Breast Feeding Help  - Blocked Ducts & Mastitis - What's the deal?

Alright, folks, let's talk about something that occasionally pops up for breastfeeding moms – blocked ducts and the notorious mastitis. So, what's the lowdown on these not-so-fun surprises?

First off, mastitis is like the villain of breastfeeding infections. It usually targets breastfeeding moms, but it can strike whenever it feels like, even in people who aren't on baby duty or pregnant. We're still not entirely sure why some moms get hit by it, but we suspect that nasty bacteria manage to sneak into the breast through little cracks or sores. Weirdly enough, even women without sore nipples can fall victim to mastitis, and not everyone with cracked nipples ends up in this battle.

Now, here's the deal: we need to figure out if you're dealing with a blocked duct or full-blown mastitis, because the treatment varies. A blocked duct shows up as a painful, swollen lump in the breast. The skin over it can get a bit red, similar to what happens with mastitis, but it's like mastitis's less intense cousin. Mastitis, on the other hand, brings along fever and more intense pain. However, distinguishing between mild mastitis and a severe blocked duct can be a bit tricky because they both come with a painful lump. Interestingly, a blocked duct can sometimes pull a superhero move and transform into mastitis.

Now, when it comes to these breastfeeding problems, a bad latch, which leads to poor milk drainage, is the real troublemaker here.

Blocked Ducts

Blocked ducts usually clear up on their own in 24 to 48 hours, even without any special treatment. During this duct blockade, your baby might get a little fussy while nursing on that side because the milk flow can be slower. But, hey, there are ways to speed up the unblocking process:

1. Keep breastfeeding on the affected side and try to drain it better. Get your baby in a position where their chin is pointing at the blocked area. Think of it like baby target practice. You can also give your breast some love by gently squeezing the blocked area while your baby does their thing.

2. Heat things up! Apply a heating pad or hot water bottle to the blocked zone (just don't burn yourself, we're not making soup here).

3. Get some rest if you can (easier said than done, right?). Take your baby to bed with you, and catch some Zs together.

4. If there's a little blister on the nipple along with the blocked duct, you can pop it with a sterile needle. Just remember, a bleb or blister without the painful lump doesn't count as a blocked duct.

5. Ultrasound time! If the blockage is as stubborn as a mule and won't budge within 48 hours, therapeutic ultrasound can work its magic. You can schedule this at your local physiotherapy office. Don't be surprised if they haven't heard of this use for ultrasound – not everyone is in on the secret. If it's going to work, one treatment is usually enough.

6. Lecithin to the rescue! This supplement may help prevent blocked ducts. It works its magic by making your milk less sticky and more slippery. It's safe, affordable, and does the job for some moms. Take 1200 mg four times a day.

Mastitis

Okay, now, mastitis – the big boss. If you suspect mastitis, here's the battle plan:

1. Get your butt to bed! Rest is your best friend when fighting infection.

2. Keep on breastfeeding unless it's too painful to bear. If nursing isn't an option, at least express your milk as best you can. The sooner you can get back to nursing, the better. It helps mastitis retreat faster, and your baby is A-OK during the process.

3. Warm things up with a heating pad or hot water bottle.

4. Fever's not all bad; it's your body's way of fighting the good fight. So treat it if it's making you miserable, not just because it's there.

5. Ever tried using raw potato slices to soothe the breast? Within the first 24 hours of symptoms, this little kitchen remedy can be surprisingly effective at reducing pain, swelling, and redness.

6. If symptoms have been consistent for less than 24 hours, we'd give you a prescription but hold off on taking it for now.

7. If things are getting worse over the next 8-12 hours (more pain, redness, or a growing lump), then it's time to unleash the antibiotics.

8. If you're not getting worse but not better after 24 hours, start the antibiotics.

9. If you've been dealing with mastitis for more than 24 hours, don't wait – go for the antibiotics.

10. When symptoms start to ease, you don't need to jump on the antibiotics train. Most of the time, things will keep getting better, and within 2 to 5 days, it'll all be ancient history. The fever usually bows out within 24 hours, the pain within 24 to 48 hours, and the breast lump will bid farewell in the next few days. Redness might hang around for a week or so or vanish sooner than that. If things don't go as planned, get in touch with your medical squad.

11. Important note: Not all antibiotics are created equal. Some are useless against mastitis. Look for ones that can take on the Staphylococcus aureus gang, like cephalexin, cloxacillin, and a few others. If you're allergic to penicillin, clindamycin and ciprofloxacin are your go-to heroes. And here's the best part – you can keep breastfeeding while taking these meds.

12. To ease the pain, over-the-counter pain relievers like ibuprofen or acetaminophen can be a lifesaver. You'll feel better, and what little makes it to your baby through the milk is harmless. Acetaminophen is probably less of a superhero since it lacks the anti-inflammatory punch.

The Drama of an Abscess: Sometimes, mastitis takes it up a notch and an abscess forms. But here's the thing: you don't have to halt your breastfeeding journey, not even on the affected side. In the past, the go-to solution was surgery, but nowadays, we have some alternatives. Repeated needle aspiration or drainage under radiographic control can save the day with less breastfeeding interference. If surgery becomes necessary, keep it as far away from the areola as possible. Just give your local clinic a shout.

A Stubborn Lump: If you have a lump that's hanging around for more than a couple of weeks, it's time to call in the pros. No need to put a stop to breastfeeding just to get that lump checked out. Ultrasound, mammogram, and even a biopsy can be done without saying goodbye to breastfeeding, even on the affected side. A breastfeeding-friendly surgeon knows you don't have to wean before they can investigate a breast lump.

Questions? Email Jack Newman at drjacknewman@sympatico.ca or Edith Kernerman at breastfeeding@sympatico.ca or consult: Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA) or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding; or The Latch Book and Other Keys to Breastfeeding Success; or L-eat Latch & Transfer Tool, or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.  See our website at www.drjacknewman.com.  To make an appointment email breastfeeding@ccnm.edu and respond to the auto reply or call 416-498-0002.

Handout Blocked Ducts ad Mastitis Revised May 2008
Written and Revised by Jack Newman, MD, FRCPC 1995-2005
Revised by Edith Kernerman, IBCLC, and Jack Newman, MD, FRCPC © 2008 

This handout may be copied and distributed without further permission,
On the condition that it is not used in any context that violates
The International WHO Code on the Marketing of Breastmilk Substitutes