Plugged Duct Care Plan

Plugged Milk Duct Plan of Care

 

Contact your lactation consultant and obstetrician if

you are experiencing breast pain and any of the following are present:

you are less than 2 weeks postpartum, nipple trauma is present, you see blood or pus in milk, one or both breasts

has a reddened area, your temperature increases suddenly, or you feel like you're coming down with the flu.

 

  1. Bedrest is key for prevention and treatment of plugs and mastitis.  If you are resting in bed, the swelling in your body resolves more quickly and your body's energy can be utilized for fighting infection and healing.  Ask for and accept help at home for a few days.

 

  1. Reduce swelling around the affected area with bed rest and anti-inflammatory medications. Ibuprofen is preferred while breastfeeding – ask your OB about dosage and use.  Cold compresses are also key to reducing swelling.  Green cabbage leaves, if you are not allergic to cabbage, can be placed on top of the affected area of the breast inside your bra.  Replace the leaves when they wilt and apply the leaves continuously until the breasts are comfortable.  Cabbage does not reduce milk supply.  Leaving milk in the breasts reduces milk supply.

 

  1. Moist heat and gentle massage before nursing or pumping.  A diaper filled with hot water is a quick easy way to apply moist heat.  Hold the diaper around the affected breast for several minutes before you nurse or pump.  Gently massage breast from the base of the breast toward the nipple, paying special attention to the affected area.  Massage before and during nursing and pumping.  Some mothers have found it helpful to gently comb the affected area with a wide tooth comb or a vibrating toothbrush to help “break up” the plug, aiding release of the milk.

 

  1. Aggressive milk removal until symptoms are relieved.  This means frequent nursing or pumping - every 1-2 hours day and night until feeling better.  If nursing, start on the affected breast.  Pumping after nursing to aid breast drainage is also helpful. 

 

If it hurts to pump or if milk is not releasing well, check to see if your breast shield (flange) is fitted properly.  If it is too small or too large, the milk may not release well.  The size that is right for you may change over time.  For help finding your best fit, go to www.medelabreastfeedingus.com.

 

If pumping only, pump one side at a time, gently massaging from the affected area toward the nipple with your free hand.  Coconut or olive oil can be used on the breast to aid massage as well as the nipple to aid pumping comfort.  You can lean forward while nursing or pumping, using gravity to help move the plug.  If you see something that looks like a “milk blister” on the tip of your nipple, contact your lactation consult or obstetrician for further instructions.  It is common to see thick or stringy milk when a plug is being expressed from the breast.  It is ok to continue nursing your baby.

 

  1. Probiotics can help your immune system fight infection.  Culturelle brand probiotic capsules contains Lactobacillus GG.  This type of good bacteria has been well studied and widely recommended by healthcare providers.  You can take 1 capsule twice daily for about 2 weeks, or longer if desired.

 

  1. Lecithin capsules can help milk release better.  Lecithin is not a medicine, it is a nutritional supplement.  Recommended dosage is one 1200 mg capsule 3 times daily until resolved, then twice daily for a week or so, then once daily.  If you produce a large volume of milk, you may want to continue once daily to help prevent recurrence of symptoms.  Your IBCLC can provide more information if needed.

 

  1. Anticipate a minor and brief reduction in milk volume until your symptoms are resolved. Your baby may need to nurse a little more often during this time.  Contact your lactation consultant and physician if a decreased supply persists more than a week.

 

  1. Continue to protect your rest after symptoms resolve to avoid recurrence.  If your symptoms do recur, consult your lactation consultant to review possible causes.

 

References:

  1. Academy of Breastfeeding Medicine Clinical Protocol #4:  Mastitis, