center with the help of midwives and the support of an experienced doula.  Based on my experience and research, I believe that these and other birth choices I’m making will help our breastfeeding relationship to have the best possible start.

In addition to surrounding myself with accurate information and having a natural birth, I will have personal support from my midwives.  They’ve got extensive experience helping moms and babies get off to a good start with nursing, and I will not be cut adrift once I go home.  They will visit me in my home the day after the baby is born to check on both of us.  Following that, they will call daily and be available for me to call if I need help.

I’ve also found a local La Leche League group and I will begin attending meetings starting this month!

I know so much more now than when I was pregnant with Gabi.  Now I don’t say, “I hope to breastfeed.”  This time I know that I can.  It is simply what we do in our family.  I know that if I run into difficulties that help is a phone call or keystroke away.  Whatever we may stumble upon, we will overcome.  Just like Gabi and I did.

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I’m celebrating World Breastfeeding Week with Natural Parents Network!

You can, too — link up your breastfeeding posts from August 1-7 in the linky below, and enjoy reading, commenting on, and sharing the posts collected here and on Natural Parents Network.

(Visit NPN for the code to place on your blog.)