Problems

Clogged Ducts are The Enemy...

… here's how I knock out my nemesis,
GI Jane style.

By Jen Humberson, MD

I am writing this as a mother of two boys whom I nursed for one year each. I’m also a pediatrician, but I’m writing this as a mom. Some of my thoughts below might not be ones I’d share gracefully in the office.

So in two years of nursing I probably had clogged ducts 15 times. I have no idea if this is average, but I certainly know friends who’ve had 5 or so. I got to where I could tell when one was starting and begin my routine ASAP to keep it from getting worse. One thing I DID know from my medical experience: clogged ducts can lead to mastitis, and I do not ever want to have mastitis. I’ve seen lots of people in lots of pain, but none of it compares to the women I’ve seen with untreated mastitis.

How do you know if you have a clogged duct? Well read good sources of information. My signs? A vague feeling like one section (think pie slice) of one breast wasn’t emptied at the end of a feeding, and the same area feeling more so a feeding or two or three later. Or feeling a lumpy firm area (again, sometimes like a pie slice, sometimes like a rock) in my breast that became increasingly tender. Sometimes the area was starting to pink up, and sometimes the veins in that area would become a little bluer, a little more noticeable. Only once did I have the “little white spot on the end of the nipple” that some resources describe.

What to do? Simple. Get the area unclogged. How to do that? Not always easy. I would do a few things, alternating between them, until I got it completely unclogged (when the whole breast is soft, there’s little to no more milk coming, and the pain is pretty much gone about 12 hours later, save for some bruising if you had to cause some… read on.)

1.  Nurse, nurse, nurse. Let your baby drink as much as s/he wants as often as s/he wants while you’re trying to get unclogged. While nursing, as much as possible, massage (with your hand) the firm and tender part of your breast. How hard? Not as hard as you can take it- Harder than that. This is the not-fun part, but it is ABSOLUTELY worth it when you get it unclogged and you avoid further problems. Frankly, nursing alone only solved my clogged ducts once or twice

2.  Take two to four ibuprofen, ie Motrin or Advil (400mg to 800mg) with your doctor’s okay. It will make the next part more bearable.

3.  Pump, pump, pump. Find a good t.v. show, brew some tea, and pump the affected breast (you can pump both if you want to) and, with your hand, massage the tender firm area like it’s a bear about to mawl your baby. You can start gentle, but you will likely have to use a good bit of pressure (read: a heck of a lot) to get the milk to get through. Also increase the strength of the pump to the highest you can stand without harming your nipples. You will know when it really starts releasing as there is a flood of more milk (sometimes yellowish or reddish- don’t be alarmed) and the area slowly turns softer. KEEP GOING until the whole breast feels soft and there’s pretty much no more milk coming. This method worked for about 75% of my clogged ducts. The worst ones took 2 or 3 pumping sessions, usually about 30 minutes long each (one time was 45 minutes but finally worked).

4.  Shower Power. Basically, you use your hands to massage and somewhat manually pump the affected breast. I used this method more after I realized how well it worked with my second child. After trying the first two, if the area is still partially or completely clogged, turn on a steamy shower, as warm as you can take it, and step in and massage the firm tender area more firmly than you can take and use the fingers of your other hand to express some milk.

In my experience, it often took 5 to 15 minutes, and occasionally two showers, but then the area unclogged and I was able to manually express the milk until the whole breast was soft.

Re-clogging: The same area will be sore and slightly swollen for a day or two, and is also at risk of re-clogging. So try to make sure your breasts get completely emptied with every feeding or pumping over the next few days.

Be Proactive: The sooner you start trying to clear a clogged duct, the easier it will be. The longer you wait, the harder it will be (and the more you’ll regret waiting- you might get to the point where you can’t tolerate even the slightest touch to the area).

If your pain is severe, you get a fever, or your baby isn’t eating well or seems ill, call your doctor. I was able to treat all mine at home, but I was aggressive and I knew the signs of when I should call my doctor.

This post might highlight some of the rougher parts of breastfeeding, but the VAST majority of my nursing times were some of the most intimate, cozy, beautiful times I’ve had with my children.

I hope this helps if you ever have clogged ducts. Please write any other things that worked for your clogged ducts in the comments!

