As a Lactation Educator and Counselor, I am often asked about plugged ducts and how to handle them. I personally had a heck of a time with recurrent plugged ducts. Through my professional training, education and experimenting with different approaches, I came up with a multi-pronged plan of attack to prevent and treat these little (or not so little) buggers.
- Proper latch. An improper latch is the culprit for most breastfeeding issues. It can result in insufficient emptying of the breast, which can in turn contribute to plugged ducts. This is a very helpful video I share with students and clients to demonstrate how to achieve a proper latch.
- Frequent & thorough emptying of the breasts. The longer milk sits in the breast, the thicker it becomes, making it more likely to cause a plugged duct. Don’t wait too long in between feeds and/or expressing milk (every 1-2 hours with a plug present) and be sure the breast is thoroughly drained. Be sure not to neglect the unaffected breast – you want to make sure it’s also being thoroughly drained to avoid a potential issue.
- Breastfeeding Positions. Start each feed on the side with the plug (when baby’s suck is the strongest) and aim baby’s chin in the direction of the plug. For example, if the plugged duct is in the bottom outside area of the breast (8 o’clock), then feeding the baby in the football or clutch position will be most effective. It’s also a good idea to change breastfeeding positions each time you feed so the different milk ducts can each flow and drain. This sounds silly, but many women have been able to release a plug by using gravity. Lay baby down on the bed and hover over baby on all fours and offer the affected dangling breast.
- Apply heat. You can do this with a heating pad, hot water bottle, rice sock or basin of hot water. Use caution not to burn your skin by using too much heat for too long. I found moist heat to be most effective particularly before a feed or expressing milk. Take frequent hot showers (as hot as you can tolerate) or soak in a hot bath while firmly massaging the plug towards the nipple and hand expressing the milk out.
- Milk blister or bleb. Sometimes, but not always, a plugged duct is associated with a “bleb” or milk blister on the end of the nipple where the nipple pore is. It is usually painful and commonly due to a poor latch. A lactation professional can help open the blister with a sterile needle. She will gently puncture the top or side of the blister and squeeze just behind the blister to see if the plugged up milk will come out. This might result in the duct unblocking. Putting baby to the breast after puncturing the bleb may also result in the baby unblocking the duct.
- Pressure Massage. This method of massage from Dr. Sears works by applying pressure to the edge of the lumpy area closest to your chest wall with the heel of your hand to the point just before it becomes too painful. Hold the pressure at that level until the pain eases off. Then increase the pressure again, (without moving your hand) and hold it until the pain eases. Continue to gradually increase pressure at that same site until you are pressing as hard as you can. Then pick your hand up, move it down toward your nipple about a half inch, and repeat the pressure massage in this area. Continue moving your hand a half inch and repeating the massage until you get all the way down to the nipple. You may see the dried milk come out from an opening in your nipple. Even if the plug doesn’t actually come out, you will at least have dislodged it and moved it toward the nipple so that when baby goes to the breast and sucks, it can be more readily removed by baby’s suction.
- Rest, De-Stress and “Babymoon.” It’s not always easy to get some rest with a baby. Get help with chores and errands or just let them be- this is not the time to fuss over the dishes. If you work outside the home, take the day off if you can. Take baby to bed with you (babymoon) and breastfeed there. Stress can also contribute to plugged ducts so as difficult as it may be, try to “keep calm and carry on.”
- Holistic & Natural Approaches. B-complex vitamins, vitamin C, evening primrose oil, thyme, probiotics and consuming 3-4 raw garlic cloves (try taking with orange juice) have been known to help plugged ducts. Also, try eating wholesome, nutritious foods, reduce your intake of saturated fats and drink water to thirst or about 64 oz. daily. Soy Lecithin has helped some mothers prevent plugged ducts. It as been suggested that it decreases the viscosity or “stickiness” of the milk by increasing the percentage of polyunsaturated fatty acids in the milk. I have used Health Alliance Non-GMO Lecithin Powder. The dose is 1200 mg, 3-4 times a day. Traditional Chinese Medicine (TCM) typically views plugged ducts as an accumulation of toxic heat. Acupuncture can help clear the heat and toxicity while treating any underlying imbalance that may be causing or contributing to the condition. This homeopathic protocol has been effective: First, take 3 pellets of Hepar Sulphur 30C. Three hours later, take 3 pellets of Phytolacca Decandra 30C. Repeat until symptoms improve. Castor oil packs have also been effective.
