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. 

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.

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.