I am, unfortunately, a bit of an expert at this.
Not the kind of expert that is a certified lactation consultant (though I’ve taken breastfeeding classes, and learned more while becoming a certified childbirth educator) – but my expert status comes from the fact that I have had countless plugged milk ducts. Countless. And have tried it all (even putting cabbage leaves on my boob, resulting in itchy hives).
With my first, my body just made way too much milk. Comical amounts. Months into motherhood I would wake up in soaking wet tank tops (like, I could wring them out). Day and night for almost a full year I would have to double-up on breast pads to stop from leaking through layers of clothes. For months I would only wear black, just in case.
There are many things that can cause a plugged duct, which we’ll get to. And for me, it was oversupply.
Fortunately, with each baby, my body got better at producing only the milk my baby needed, instead of enough for all the babies in the whole world ever.
By my third, at over a year in, I have only had 1 small plugged duct.
But first, let’s back up a bit, what exactly is a plugged duct?
What is a plugged/blocked milk duct?
Within the fatty tissue of the breast, there are sacs called mammary glands, within which lobules (which are filled with milk-producing cells) produce milk, and the milk is brought from the glands to the nipples via milk ducts.
Sometimes, the milk duct can get blocked, either within the breast, or at the nipple (which is called a ‘milk blister’)
How do you know if you have a plugged milk duct?
Blocked ducts can present in many ways – it’s hard to say what exactly it will look like for you.
If you have a blockage, you may have some or all of the following:
- A painful hard lump or engorged area
- Area that is red, hot, tender, swollen (with or without a lump)
- Painful nursing on the affected side
- Engorged breast on the affected side
- In cases of ‘milk blister’ (or blockage at the nipple), you may have just a painful white, clear, or yellow dot on the nipple/areola, and pain is limited to that area/behind the nipple
- May or may not have a low-grade fever (less than 38.5°C/101.3°F)
Why do milk ducts/nipples get blockages?
- Inadequate emptying of the breast, due to:
- Poor latch/tongue-tie/ineffective suck
- Sleepy/distracted baby
- Limited breastfeeding time
- Infrequent/skipped feedings – like when babe sleeps longer than usual, or you were away from baby longer than expected, or you miss a pumping session. Can also happen if baby is sick or teething, or you’ve started supplementing with bottles
- Breast compression (resulting in ‘milk stasis’, or milk that can’t move freely through the milk ducts), due to:
- Underwire bras, sports bras, or tight-fighting clothing (or even sleeping in a position where your breast is compressed for long periods)
- Previous breast surgery or biopsy
What is mastitis?
Mastitis is localized inflammation of the breast caused by infection and/or obstruction. An untreated blockage can turn into mastitis, since it is caused by a prolonged period of engorgement and poor drainage or milk removal. This is why trying to clear a blockage immediately is important.
- Fever greater than 38.5°C/101.3°F
- Muscle aches
- Breast pain and redness (and really, any of the symptoms associated with a blockage, as that is what usually causes mastitis!)
In addition to trying to clear the blockage, you should see your doctor, as you may require antibiotics.
The best way to get rid of a plugged duct!
Ok, time for the good stuff, how to get rid of a plugged duct.
Fortunately, blockages are most common in the first few months, and should decrease in frequency over time. Until then, here is what you can do.
- Fill a large bowl with very warm water (ok, ideally, hot water, but don’t burn yourself!) and add some Epsom salts
- Soak affected boob by submerging it in the bowl for ~10 minutes (this is both awkward and effective, but faster than having a bath)
- Vibrate and massage
- Immediately after soaking, grab something that vibrates (toothbrush, electric shaver, an actual vibrator) and massage the affected area with it to loosen the blockage
- If you don’t have something to vibrate the area, just massage it/hand express
- Nurse, nurse, nurse (or pump, pump, pump!)
- Nurse/pump in a position that is different from what you usually do, as often as baby and you are willing (i.e. all. the. time.)
- Positions great for clearing a blockage are:
- All-fours (gravity!)
- Place baby below you and nurse on all fours
- If you can, position baby so their chin is opposite the blockage
- Football hold
- Nestle baby’s side against your side, with their feet and legs tucked under your arm, on the same side as the breast baby is nursing from
- Pump or hand express on the affected side to keep trying to clear the blockage (even if you’re nursing as well)
- Don’t neglect the unaffected breast – use a pump regularly to keep milk moving while you work to clear the affected side
- All-fours (gravity!)
- Repeat until cleared
- Drink lots of water
- Wear lose clothing
- Visit a clinic, if needed, familiar with therapeutic ultrasound for plugged ducts
- Lecithin supplements can prevent future blockages, many people swear by them. Talk to your provider or a lactation consultant about starting lecithin
- Try to evaluate what may have triggered the blockage in order to prevent another one!