Blocked milk ducts and mastitis
If you develop a tender lump or a red inflamed area in your breast when you're breastfeeding, it could be a blocked duct or mastitis.
Duct blockages are caused when something has stopped your milk flowing freely in that area. This can happen if your bra is too tight, if you've been sitting for hours with a seatbelt across your breasts, if you've slept awkwardly, particularly on your stomach, or (here we go again) if your baby is not latching on properly.
It can also happen if your baby is not feeding enough and your breasts are not being 'emptied' during their feed, or if your baby is feeding from one side more than the other.
The first thing to do is to check out your latch, even if your baby is no longer a newborn and you've been breastfeeding happily for ages. Try and treat a blocked duct as soon as you can to avoid the development of mastitis or worse.
About one in 10 breastfeeding mothers will get mastitis (inflammation of the breast) at some point, usually when a blocked duct hasn't been successfully cleared and the trapped milk becomes infected or it causes an inflammation (one theory is that naturally occurring cytokine proteins in the milk provoke an immune reaction if the milk is left to collect).
It can also occur without a blockage if your resistance to infection has been lowered (by stress, tiredness, illness etc), but this is rare. You may also be at greater risk of infection if you have cracked nipples. Mastitis can usually be treated and breastfeeding can continue, but it is important to act quickly.
What are the main symptoms of mastitis?
Typical symptoms are:
- Sore, red, inflamed area on the breast. It usually only affects one breast
- Burning pain in the breast
- Hardness in the breast
- Raised temperature
- Sometimes, a fever, shivering and achiness will develop, but not in all cases
What should I do if I have a blocked duct or mastitis?
- The most important thing to do is to check that your baby is latching on correctly and your breasts are being emptied efficiently.
- Rest and feed your baby as often as possible because frequent feeding prevents engorgement and helps to clear the blockage. If there is an infection in the breast, your baby will already have been exposed to it and breastfeeding will not make them ill.
- Feed from the affected breast first, as the initial strong sucking at the beginning of a feed will help unblock the duct.
- Keep hydrated and drink plenty of fluids.
- Use warm compresses to soothe your breast and help with the flow of milk. A warm bath or a shower before a feed can also help.
- Try to empty your breasts at each feed. Express if necessary.
- Massage can help. Focus on the affected area and massage it trying to encourage the milk to flow towards the nipple. Do this gently, so that you don't damage the breast tissue, using natural oils if that makes it easier.
- Try to use different positions when feeding as this may help the baby to drain all the ducts in the breast and avoid any build-up of milk.
- If you suspect you have mastitis, ask your midwife or GP for advice. If it has been caused by an infection you may be prescribed antibiotics that are compatible with breastfeeding.
- If you're finding it very painful, ask your midwife to recommend a suitable painkiller (paracetamol or ibuprofen can help and are safe to take while breastfeeding).
For a small but unfortunate number of breastfeeding women, mastitis (particularly if it's not promptly spotted and treated) can lead to a breast abscess: a pus-filled hollow just under the skin (caused by bacterial infection), surrounded by hard, inflamed tissue that usually feels like a lump.
If you get an abscess, it will need draining - with a needle, if it's small, or through a small cut, if it's large. And, as ever with these things, the sooner you get the right treatment, the better.
Mumsnetters who've had abscesses strongly recommend insisting on a referral to a breast-specialist consultant and, if you want to continue breastfeeding, seeking advice from a breastfeeding-specialist midwife.
If you continue to feel ill/feverish, see your GP, who may well prescribe some antibiotics, but this doesn't mean you need to stop breastfeeding.
What Mumsnetters say about coping with blocked ducts and mastitis
- It's very easy to get a bit sloppy with your latch - I certainly did once we cracked the breastfeeding - and ended up with very painful breasts from not making sure my son was latching on properly. Do make sure you are really scrupulous with latching on as well. fingerwoman
- Place warm flannels on your breast prior to feeds to encourage the milk to flow and ease the pain. Put your baby to the sore breast first and, as she feeds, very gently massage the affected part towards the nipple in small circular motions to assist the milk flow. Pupuce
- Take lecithin supplements (three a day when ducts blocked). Angelico
- I found a long, hot bath (as long and hot as you can manage) and lots of massage and expressing underwater really worked. AnybodyHomeMcFly
- Use a wide-toothed comb to literally comb your breast, over the lumpy bit, towards your nipple, whilst standing under a warm shower. HunkerMunker
- My GP's advice was to continue feeding, as otherwise my breasts would become engorged and that would make the mastitis worse. WigWamBam