Getting Through Severely Cracked Nipples (not for the fainthearted)

"Cracked Nipples" sounds pretty bad, but considering it describes nipples that look and feel like they've been pressed against a belt sander, the term is actually a euphemism. I feel a strong sisterhood with anyone cursed to pass through this dark, dark place on the path to established breastfeeding and a strong jealousy toward the lucky majority who never had to deal with this. This is not a post about pain, which is common; it's about raw, abraded, and even broken skin.  I've been through it twice, and still can't decide which time I was less prepared for.

With my first, I knew I might have sore nipples, but had no clue what horrors were in store.  After a natural birth, I thought I'd conquered a pretty tough experience, but that was nothing compared to the first weeks of breastfeeding. I tried everything - changing my latch, using lanolin, applying breastmilk, leaving my boobs clean and dry - all of it.  Nothing worked, and soon my beautiful baby began to resemble a savage pirana and my supply began to fade.

Now I have read (and you may have, too, if what brought you to this post is your own pain) that cracked nipples are only caused by caused by poor technique and latching problems. To be sure, a number of things I learned from working with a certified lactation consultant, including better technique, helped me get back on track with my first son.  Then, 3 1/2 years later and with almost 3 years of breasfeeding experience under my belt, I was again looking down at my beautiful newborn baby past two horribly cracked, insanely painful nipples. 

Though I fully agree that poor latch can be the culprit, I have also observed that some women just have really delicate skin or an extra rough-nursing baby (or both).  Expert latching or no, these women will have an extra hurdle getting started breastfeeding (and not just with kid #1).  If you're the girl on the ski trip whose cheeks and lips get chapped the first day, this is a bad omen.

Unfortunately, study after study shows that ointments, creams, gels, breastmilk, and warm compresses don't help much with cracked nipples (breatmilk can help reduce pain). What does work? Preparing beforehand and doing what you can for the pain and damage to get through it and keep on nursing.
 
First consider the basics of lactation. Note that Lactation II, the milk production phase that begins at birth and ends 3-5 days later, does not depend on suckling the way later milk production does.  This means your milk will not come in faster if you nurse constantly in the first 48 hours (plus, the colostrum you produce at this time is perfect nutrition for your baby - no need to rush it!). 

You won't feel sore until the second or third day, and it's better if this doesn't hit you like a ton of bricks.  Certainly, feeding on demand is best, but don't initiate extra frequent or long sessions in a race to bring your milk in.  It won't help, anyway, and instead of a first place trophy you may end up with sore, damaged nipples.

Once you're home, keep your boobs in a breathable accessible place, like the open air.  An open nursing bra will let you add nursing pad quickly as needed.  This "boobs out" state is a great reason that anyone not in your innermost circle will be more comfortable waiting a few weeks for when all this "early breastfeeding stuff" is done before they intrude, I mean visit.  Although it truly saddens me that so many people are scandalized and offended by breastfeeding, use it to your advantage when you can.  You'll catch the downside of it enough once you're ready to take your baby out in public

Besides seeing a lactation consultant, pacing yourself, and keeping your boobs out/dry/clean, you can try to deal with the pain.  Remember this is not advice for everyone who has a twinge of pain or general soreness, it's advice for people whose skin is worn off and scabbing over. 

Here are some options:

1. Nipple Shields:  These can be hard to use properly so get help choosing and fitting one at a breastfeeding class or with a consultant.  They can also complicate and already tough process for both you and your newborn.  That said, a good nipple shield can really save your skin.  You may hear that nipple shields can cause the dreaded "nipple confusion" (more thoughts on this later). Unfortunately, when your nipples started bleeding, you officially left the realm of "ideal scenario" and entered the realm of "make it work" (this applies to #5, A Pump, too). 

2. Ice Water: Sound awful? It is for a minute, but when your nipples are wrecked, numbing them can get you through the first extra painful moments after latch-on.  

3. Drugs: Motrin (ibuprofen) and Tylenol (acetaminophen) are cleared for breastfeeding mothers (look them up here, but still talk to your pediatrician about her recommendation).  Like many biochemists (the very people who make them), I am sketched out by almost all drugs, especially while pregnant or nursing a newborn.  I don't take cold medicines, skip the lidocaine at the dentist, and did two natural births.  That said, I took Motrin and was happy to have it when my nipples were a warzone.

