By Dr. Nancy Brent
Nursing mothers may occasionally develop hard, sore areas in the breasts. These are often collections of milk which are not draining. The area may be hard and painful and not improve after nursing. If this is associated with a fever or generally not feeling well, call your doctor to see if you may be developing a breast infection.
The most common reason for clogged ducts is a skipped feeding or change in the feeding schedule. This can be anything from going back to work, the baby sleeping through the night, illness in mother or baby, weaning the baby from the breast, or other circumstances. Another cause of clogged ducts is undue pressure on the breast from a tight fitting or underwire bra.
Managing clogged ducts
In order to relieve the clog, you need to get the milk flowing again. Try to nurse as often as possible and alternate different feeding positions, trying to point the baby’s chin in the direction of the clog. During the feeding, massage the tender area, pressing in and then towards the nipple. In between feedings, use warm soaks to the area like the rice soaks described below. You can also use castor oil packs as described below. Try to correct the underlying cause, if there is one. For example, if you are back to work, try to keep your pumping schedule the same as the baby’s nursing schedule. If that is not possible, on the days that you are home with the baby, nurse him on the same schedule you would use when pumping at work.
Recurrent clogged ducts
If you are prone to getting clogged ducts, you can use 1200mg of lecithin four times a day and/or the castor oil packs. There is no scientific data that any of these measures are successful, but years of experiences of many nursing mothers suggest that they may help. If these measures don’t help, call your doctor to see if you have a breast infection or the Breastfeeding Center of Pittsburgh for further help.
A homemade rice bag can provide a convenient source of moist heat for treating clogged ducts. It can be made by filling a clean sock with 1 cup of raw rice. Close the sock by tying with a string, a rubber band or stitching. Place the sock in the microwave with ½ cup of water beside it. The water and the rice should never touch. Heat the rice bag for about one minute. Test to see if the heat is comfortable. Tuck the rice bag into your bra or hold it on the breast over the area that is clogged. It should be as hot as possible, while still being comfortable. Leave the sock on the breast or in your bra for 10 minutes before nursing or use it over the castor oil pack.
Castor oil packs
Apply castor oil to a warm, moist washcloth folded to the size of the involved area. Place plastic wrap (like Saran Wrap) on top, and then a heating pad on low on top of that. Do not place castor oil packs on the nipple or areola. Let it sit for 20 minutes before nursing or pumping. Then nurse or pump while massaging the area. Repeat every 2-3 hours before feeding.
It is important to use heat prior to every feeding or every 2-3 hours for a 24 hour period to effectively remove a clog. If you feel there is no improvement after 24 hours, you may continue until 48 hours. If there is no improvement by then or if your symptoms get worse at any time during this procedure, you should contact your doctor or the Breastfeeding Center of Pittsburgh.
If the area is red, feels warm to touch or you feel ill with a fever and flu-like symptoms, this may be a sign of a breast infection. You should immediately call your doctor, as this will probably not respond to the above recommendations without antibiotics, and continue the treatments mentioned above for clogged ducts.
Dr. Nancy Brent is the former Medical Director of the Breastfeeding Center of Pittsburgh.