Update on evening primrose oil

I’m pretty excited about the evening primrose oil!  I’ve been taking it for about 6 weeks, and haven’t had a serious plug since, and only one mild one that required a small amount of attention and about 4 hours of rest.  This is completely different than the past 6 months (and maybe more, but I can’t seem to remember back that far), when I had at least one and usually 2 serious plugs a month, sometimes requiring more than one day in bed. 

This is a huge victory! 

I can’t promise that this stuff will help everyone, and I’m still doing daily maintenance things, like clearing the usual suspects in the shower and not eating too much sugar and dairy, but it’s definitely worth a try for plug sufferers!

During the past 6 weeks, too, I’ve taken a long road trip involving lots of driving and not as much downtime as usual, as well as lots of outdoor activity and unusual hours (late nights, early mornings).  Since returning from that trip, I’ve been hiking, gardening, walking, and generally throwing myself into great summer activities.  I’ve also been working through Jillian Michaels’ 30 Day Shred video, doing a workout about 5 days per week.  So I haven’t been sitting idle in an attempt to avoid plugged ducts – I’ve been giving this oil a good tryout, and it’s working well! 

I can’t tell you how exciting this is for me!  The exercise component is so key, because the stronger I am, the less likely it is that extra exertion will push me over the edge to a plug, and I’d been struggling with working the exercise in, trying to get stronger without working too hard and plugging a duct as a result of trying to get stronger to avoid ducts.  Now I’m really starting to feel strong and fit, and feeling like I’ve got a good start on staying that way. 

I’m not a physician, so I’ll just suggest finding out if evening primrose oil is okay for you and then giving it a try?  And then let me know how it works for you!  

Something new

I make it a practice to scan breastfeeding books every so often for new information on overabundant supply, plugged ducts, or mastitis.  Usually there’s not a lot of new information, but small helps here and there are worth finding, so I still do it.
Recently, while scanning one of Dr. Jack Newman’s breastfeeding books (I love that guy!), I came across a short paragraph on Evening Primrose Oil.  Basically, he’d heard that it helps protect against plugs, he’d tried it on a few people, he had no studies, but the anecdotal evidence looks good so far, so he thought he’d mention it.
Evening primrose oil is easy to obtain at a grocery store, so I got some that day and started using it.  Since then, I’ve had one small plug that had me resting for about half of a day, and nothing else.  I’m excited about this because I’ve been having two or three a month since February – or was it March?  In any case, the incidence of plugs has dropped dramatically, and that was with a road trip to Yellowstone that included late nights, early mornings, and some missed naps (on my part!).  I plan on continuing to take it, and will start recommending it to others based on my anecdotal evidence.  Of course, we all know that I’m not a medical professional, so check up on this yourself to make sure it’s safe for you.
As a bonus, it has helped my nursling, who sometimes suffers from constipation.  TMI, perhaps?  I guess I figure that if we’re talking about all the stuff we talk about here, I can just go ahead and say that evening primrose oil is supposed to help with constipation, too, and whatever it is that helps passes through the milk enough that Tess is benefitting from it. 
I love that Dr. Newman mentioned it as a possibility, because if he’d waited until there were large-scale studies, it probably wouldn’t be helping me now. 

Breastfeeding reads: Nursing Your Baby

Well, that sounds like a fairly straightforward breastfeeding book, right?  Nursing Your Baby, by Karen Pryor and Gale Pryor was one I really liked.  And continue to like.  It doesn’t have a ton of help for overactive letdown or overabundant supply (although they’re mentioned), but it has a lot of other important information.
The first segment of the book is about how breastfeeding works, and covers both science and history.  It’s fascinating – at least, I found it fascinating.  There was a ton of research covered, too, including all about antibodies and breastmilk, how the breast works, and on and on. 
The second half of the book covers the art of breastfeeding, and has lots of helpful information.  Reading this section helped my sister figure out that her son had a short frenulum.  There’s a chapter about preparation before the baby’s birth, a chapter about getting started, about one to six weeks, and then a chapter called “The Reward Period Begins.”  This was something of a revelation to me, as I read this book before my first baby was born:  prepare to have the first six weeks be tough!  The breastfeeding classes all seemed to indicate that, if you were doing it right, there wouldn’t be pain or bother once you got started.  What a myth!  Planning for six weeks – at least – of a steep learning curve is a good idea.  There are also chapters on working mothers and nursing older babies. 
I recommend this book – it’s got loads of great information on breastfeeding.  The paperback edition is also about the size of a largish novel, which means that it’s easy to hold while breastfeeding, which – let’s face it – is when nursing moms get most of their reading time. 

Fangirl post: Dr. Jack Newman

Okay, so technically I guess a fangirl is an obsessed fan of an actor or character, not a breastfeeding doctor.  But I have to say that, while not obsessed with Dr. Newman in that particular way, I do love his breastfeeding information. 