4. Lamaze Breathing: Another technique that keeps your focus off the pain and on the goal (one feeeding at a time until you start to heal).  The bonus is, you probably have this technique fresh in your mind.

5. A Pump: This is never a first resort for an early breastfeeding problem, but it's often the last. If you have major damage, alternating between your baby and a pump (which will still hurt) can spare some areas that have gotten especially worn down.  Also, pumping can help you get out of a vicious cycle of pain/damage -> incomplete emptying of the breast through nursing -> reduced supply -> increased, frustrated suckling -> pain/damage, etc..

6. A Stout Heart: I think I've been pretty candid about how bad this can be, but there is one more thing that no one likes to mention. If your nipples are cracked, they will bleed.  Your baby will injest some blood.  Sounds like something out of a nightmare, but it does happen. It's not going to hurt your baby.  It may cause your baby to have reddsih brownish spit-up.  Don't lose it, and don't quit brestfeeding over it.  Being a mom is tough stuff.  Being a breastfeeding mom is even tougher.  Talk to your IBCLC and your pediatrician about what you are going through and get through it - you will! 

The biggest thing that will get you through this phase is knowing that it will end.  It can take up to a month or more for your boobs to improve.  Once they get adjusted to nursing and your newborn becomes less of a savage, the damage will completely heal, the pain will fade, and you will still be nursing your lovely bundle of snugglefection. You'll be on your way to sucessful mothering and able to use the most reliable rule of parenting - "When the baby cries, stick a boob in her mouth." It really is a magical balm - for you and your baby.  Until you get there, do what you can to make it though - and remember you are not alone. 
 

Note: This post does not address two other problems that cause nipple pain, mastitis and thrush.

Also see:

A great and thorough discussion of nursing pain from from PhD in parenting

More information about cracked nipples from kellymom

Please post any other references you know in the comments!

Expect a Tough Time in the First Month

True, the first time you hold and nurse your brand new baby is total bliss.  Then a few days pass, and you can begin to feel extremely tired from having a baby and then waking every 2-3 hours to nurse.  Next, your nipples become sore and you will probably get anxious about your milk coming in (which takes a few days) and the baby’s cries all begin to sound hungry.  Your baby may not regain his birth weight on time, your nipples may become damaged from the high-powered sucking of a newborn who could suck the paint off a car.  They may even bleed and hurt far more than childbirth did, and a breast infection may rear it’s ugly head.  Whatever hurdles you encounter, you can begin to feel very, very alone and start to believe that you are uniquely unsuited to breastfeeding or cursed with an inadequate supply.  Not true! 

Most women have at least a few of these problems, and being ready for them and prepared to respond quickly and with a clear head is how you can make it to the elusive second month - when your boobs actually heal, stop feeling sore, and begin to work properly.  At this point, your baby has learned how to effectively suck milk out of whatever is presented.   Then it’s on to other interesting problems like how to use that bizarre-looking pump (if you've been lucky enough not to need it to help establish your supply) and how to nurse in public on those days you just aren’t feeling fierce. 

Update: 

This useful infant feeding chart from Tiny Playground helps you keep track of what is going on so that you can address a supply or latch issue before your baby has weight gain problems or dehydration.  I wish I'd had this not only for me but also for discussions with my lactation consultant and pediatrician.  Thanks Adrienne!

 

Breastfeeding Truth

This blog is dedicated to providing honest and thorough information about breastfeeding, which is much more difficult to find than it should be.  Most expecting mothers plan to breastfeed because of general knowledge this provides optimal nutrition.  Unfortunately, the details of how breastfeeding benefits both babies and mothers are often left vague or left out.   Other important information is also frequently left out of advice given to expecting and new moms (or even lied about) - how tough it can be to establish and continue breastfeeding!

Breastfeeding Truth addresses aspects of breastfeeding that are rarely and poorly covered by most books, physicians, and advocates.  First, it addresses the real problems that you may encounter as a bresatfeeding mom – everything from a dehydrated newborn and cracked nipples to nursing in public to pumping milk in a cold, dirty bathroom stall.  This blog also provides an objective look the biology of breastfeeding and its effects on human health and development.  Additionally, Breastfeeding Truth informs readers about important legal rights that protect breastfeeding moms, and how to help improve brestfeeding legislation in your state and across the nation.

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