- Pain Relief. Ibuprofen is the preferred anti-inflammatory pain medication by lactation professionals for breastfeeding women and will help reduce swelling. I was stubborn about this one at first but I quickly learned that it really helps and gives you the relief you need to get a good milk letdown which is essential for good milk transfer and thorough emptying of the breast.
- Ultrasound therapy. Most plugged ducts will be go away with these measures within 48 hours. For really stubborn plugs, therapeutic ultrasound treatments are painless and have been proven effective. It is especially effective when combined with lymphatic drainage massage. Most physiotherapy or sports medicine clinics can provide these treatments for you. However, few are aware of using ultrasound to treat plugged ducts so you may want to call around to find someone who is experienced. If you live in the Los Angeles area, please contact me for a referral. Each treatment should last for about five continuous minutes on the affected area. If two consecutive treatments (for two days) don’t work, then it should be evaluated by a specialist. One of my “plugged ducts” actually turned out to be a lactating adenoma. At home, you can try using the flat end of an electric toothbrush or Clairisonic face brush to give yourself a mini “ultrasonic” treatment for less stubborn or smaller plugs.
- Sneaky Offenders. Be mindful of the below ways which can obstruct the flow of milk through the ducts, thus causing a plug:
- Seatbelt Straps. Be aware of how your seatbelt fits across your chest and adjust it as needed to alleviate pressure on the breast itself. Many vehicles have adjustable heights, but if yours does not you may want to use a folded washcloth or cloth diaper to place underneath where a belt presses against your breast to redistribute the pressure.
- Purses. Same as above.
- Bras. Wear a comfortable, loose fitting nursing bra without underwire. My personal fave is the Bravado Body Silk Seamless Nursing Bra. At home or out, consider “free-boobing” it
- Sleeping Positions. A sleeping position that puts pressure on your breasts is likely to contribute to plugged ducts. If you are a tummy sleeper, try sleeping on your side with a pillow between your knees. I experienced my first plugged duct after a massage while laying on my stomach and have requested pre-natal massages in the side-lying position ever since.
- Introspection. Louse Hay published a book called You Can Heal Your Life which describes “the mental causes for physical illness and the metaphysical way to overcome them.” It contains physical maladies plus the way to look at that condition spiritually. It also contains the positive affirmation you can meditate upon to help you work toward healing. The section on breast problems including cysts, lumps, soreness, plugged ducts and mastitis states: “A refusal to nourish the self. Putting everyone else first. Overmothering. Overprotection. Overbearing attitudes.” The positive affirmation associated with breast lumps and cysts reads: “I am important. I count. I now care for and nourish myself with love and with joy. I allow others the freedom to be who they are. We are all safe and free.”
- Support. Plugged ducts are no picnic. I would be lying if I said I didn’t want to give up when in the throes of a plugged duct attack. Get friends and family to help with chores and errands, have a good cry if you need to, enlist your partner to give you a relaxing foot massage and find a local breastfeeding support group such as La Leche League. I am here to offer breastfeeding support too!
Note: When you finally do break up the blockage, you may not be able to tell until for a day or so as the area will remain tender. Plugged ducts can also lead to mastitis. If left untreated, mastitis can result in a breast abscess. If you think you have an infection or are experiencing flu-like symptoms, consult an IBCLC.
Please consult with your health-care provider or naturopath before starting any treatment plans or taking any supplements.