It all began with my first baby, Hannah, the baby who introduced me to breastfeeding difficulties in a big way.  I developed a nipple crack, and spent three MONTHS trying to get it treated.  Nobody, but NOBODY knew what to do with me.  I would sweat when I even thought about nursing, it was so painful.  Of course, I couldn't wean, thank God, because Hannah wouldn't take anything that even thought about being a fake nipple -- I managed to get her to take a nipple shield a couple times, but that's as close as we could get to it.  So I spent three months sweating, crying, and trying to figure out how to deal with a cracked nipple.

Then a friend of my sister's pointed me to Dr. Jack Newman's recommendation for All-Purpose Nipple Ointment.  I could not convince my OB or my usual PCP to prescribe it for me -- "You don't need that.  Have you tried tea bags?"  Dude, I have an open wound on my nipple.  We're WAY beyond tea bags here.  I took a recommendation from another friend about a family practitioner in our area who saw me (and commented that it was the worst nipple crack she'd ever seen -- sometimes I really don't want to be the one who inspires superlatives) and heard my history and decided it was worth a try.  (Needless to say, I switched over to her, and she's been our family doctor for nearly 10 years now.)

People.  I am glad that I didn't meet Dr. Newman right then, because I would have embarrassed everyone in the room with my protestations of love and never-ending devotion and lifetime supply of homemade cookies in gratitude for his unwitting help.  In less than a week -- less than a week!!!! -- that crack healed, never to return again.  Although I do still have a scar. 

So, he won my undying devotion at the beginning.  Since then, I've explored a bunch of his materials, and I can't say enough about the great stuff he's got going on.  He posts videos of babies nursing correctly and improperly so that we can look and compare and see the difference.  He says things that make sense, like, "The whole notion of feeding a baby by the clock makes no sense at all." 

Recently, I read again his recommendations on blocked ducts in a book of his that I have.  He said that some people recommended evening primrose oil for recurrent plugged ducts.  He mentioned that he has only anecdotal evidence that it worked with some people, and he doesn't know why it works.  But he took the time and energy to mention it despite that.  I love that, because we all know that every body is different, and why not mention it so people can try it? 

So...if you're looking for breastfeeding information, try Dr. Jack Newman's books or website.  I heart Dr. Jack Newman.  :)

An Awesome Tool

I have great friends, and many of them are breastfeeding or have breastfed in the past. Only one of them has had an oversupply of milk, but the breastfeeding ones have all heard about my challenges. (Some of them were very afraid of breastfeeding because they’d heard my story BEFORE they had actually had kids. I feel somewhat guilty about that, but it did mean that they got help with breastfeeding way earlier than others might!)

When I had baby #4, I got a call from one of my breastfeeding friends, who told me she was sending me something from Amazon. I looked it up: a Milk Saver from Milkies. I was intrigued, because one of the most annoying things about my early lactation is double let-down. I let down on both sides whenever letdown happens, no matter which side the baby nurses on. This leads to my entire outfit being covered in milk, or lots of use of burp cloths (one or two per feeding, at least), and difficulty in nursing anywhere but the comfort of my own home, since I sometimes cover whatever I’m seated in or on – and possibly the baby and other people around me, depending on my burp cloth placement – in milk. Awkward! Later in nursing, around 4-6 months, I can trust the nursing pads to keep things in line. By 9-12 months, dual letdown only happens when I don’t have my daytime breast coverage setup in place. (For normal moms, this might be a nursing bra. For me, it’s usually something that doesn’t exert much pressure, because I’ll get plugged ducts just from wearing a nursing bra.)

Back to Milk Savers! A Milk Saver is a flattened cup with a hole in the side that catches milk from the breast that the baby isn’t nursing on. It’s designed to fit over a woman’s nipple without compressing or changing the shape of the nipple, and then just catch the flow of milk. It fits right into a bra or tank top, and can hold slightly more than 4 ounces of liquid. It’s made of silicon, so that when it’s full, a mom can gently squeeze it into a spout shape and dump the milk into a freezer bag or other container for storing milk.

This tool changed my early nursing days dramatically. Two cons: I would forget and lean over while wearing it, which meant that I spilled the captured milk all over myself. And I sometimes wouldn’t get it on correctly – just on one side – and it would leak a bit on me. The first con really just meant that I should remember not to lean over, and the second was easily fixed with a strategically placed burp cloth.  I had the burp cloths anyway, and they weren’t getting nearly the amount of use they’d gotten before the Milk Saver showed up. The pros far outweighed the cons with this device.  I can’t tell you how much laundry I didn’t do because of this thing! It was so awesome, I couldn’t even begin to do it justice. AND I had a supply of milk in the freezer for the first time ever.

(I know that sounds strange, coming from someone with abundant milk, but I only pumped when absolutely necessary, because I didn’t want to increase my milk supply in any way, shape, or form that wasn’t completely obligatory.)

