Recurrent blebs and pregnant again, argh!

[threadedwithstars]

I'm 22 weeks with no4 and beginning to panic about breastfeeding. My last 2 were tongue tied and even after the snip I ended up with recurrent blebs, vasospasm and frequent mastitis. I got advice from a lactation consultant who told me to soak in Epsom salts, open the blebs with a sterile needle, feed, take lecithin, rub olive oil and vinegar (don't recommend that, felt like I was melting on the school run) in after feeding to keep them soft. None of this worked and I had 18 months of this routine before and after each feed. And so much pain. Not fun and affected my enjoyment of baby no3 hugely. I didn't feel able to stop because I started getting mastitis each time the milk slowed down.

I really would like to feed the next baby, but I can still see white patches all over both nipples covered with quite thick skin, which look like huge deposits of old milk. I don't fancy trying to feed with those! I'm rubbing away as much as I can in the bath but it's not making much difference. I'm not a surgeon and getting rid of them all would be major surgery!

I don't know what to do. I can't face another 18 months of agony and DIY nipple lancing. Is there anywhere in the UK a breast specialist who'd be able to help, surgically or otherwise? I'm nervous about waiting to see what happens with no4 is there anything I can do before she arrives? My doctor thinks this isn't really an issue for doctors, whereas if my leg was dodgy they'd definitely help. Am I just being daft at even wanting to breast feed this one?

[JiltedJohnsJulie]

Congratulations on your PG OP

I have absolutely no idea on this one though, sorry. Could you try calling one of the BFing Helplines and seeing if the BFC has any suggestions? Have you got the numbers?

[allthatmalarkey]

Big fan of breastfeeding, but formula exists for a reason. Not everyone has equipment that works like a dream and yours sounds like a total pita. Before formula, you'd have been relying on friends and family or a wet nurse if you could afford one. In case I've caused offence, I'll point out that whilst I could BF, I couldn't get pregnant naturally. Bodies are not reliable.

I've seen a close friend get in an absolute state about this and for her second baby she decided she just couldn't go there again.

Here are a couple of ideas:

Even if you do breastfeed, you have to stop sometime and you need a managed way to stop. Could you say you'll do some colostrum and then see how it goes and in the meantime find out how to reduce your supply without getting mastitis? If you introduce a bottle a day at a time and give it 4-7 days to settle down before introducing a second bottle and massage any lumps down the milk ducts to prevent mastitis, that could be a managed route to reducing how much you BF.

Each bottle could be a really small amount - tomorrow's milk supply is determined by what milk your body was demanded to produce today - eg 9am feed of 150ml today = 150ml production 9am tomorrow. So a bottle of 80ml formula followed by a top up breastfeed will clear your breast but reduce the amount demanded for tomorrow.

Tiny babies are only demanding a small amount but as they get bigger and hungrier, they telly our body to produce more milk. You could use bottles to meet this extra demand and keep your supply quite low.

IME you can combine feed if you do one or two bottles at the same feed every day with BFing being the main source of food around it. I haven't tried it with more bottles a day, but suspect it's possible. You need to introduce a bottle before 11/12 weeks though - I left it late with DC2 and she was not interested in a bottle at all.

Or you could work up to fully formula feeding and be proud of yourself for having done the most useful early breastfeeding. There is no shame in formula feeding.

Wishing you luck, I think you've done amazingly well, but I think you should take the pressure off yourself, you have enough going on!

[threadedwithstars]

Thank you both so much, just what I need is a bit of rational advice. All that malarkey, thank you for what sounds like a very sensible plan. I think having an exit plan in case it goes tits up (snigger) will help with the anxiety immensely.

[Merename]

Hi OP, I have had two tongue tied babies and had he exact same experience you describe with my first. Blebs are HORRIBLE. when I look back, I cannot believe I spent so long sticking pins in my tits, it’s mental.

I was very anxious about the same happening again with this baby, but I have only had one bleb in 5 months so far, and it was easy to resolve.

You’ve had some good advice, here’s a couple more thoughts. Can you discuss with midwife and get a plan in place for v early tongue tie snip with this one if they have it? I think the issue can be baby learning a poor latch with tongue tie that is difficult to reverse. And the blebs will most likely be all about inadequate latch. Same with planning early bf support, even paying if possible.

I found gps and many bf workers knew little about blebs, but they can help with latch. Are you feeding just now? Or do you just still have blebs with no milk? I find that I can always express little bits of thickened milk from problematic ducts, even when taking lecithin, and doing this daily along with loads of massage I think helps keep ducts clear.

This time I had mastitis 3 months in and felt thoroughly miserable. It’s awful how anxious blockages make you feel. I do believe that anxiety is part of making it worse though, as there is a hormonal component to oversupply. Do you feel you tend towards this? You are likely to with the symptoms you describe. It’s a good idea to get on this from the very start with cabbage, block feeding etc.

