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!