I didn’t constantly smell like old milk from the milk that had leaked on me. I could pack it into my purse and use it when out on the go.  Sometimes I’d pack bags for the milk, and sometimes the plants nearby would get a little extra protein boost that day.  One feels so much more confident nursing out and about when one is fairly sure that milk isn’t going to make a huge, leaky mess all over.  One morning, during my baby’s first daytime feeding, I caught 4 ounces of milk – the Milk Saver was full almost to overflowing. I couldn’t believe how much milk had been running into burp cloths before!  I could contemplate milk donation! (I didn’t actually get around to doing it, because I had a newborn and no plans in place, but maybe next time around.)

Once the baby got older and I didn’t have dual letdown – or, at least, not as much – I packed away the Milk Saver; if I have another baby, it will be one of the first things I dig out of storage. I can’t say enough about how much the Milk Saver helped me in those early months of breastfeeding. I highly recommend this product to anyone who notices dual letdown. (I’m not getting any kickbacks for this post – I’m just letting you know about a very helpful, useful product that changed my breastfeeding for the better.)

In Which I Encourage Moms to Get Help When They Need It

My first daughter was born to parents who had it all figured out – we’d read the books about parenting styles, natural childbirth, breastfeeding, Baby Sign, the list goes on and on. She took very little time to whip us into shape and teach us that we knew absolutely NOTHING about parenting, including, but not limited to parenting styles, natural childbirth, breastfeeding, etc. Baby Sign didn’t matter, because she wasn’t going to sign to us at age 3 days, no matter how much desperation drove us to pray that she would. IF SHE WOULD JUST TELL US WHAT SHE NEEDED! Hannah, the high-needs baby, wanted to nurse. She did NOT want to have a bottle. Ever. Ever. Ever. She wanted to nurse. We began pretty well in the hospital, but began hitting bumps when we got home. I couldn’t figure out how to latch her on really well, because that thing that I’d heard about how it wouldn’t hurt if they were latched on correctly turned out to be not as true as I’d hoped. And engorgement threw me for a loop – I had NO IDEA. I hit a fairly large bump about three days in. I, in my sleep-deprived, middle-of-the-night stupor, let her latch on improperly. I developed a crack in my nipple. It didn’t heal for over three months. Those three months contained pain for me every time my baby nursed. Every single time. Finally, I got the help I needed. And I realized that there had been warning signs in those first few days of small bumps in our breastfeeding road. Had I recognized that I didn’t have a clue and needed some serious help, my breastfeeding journey might  have been really different. Because of my determination to soldier on and not ask for help, I ended up having about 9 months of major breastfeeding problems. Hannah helpfully encouraged me to continue breastfeeding by not ever taking a bottle with any degree of success at all (until, at 6 months old, she figured that I wouldn’t switch over to pumping full-time if she occasionally took a bottle), but I know in my heart that, had she been willing to take a bottle, I would probably have given up the breastfeeding struggle. I often feel guilty about the friends who saw me during those days, because I’m convinced that I made breastfeeding a far more frightening experience than it needed to be for them. It turns out that most people don’t experience 9 or more months of major complications when they’re breastfeeding, starting with a crack at 3 days and mastitis at one week. When I feel tempted to wallow in guilt about all of that, though, I realize that perhaps I set them up for success by reinforcing the idea that they should get help as soon as possible with any breastfeeding problem. So maybe my pain has helped someone. And I hope it helps others, too. Get the help you need – early and often, if necessary. La Leche League is a fantastic resource. There are lactation consultants and all kinds of medical professionals who help women with breastfeeding. Dr. Jack Newman has a fantastic website with all kinds of helpful information.  Feel free to call out other helpful sites that you like, too.  Books abound! The trick is, nobody is going to come and demand to help you – they won’t know! You have to be proactive in this.  Please, for your own sake and the sake of your baby, ask for help! 

My approach for a plugged duct

Sweet baby...it's worth the difficulties, you know?

