Blocked ducts and mastitis


Blocked ducts

Blocked milk is like a traffic jam or pile-up in your milk ducts in the form of a lump. It’s important to clear it or it just continues to get worse and can result in mastitis. Some lumps are common and do resolve through feeding naturally, but others need attention.

Heat before and during a feed, will help melt the lump and ease the flow. A gentle circular massage with your fingertip - while guiding it towards the nipple will aid its flow.


Your baby is the best agent to clear the lump, so ensuring that they’re attached to the breast properly is the key, while also alternating their position throughout the feed, on the affected breast. For example, do first half of the feed in cradle position and then alternate to the football hold, so that your baby can drain each milk duct. If there is just one clear lump, choose a breastfeeding position that directly points your baby’s chin to the lump, like a vacuum. It is also a good idea to commence on the side with the lump so that your baby’s strongest, hungriest suck will move the lump through.



Mastitis

The worst thing you can do is ignore an uncomfortable, painful full breast. I find that the most common cause of mastitis happens overnight. Suddenly a baby sleeps a lot longer, and of course there’s a sense of relief in that, and the huge need for catching up on sleep. So, mums try to sleep through the uncomfortable breast that keeps waking them up. I honestly completely understand this, but it’s a huge gamble. Will you automatically get mastitis from this? No, but you may. If you’re lucky, your breast will just release on its own and leak everywhere. Hopefully you’re wearing good breast pads, and if the worst thing that happens is that you wake up covered in milk, but you’ve had a few more hours of sleep, then I think you’re winning. However, if it keeps waking you up, please don’t ignore it. The work, pain and discomfort that mastitis causes isn’t worth the extra sleep, as it will in exchange steal a whole lot more.


Your first point of management should be to get up and put some frozen nappies or ice packs on your breast. This will help your body reabsorb some of the milk and reduce the swelling and heat, while buying you some more time. It also stops you from expressing milk that you don’t need for your baby, so that in time your supply will match his or her needs.


Secondly, if you have done this but your breast continues to wake you up, you can try this one more time - if it did relieve your breast for a while - but if it did little for you and it remains uncomfortable, you’ll need to express a small amount. A Hakkaa is your best option or express gently by hand or softly and slowly by pump. Remembering to not send your body the message that there’s a ravenous baby needing lots of milk quickly. This should take the pressure off enough, to buy you some more time till you baby needs to be fed. You may need to express a little and then ice, depending on how uncomfortable and full your breast feels, or use those frozen or cold cabbage leaves – (however- if you’re in bed - you may not want to smell like a steamed dim sim – which is what happens with the cabbage leaves) The management for avoiding and treating mastitis, is similar as the treatment for an oversupply of milk. (Please refer to my blog on oversupply for more helpful tips) As mentioned earlier, the other cause of mastitis is breastmilk lumps. So again, please follow the instructions above.


Signs of mastitis

If you know that there’s been touch-and-go moments in which your breasts have been too full, or you’ve had a run of poor feeding and or unresolved blocked ducts and you suddenly get cold and flu-like symptoms, you’re probably on thin ice and need to manage your breast ASAP.

Usually, mastitis starts off with aches and pains all over your body and breast, hot flashes and chills, with or without a temperature. Examine your breasts for any shiny, swollen areas or red streaks that branch out from the nipple. Your breastmilk can also contain traces of blood and/or yellow discharge. If any of these symptoms occur, you will need to start antibiotics straight away, so while you’re managing your breast, call your doctor. It's safe and crucial for your baby to breastfeed – if they won’t, then express milk. It's essential to get that milk flow going and to clear the milk ducts.


My personal mastitis tips

I had ongoing milk lumps due to oversupply. I saw a postnatal physio, who gave me ultrasound treatments to help reduce my lumps. When I started to get a few signs of the beginning of mastitis, such as cold and flu-like pains all over my body or a very sore breast and some red streaks, I started taking both paracetamol and ibuprofen to reduce inflammation and pain. I also used a Voltaren cream on the lumps and increased my Qiara probiotic intake. (Qiara, is a breastfeeding probiotic, that I believe saved me from needing antibiotics quite a few times. It’s great in helping you avoid and treat mastitis) I also found that heat packs worked best for me.

After feeding my baby well - from my sore breast first, to empty it, I would put myself to bed at night with all these treatments and I would often get breakthrough shivers and sweats, while continually replacing my heat packs. Eventually the symptoms would subside, and I would fall asleep and wake up in a pool of sweat and milk that had cleared from my breast, having passed the worst of it. Then I would continue the above care for a few days, till it resolved completely. However, this treatment doesn’t work for everyone, and if you don’t feel improvements within a few hours, always consult your doctor.


Treatment recap and other helpful tips


· Don’t ignore painful, full breasts.


· If your baby isn’t due to feed – try ice packs on your breasts first. That should relieve some of the pressure and help your body reabsorb some of the milk. If this works well – leave your breasts till the next feed or repeat this - once again if your baby still isn’t due and the method is working.


· If your breasts still feel uncomfortable after five to ten minutes of ice – then gently express by hand, with a haakaa or use a breast pump - on a gentle and slow setting. Express enough to get you comfortable but not so much that your breast will continue to make these volumes. (20 mls could be enough)


· Treat breast lumps (as mentioned above) try Panadol and Nurofen to reduce swelling and help the lump dissolve – as well as heat packs. Voltaren cream on the lump can help too.


· Vibration - you can also try a soft vibration on the lump – instead of a gentle massage. (An electric toothbrush could be used for this.)


· An ultrasound done by a trained physio – can help dissolve stubborn lumps.


· Qiara probiotics – have many beneficial benefits. Helping and preventing mastitis is one of them. You’ll need to increase your dose – while treating symptoms. Refer to their own helpful guides - on their Instagram and website.


· Get a lactation consultant to check your breastfeeding attachment. Your baby may not be feeding effectively. A midwife or maternal and child health nurse can help too, or they can refer you to a good lactation consultant.


· Always consult with your doctor or have a health professional, to asses your breast and or signs of mastitis.



Refer to the Australian Breastfeeding association for more information and support.

Breastfeeding Helpline: 1800 mum 2 mum – 1800 686 268. There are over 400 counsellors that can provide reassurance and or helpful knowledge and advice. They can also help you with instructions on how to hire a breast pump or connect you with lactation consultants.


The Royal Women’s Hospital – is also a great resource. Checkout their fact sheets for further information – by simply searching mastitis and or blocked ducts. They also translate into many languages.


I hope you found this helpful. All the best from Your takeaway midwife.

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