Lastly, this time it has helped me to decide that if I continued to have problems, I would give up. It was affecting DD1 and family life too much, constantly tending to my tits. Somehow it felt like making this decision lifted the pressure, and I haven’t actually had to stop as things have improved. I still have to massage a lot and take care as breasts don’t drain well though. If you do a thought experiment and imagine that you don’t bf from the start, or you only do it for a while, how does that feel? I know the anxiety about how to even stop though through the risk of blockages. I wonder if your Gp could medicate you to dry up milk?

Sorry this is so long! I really feel your pain and hope things improve.

[threadedwithstars]

Merename, you don't know how amazing it is to hear of someone else who has been through the same boob/needle/lecithin rigmarole, it does seem like we are a very rare breed. I'm not feeding now, youngest is 4 and next not due until June. Interesting that you could express bits of thickened milk, I never really could. Was that hand expressing? And tell me exactly what massage you used!!

I'll talk to midwife re an early snip, and try and line up a Lactation Consultant to visit asap after birth for a check in. Cabbage will be in my hospital bag I think, oh the glamour.

So interesting about anxiety, that had never crossed my mind. Not sure anxious so much as mighty pissed off that I had to stick needles in my nipples multiple times a day! I think realising that I regretted breastfeeding baby 3 has made it blinking clear that I need an "exit if things get nasty plan" with no guilt or pressure involved. I'll work on that, how to prioritise my physical and mental health over breastfeeding my last baby, when I fed all the others (with varying levels of agony) for at least a year...

I did ask the GP last time for drugs to dry up the milk and they said no.

Thank you infinitely for your lovely message. I am so grateful.

[Merename]

Ahhh @threadedwithstars, that’s good it could be helpful. But actually I can imagine how amazing it feels, as when I went through it I posted on various forums and got zero replies, or we’ll meaning but useless advice to try a warm compress, etc. Do you have any other conditions that you feel could relate? This is just hypothesising, but since the skin of a bleb growing is an inflammatory response, I wondered if it was connected to me having a bit of a histaminey system, hay fever and dust allergies etc. I also have an underactive thyroid which I wonder if could connect somehow.

Now I’ve said that, I remember that my Gp was supportive in trying a remedy that I’d come across in a medical paper - a steroid cream on the bleb, under occlusion. I’d dab the cream on and tape micropore tape over it. It was not long after this that my blebs cleared up with first child, but I was never convinced it was that that did it. It sounds like you had them the whole time you fed your third? Mine went away at 13/14months, but I fed until around 27 months. When they went coincided with night weaning, and also i wondered if the ducts in question just died eventually.

Since you see quite thick skin over yours, I wonder do you think you have scar tissue from all the needle lancing? Towards the end I felt I was having to go deeper and deeper to free the milk, and was concerned about scarring.

So I’m wondering if it’s possible that those ducts won’t produce milk for you, if the exit is firmly blocked from the start? Do you leak in pregnancy? I produce a fair bit of colostrum in pregnancy so if you do may give you an idea of how those ducts will behave.

Feeding from one boob only is an option if one is less affected than the other?

Makes good sense about the exit plan. It wasnt easy for me to go there, as I felt it would be so unfair to give DD2 so much less than DD1, but it’s not like they will know or care I’m sure. If you don’t bf, try not to feel guilty, you are looking at your family holistically and knowing that you having better mental health and just physical presence, when you’re not stuck in the bathroom for ages, is good for all your kids.

The anxiety thing is another hypothesis- DH is medical and thought that since lactation is influenced a lot by prolactin, dopamine - a hormone of relaxation- will counter hyperlactation. And sorry if a bit woo for you, but I think on an energy level, stress creates stiffness and blockage, where relaxation helps flow and comfort. This time I definitely felt a reduction in the frequency of my blocked ducts when I made a decision to relax and take the cues from my body/ baby.

Oh and massage technique! So to get the thickened milk - to clarify this didntreally work with blebs, this is more my current boob maintenance/ prevention schedule! So something along these lines for general massage player.vimeo.com/video/65196007
Paying particular attention to any areas on each boob that you know feel a bit more thickened or difficult to drain.

To express thickened milk...you know how you’d squeeze a blackhead by kind of pulling the skin around it apart before pushing it together, up to a head? Do that, on the nipple. Gently but firmly. Both in the shower and sometimes when the nips are dry and cold. I don’t know if that makes any sense or if yours are the same, but I can see white at the end of many of my ducts, which comes out as tiny bits of thickened milk and it makes me feel that I’m keeping things clear. Probably I’m just a bit too obsessed with my nips after last time!!

[threadedwithstars]

Mereworth, that's not woo at all, that bloody enlightened. I shall employ absolutely everything you have mentioned. I didn't know milk ducts could die, I'm almost hoping they have so only my functioning ducts make milk and I don't get all backed up. And you are so right about scar tissue, I was convinced that was part of the problem with no.3 but all the professionals dismissed this as irrelevant. I'm hoping some colostrum comes in soon so I can have a go at figuring out what works and what doesn't. Thank you oodles. Bring it on!

[Merename]

Good luck. Enjoy some hard relaxing. A must for so many reasons in pregnancy no4! Let us know how you get on.