I have had my share of plugged ducts.  I’ve really lost count, there have been so many, not to mention the ones that I’ve caught before they give me trouble.  When I feel a plugged duct coming on, I start in on a fairly rigorous program that may seem like overkill, but I’m not interested in performing experiments:  Will this one thing work on its own?  Hah!  Nope, now I have mastitis!  So I go with several things at once, and if it continues to worsen, I up the ante. 
 1. Rest.  Don’t do what you planned to do today.  Do the bare minimum to keep yourself and your family going.  I mean it.  I mean feed them and yourself, and make sure everyone’s eliminations are taken care of.  Don’t go to the post office, grocery store, dentist, or anywhere else.  Don’t worry about getting dressed.  You or anyone else.  Don’t bathe anyone.  Don’t take a walk.  Don’t make dinner that means you have to be on your feet for more than a few minutes.  Don’t carry anyone besides the baby.  (If you have only one child, it’s easier to carry this out.  Presumably you don’t normally carry your spouse.)  Don’t clean.  Don’t exercise.  Don’t do anything extra.  NO!  Don’t do it!  You do not want mastitis, and the more active you are, the more likely you are to get mastitis.  Lay low.
2. Get away from any type of restriction in the bra area.  I don’t wear bras anymore.  Okay, maybe that’s TMI, but I stick with tank tops.  The only nursing tanks I’ll wear are the Majamas brand.  The others are too tight and actually cause plugged ducts for me, just as nursing bras do.  Ack!  Even the sleep-type nursing bras are too tight for my sensitive overproducers.   I have several tank tops that are form-fitting and I use them as my undergarments.  They actually help with breastfeeding in public – if I have to pull up my shirt to nurse, I just pull down the top of the tank and my belly remains covered.  This is good, because I don’t like having my belly visibly for all to see.  Go figure.
3. Cabbage.  In the first 6-12 months of breastfeeding a baby, I’ve taken to always having cabbage in the fridge.  It doesn’t go bad quickly, so it’s not hard to keep in stock.  I put a leaf of cabbage in my tank top in the area where the plug is.  Cabbage doesn’t work on everyone, and it works really well on others, so if you choose to use cabbage, you’ll have to experiment with how long and how often and how much.
4. Drink lots of water.  I mean A LOT.  That’s straightforward enough.  Just drink it.
5. Cut out sugar.  I also cut out dairy.  I think I could probably GIVE myself a plugged duct by eating too much dairy and sugar.  For some reason, I don’t lactate as well when I’m eating them.  Cutting out sugar would probably benefit anyone with a plug.  I’m not sure that dairy affects everyone as much, but it certainly does for me.  You can also experiment with different things in your diet that you think are affecting your lactation.
6. Eat more protein.  This one is a big one for me.  I start to get what I tend to think of as a hollow feeling before I have a plugged duct, or during it.  I feel worn thin.  When I eat protein, I feel much less worn thin, and I notice that I end up with fewer plugged ducts if I start really loading up on protein when I think they’re coming on.
7. Vitamin C  Apparently Vitamin C can help clear up plugged ducts.  I’ve heard taking 1 mg every 2 hours, but please check with someone if you have doubts about whether you should take that much.
8. Echinacea.  Echinacea can help with fighting nasty microbes.  Either follow the directions on the bottle or ask a naturopath or herbalist.
9. Garlic. Garlic fights nasty microbes, too.  What I generally do is take garlic pills, according to the package instructions.  Don’t get the unscented kind.  Whatever gets rid of the scent also gets rid of the microbe-killing stuff.  Look:  you’d rather smell like garlic than have mastitis.  Trust me.  If I don’t have the pills, I always have garlic on hand, so I mince a clove into bitsy bits and then take it with juice so that it’s not as hard to get down.  Again, you’ll smell like garlic, but when you’re attempting to avoid mastitis is not the time to worry about garlic breath.
10. Heat.  Put a hot pack on the site, particularly before you’re going to nurse the baby there.  Also, take a hot shower.  Let the hot water run over the area.
11. Try to get rid of the plug manually.  People say things like, “Massage the affected area.”  I think that this is a misleading use of the term “massage.”  I’m a massage therapist by training, and what I do to get rid of the plug manually doesn’t look like ANYTHING I learned in massage school.  I’ve tried the whole “pressure on the sore area” thing, and I’ve found it just doesn’t work for me.  It’s never, ever worked to put pressure on the sore area for me.  It might work for some people, and you can certainly try it – I won’t try to stop you.  But I’ll tell you what has worked for me remarkably well in a huge percentage of plugged ducts.  I look at the nipple for the plug.  This can be tricky, because the plug at the nipple is often in the same quadrant as the sore area, but not always.  So I start there, but I don’t limit my investigation to that area.  What I do is squeeze the actual nipple to see where milk is flowing freely and where I can see a white spot that might be a place where milk should flow, but is blocked.  Often I’ll find the spot, and I can often get the plug out – sometimes partially, sometimes fully.  I’ll tell you, though, partially is a LOT better than nothing.  And then I try again later.  I try to do this in the shower, because it can be quite messy, and because the hot water can help loosen things up.  When I find the area that’s plugged, I carefully try to squeeze the plug out.  It can be like toothpaste.  Gross, right?  But it’s milk that’s all thickened up and is stuck, so that is what it’s like.  It can also take a surprising amount of pressure, but not so much that I’m going to bruise the area or crush the workings of the nipple – it’s not worth damage to the rest of the breast to get this plug out.  If the plug comes all the way out, sometimes there’s a big fountain of milk behind it that comes flowing out.  If it doesn’t, try again later.  I’ve been known to take several showers a day when I am trying to clear a plug. 
12. Vibration.  You can use a hand massager that has a vibrate feature to loosen up the plug.  This works best before heat and nursing or manually trying to clear the plug.
13. Mullein and lobelia  An herbalist told me to make a tea of mullein and lobelia leaves in a 2:1 ratio (steeped for 10 minutes) and drink a quarter cup of it 3 times a day. I'm not an expert, so please check with someone about this if you want to do this.  You can also use the mixture to make a compress and apply it to the affected area.  This stuff is disgusting, really.  It tastes horrible.  Apparently lobelia is referred to as "pukeweed" among people in the know.  If you're likely to throw up easily, this is not the solution for you.  I don't throw up easily, but if I did, this would make me do so for SURE.  But it also seems to help.  Go figure.
**A couple of things that I haven’t tried, but have heard suggested:
1. Ultrasound.  Actually, I don’t know if this works for me because I’ve never tried it.  But there are recommendations about how much to use and you can find those online easily.  I guess the thing that doesn't work for me about ultrasound is that it seems like a lot of work to line up an appointment and a babysitter for the kids while I have a plugged duct so that I can do the ultrasound.  I should give it a try, though -- if it works, I'm sure I'd be willing to put in the effort!

2. Tangerine oil. The poster recommended rubbing the oil over the affected are.  I'll give it a try next time and let you know how it works. 



Eventually they get old enough that they
don't cause plugged ducts anymore.

**I haven’t listed a few things that are often listed for plugged ducts, because they don’t seem to work for me.  I’ll tell you here, because they may work for you.

1. Lecithin.  Lecithin is an emulsifier and I’ve been told that that means it makes your milk less likely to clot up and cause a plug.  I’ve tried it and haven’t seen a difference, but it may just not work for everyone. 
2. Putting pressure on the sore area.  See “Try to get rid of the plug manually” above.
3. Position the baby so his chin points to the plug.   Okay, I know that this works wonders for lots of people, so please try it.  It is supposed to get the strongest pull of the baby’s mouth to the position that’s right around the plug, the idea being that this will work the plug free.  I haven’t had good luck with this personally, maybe because I’m not good at positioning the babies so their chins point in the right spot, or maybe because I have hair-trigger letdown reflex, so the pull from their suck isn’t as strong as it would be if they were having to work really hard to get the milk out.  Others have a lot of success with this, I’m not saying it doesn’t work.  I just want you to know that if it doesn’t work for you, you’re not alone. 
4. Phytolacca  This is a homeopathic remedy, and many women swear by it.  In defense of it, I actually think it did help with my plugged duct.  However, I will never use it again, because it also gave me vertigo.  I had to spend an entire day in bed (when I had a small baby), holding my head as still as possible, because I couldn't move without the room spinning.  It was awful at night, too, because I would forget, and move to get the baby or nurse her, and then the room would spin.  As I mentioned above, I'm not one to vomit easily, but I came close to it many times during both episodes.  Both episodes? you ask.  Yes, the second one, thank God, I didn't take as much as I had the first time, and when the symptoms began, I recognized them and pieced together what must have happened the first time, too.  Never again with this.  But it might not affect you the same way.

Okay, that's the list!  It's long and involved, but if you don't have all the ingredients it calls for, just get started with the rest, heat, and trying to remove the plug manually.  Then add others as you can or need.  I'd like to hope you're looking at this out of an unusual curiosity about what mothers who have plugged ducts do to get rid of them, but I imagine that's not the case for most readers.  I'm sorry if you have a plug.  I hope it goes away quickly!

*****Updated!***** June 20
Here's another thing I started doing:  taking evening primrose oil daily.  It may or may not help with an acute plug, but I've found that the daily amount I take has helped keep the incidence of plugs much, much, much lower, which is awesome!

Rest!

Here I am, a little over 3 months to my baby's second birthday.  (If you're tempted to tell me that she's not a baby any more at this age, just spare your breath; I won't listen to you.  She's a baby until and if we have another baby.)  Last night I felt the tell-tale lump in my right breast.  I emptied it out, and took echinacea and vitamin C, but I must have caught it too late, because I woke up at 4:20 a.m. with a low-grade fever and painful, red breast.  Ugh.

How is it that, this late in my breastfeeding career -- this late in my baby's life -- I'm getting plugged ducts?  How is that?  Shouldn't it be all smooth sailing at this point? 
Regardless of my thoughts or feelings on the matter, here I am, so now what?

Rest is one of the most important things on the list of what to do with plugged ducts and mastitis.  This doesn't mean that you do your normal day, putting up your feet briefly after lunch.  This means REST.  I have been in bed most of the day.  I took a nap.  I read my book.  I read books to my kids.  I nursed the baby.  I instructed the 9-year-old in what to give her siblings for meals and snacks.  I took a shower to work on clearing the duct.  It looks like it's clearing, and I need to keep resting until it's run its course, because otherwise it will be back and I might be facing full-blown mastitis.  And nobody wants that.

Rest means that you have to cancel appointments, meetings, playdates, and anything that uses your energy.  I spent time on the phone this morning (in bed), calling those with whom I had plans today and telling them it wouldn't work.

Rest means no housework. I planned to deep-clean the kitchen today, make chili, make granola bars, etc.  Nope.  The kitchen's a mess because, even though the 9-year-old makes a mean smoothie, she doesn't necessarily clean up after herself.  And to be fair, I was pickling asparagus last night, so there's some of that left around, too. 

Rest may mean videos for the older kids, or asking a friend to come over and play with them. 

Rest, for me today, meant calling my husband and asking him to come home in time to take the oldest two to their afternoon activities.  It meant sending my kids out to water the garden instead of going with them.  It will mean no workout of any kind.  Rest means lying in bed while typing a blog post on my Surface. 

 

I struggle with rest.  There's a lot to do in my life, and I'm sure in the lives of all of us who get plugged ducts and mastitis.  The stuff to do doesn't disappear -- when the plug is gone and I go back to my usual activities, I'll have to deal with all the stuff that didn't get done today.  Weird that rest can be hard.  But I've learned, the hard way, that if I don't stop and rest when I have a plugged duct, I'll get stopped to rest by mastitis, which is miserable, and lasts longer.  So I rest.

Exercise for those prone to plugged ducts and mastitis

How's that for a catchy post title?  I know what you're going to say -- keep those hip titles coming!

All right, exercise really helps with preventing plugged ducts and mastitis, BUT one has to be very, very careful.  Here's the thing:  the bodies of women prone to plugged ducts and mastitis deal with overwork or stress or any unusual exertion by getting a plug.  So exercise has to come slowly into the picture -- very slowly. 

I finally figured out when I was pregnant for my fourth child that if I did lots of great exercise during pregnancy, I'd be in better shape after the baby made her appearance.  This revelation was long enough in coming, wasn't it?  So I exercised diligently throughout my second and third trimester (the first trimester, I practiced sleeping and feeling nauseated).  This made my postpartum time much easier as far as bouncing back physically, and I also noticed that I didn't get the worn thin feeling as easily.

After a baby comes, I spend at least six weeks recuperating before I do any exercise at all, besides walking around my house.  One must approach exercise with caution, particularly if one has either high or low supply.  Using up too much of one's reserves for exercise can cause trouble.  At one point, I theorized that maybe exercise would decrease my milk supply, since it seems to do so for some people who have low supply.  This theory wasn't correct in my case; I just got plugged ducts. 

The bottom line seems to be -- do exercise.  Carefully build up your strength, making sure not to overdo things.  Once we're strong, it's harder for us to get plugged ducts, because our bodies handle any extra stress and strain better.  Start slowly and build up, checking to be sure that you're not overworking your body.  If you have a busy day, get a little bit of exercise, but be sure to balance your schedule with your exercise so that your body can handle what you're asking it to do.

We're not alone!

Personally, I have come across very few people, including medical professionals and lactation experts, who know a lot about overproduction, or what to do with it.  Non-professionals haven't heare too much about it, either, and it can be a lonely road when you feel as if no one understands what you're experiencing, much less offers help!  So when I read this article,  in the International Breastfeeding Journal, by Caroline GA van Veldhuizen-Staas, I felt a sense of relief -- this woman gets it!  Even rereading it today, I feel a certain relief at the thought that she understands the things that I struggle with as I breastfeed.

Methods to treat real or perceived low milk supply are well referenced in the literature      Overabundant milk supply or hyperlactation on the other hand is not discussed in depth in the literature. There is no consensus on treatment or terminology. However, overabundant milk supply can be as devastating for the continuance of breastfeeding as underproduction.

So I'm not the only one who couldn't find much help for overabundant supply.

The hyperlactating woman will often experience a constant feeling of (over-) fullness, engorgement and tension. She may leak milk in between feedings, or leak copiously from the opposite breast during feedings, and has an increased risk for mastitis. 

When I say that she gets it, I mean it.  And she understands the baby's problems with the problem, too:

The infant may appear to be a greedy feeder, struggling not to choke or aspirate milk. He or she may often spit up after feedings and/or have reflux-like symptoms, and suffer from intestinal gas, colic and explosive, often green and foamy stools. The baby may show either a very low or a very high weight gain. The baby's struggle to cope with rapid flow may result in restless nursing behaviour, or even aversive behaviour, such as breast refusal or shortened feeds. Fussiness, crying and possible low weight gain can lead the mother to think that her milk is insufficient in quantity and/or quality.  

...A common secondary symptom in hyperlactation syndrome is a sub-optimal nursing technique in the infant. This may be the result of the child's attempts to cope with an overabundant milk flow, sometimes slipping from an optimum latch in order to clamp down on the nipple to slow the flow, often traumatizing the mother's nipple in the process. Or the infant may develop a conditioned habit of drinking but passively suckling at a breast that will give milk without any effort by the infant itself. This has the potential to lead to supply problems after 4–6 weeks when supply stimulation patterns transition from primarily hormonal stimulation to feedback inhibition mechanisms.  

After many, many months of having to piece together small bits of information here and there about overabundance and its resulting problems, I rejoiced to find an entire article -- scholarly, at that -- that discusses in detail these difficulties.

She talks about some of the physiological mechanisms that regulate milk production, as well as some of the common treatments, including block feeding, which I've found to be extremely effective in my own attempts to regulate supply. 

She then offers a new technique that she's developed, and describes some case studies that have used the technique.

 The treatment sequence starts with an as-complete-as-possible mechanical drainage of both breasts. ...The infant will latch on immediately after drainage and will be offered both "empty" breasts to satisfaction. ...Subsequently the rest of the day is divided into equal time blocks starting with about three hours, initially. Every time the infant shows hunger cues or other signs of interest in the breast the same breast will be offered without any restriction in either frequency or duration of feeds. At the end of such a time block, or after a multi-hour period of sleep, baby will be offered the other breast for all feeds within the next time block. ...Depending on the seriousness of the symptoms time blocks may gradually be increased to 4, 6, 8 or even 12 hours. For less complex situations one-time mechanical drainage will suffice; for others occasional repetition may be necessary. Intervals between drainage will gradually increase as the symptoms lessen.

When I found the article, I was already well into my breastfeeding relationship with my youngest, so I haven't tried this technique.  However, if I have more children, I will definitely try this method.  I would probably even try it now (my nursling is almost 20 months), except that with other babies, I experienced a huge decrease in the effectiveness of pumping after 12 months -- my breasts just don't react to the pump as they do to the baby after that time.

I highly encourage you to follow the above link and read the entire article -- it's fascinating and not too technical, and can make overproducing moms feel a bit more understood. 

She concludes her article with this statement:

 More research will need to be done to understand why some women will easily produce much more milk than needed and why for some it is so hard to regulate milk production to meet the needs of their children.

I totally agree.

International Breastfeeding Journal 2007, 2:11 

How it all began

I first learned that I had overabundant milk supply and overactive letdown when I was trying to nurse my first baby.  Boy, can first babies be humbling!  I learned a lot from Hannah -- and a lot of it was how little I actually knew. 

Breastfeeding classes encouraged me to nurse my baby fully on both sides -- 15 minutes, 10 at the very least.  Have her empty both sides. 

Hannah would nurse for 3 minutes or so and be done.  I'd encourage her to get back on, and she would scream and tense and scream some more.  I felt terrible, as if my baby was going to die of malnutrition because she wasn't getting enough milk. Never mind that she was back up at birthweight by her 3 day checkup and never looked back.  I'd been told how much she needed to nurse to get enough. Seeing the scale go up didn't get through to me.  I attribute this to lack of sleep and abundance of hormones, besides being entrusted with a new baby.

See the Lansinoh in the background? 

I would spend the first minutes of our nursing time praying that she'd fall asleep before letdown, because if she did, she'd nurse fully and well.  If she didn't, she'd pop off and scream.  I'd latch her on and anxiously wait to see her eyelashes slowly lowering...darn, letdown came too fast. 

By three months old, besides all of the other breastfeeding problems we endured, Hannah had enough.  She refused to nurse.  She wouldn't take a bottle.  She was unconcerned about the idea of malnutrition, she just didn't want to deal with the huge quantities of milk shot at her whenever she ate.  So began our 6 months of getting her to sleep and then nursing her.  Humbling doesn't begin to describe this experience.

I can't remember exactly when I learned about overabundant milk supply and overactive letdown, but I do remember the sense of relief -- I finally knew what was happening.  Of course, I could find almost no information about it anywhere -- my health care professionals didn't know much, nor did anyone else I approached.  There was lots of information about too little milk, but not a lot about too much.  It was a lonely, lonely time.

I have scratched the surface of our nursing problems in those early days. I'll talk about mastitis, plugged ducts, enormous cracks in the nipple, and thrush in other posts. Looking back, I think how miraculous it is that I didn't give up.  I'd like to share some of my hard-won knowledge about this with others so that we don't all have to reinvent the wheel, and so that others know that they're not alone with this difficulty. 

Daily maintenance

...for women with high supply or frequent plugged ducts 

**I'll have follow-up posts to talk more about the things that need to be more fleshed out here, but this is the general list.  Of course, as you read through this, remember the Disclaimers!



Things that I do daily to maintain good lactation:

1.        Check for sore spots.  I use this throughout the day to make sure that I am not developing a plug.  It’s a bit like a monthly breast exam, only a more general.  I use the heel of my hand and feel around to see if there are sore spots.  If there are, I check again after I’ve nursed the baby on that side.   If it’s still there, I go into full Plugged Duct Eradication mode.  (More on that in another post.)

2.       Check for plugs in the nipple.  This I do in the shower.  Just a quick squeeze to be sure that the milk is running where it should be.   I’ve become very familiar with many of the outlets on the nipple, especially the ones that tend to plug.  I’ve had countless times that I’ve gotten a bit of a plug out in the shower before it starts trouble. 

3.       Drink lots of water.  Lots.

4.       Nurse the baby.  Lots.

5.       Utilize cabbage to avoid oversupply issues. 

6.       Eat healthily.  Avoid eating lots of sugar.  I eat a small amount occasionally, and some seems to be okay, but if I go overboard, I pay a high price, so I am careful.  Also, I never, ever, ever eat sugar without something to balance it.  Ice cream is good because there’s a lot of fat to balance the sugar.  But ice cream actually doesn’t work for me because dairy also tends to add to plugged ducts for me.  So watch your diet and see if you have foods that trigger plugs. 

 

See how I'm in bed?  Rest!  Don't bother making your bed if you have a new baby -- you need to be IN that bed!  And really, if you're a plugged duct kind of person, you may not make your bed for months, even years, depending on how long you nurse.

 

7.       Rest.  If you are prone to plugged ducts and mastitis, please accept right now that while you’re breastfeeding, especially in the early months, you will have to have a much slower pace of life than you used to.  OR you will have a hectic pace followed by a slower pace that is forced on you because you have mastitis.  This is not a fun way to slow down. 

8.       Exercise, but in a sane way.  And only after your healthcare providers give you the okay.  Exercise will definitely help you to build up your strength and be more able to do activities, but you have to work up slowly.  Don’t expect to have your baby and start right back in where you left off, if you were exercising.  Start off slowly, or you’ll give yourself plugs or mastitis just by exercising.

9.       Take vitamin C.  And other vitamins as you need to stay healthy. 

10.   If you feel worn thin, tired, or overstretched, call a halt and get some rest!

 

I like this photo, because although I look tired, I'm sitting, holding the baby.  Listen to your body and rest when it's time.

The continuing difficulties of chronic plugged ducts



I have never had the terrible difficulty of low milk supply.  I've seen friends struggle with it and have not wanted to change places with them in the least.  I don't think this means, though, that the struggles of overabundant supply are insignificant in comparison.  The truth is, we all need help and support no matter what our difficulty with breastfeeding is, and although the grass may look greener on the other side of the fence, if we actually go to the other side of the fence, we'll see the weeds, bare spots, and piles of poo that exist in any field.

One of the surprising difficulties of abundant supply is the fact that, even though I'm nursing a 19-month-old, I still have to be extremely vigilant about plugged ducts.  In the last month, I've had two serious ones (one had probably developed into mastitis) that meant that I had to spend a day  in bed and several days taking it easy to recover -- no small task with four kids.

This morning, as my 19-month-old struggles with a cough and stuffy nose, she doesn't want to nurse.  She's cranky and feels terrible and nursing is harder than usual because of all the mucus, and she doesn't want to put in the effort.  Because of my history, I am worrying on many fronts this morning: first, the baby front:  will the baby get dehydrated from not nursing?  How can I get her to nurse?  Maybe she'll drink some water?  Is she developing another infection?  Then, the nursing front:  should I be pumping?  How am I going to take care of a sick baby (and three older kids) if I get a plugged duct? 

Over my breastfeeding career, I've figured out tricks for dealing with the difficulties that accompany the abundant supply, and I'll talk about those in another post.  My baby and I will work our way through this particular bout of trouble, too. 

I have had to accept, though, that as long as I'm nursing, I will have these challenges -- I remain vigilant at all times.

Disclaimers

I'm not a medical professional.  I'm a mother of four who has had almost 10 years of breastfeeding experience.  In this blog, I'm planning on telling about things that worked for me, but I'm not planning on prescribing for other people -- these will be ideas for you to consider and use as you and your medical professionals see fit. 



Some things that work for me won't work for others, and some things that have worked for others don't work for me.  I can only pass on the knowledge that I've accumulated and hope that it helps someone, but please be wise and consult with a medical professional, because I'm not one. 

Why "more like a firehose than a faucet"?



When I had my first baby, I was clueless about a lot of things.  (I'm still clueless about a lot of things, but I've gotten a few clues about some things along the way.)  Breastfeeding -- that mysterious, wonderful, rewarding, beautiful, frustrating, hair-raising, tiring, glorious, painful experience -- was one of them.  And I happen to be a person who has overabundant milk supply, as well as overactive letdown.  Okay, I haven't been officially diagnosed, but I have read the descriptions and nursed 4 babies, and I have an idea about this now. 

I tried to explain the difficulties my baby and I experienced day and night for ages to a man who was not familiar with breastfeeding -- at least, he knew about breastfeeding, but he didn't know about breastfeeding.

**As an aside, why try to explain my breastfeeding difficulties to someone -- a male acquaintance, no less -- who didn't know anything about breastfeeding?  The answer to this question remains lost in the haze that (perhaps blessedly) surrounds postpartum times and tough breastfeeding times.**



As I described (hopefully in not too much detail, but I don't remember what I said to him -- again, this might be a blessing) the ordeals we faced at each feeding, he had a lightbulb moment, "Oh!" he said, looking pleased, "so it's more like a firehose than a faucet!" 

I owe a debt of gratitude to him for explaining in a short sentence what the heck what was going on.  Too bad I can't remember who it was so that I can thank him.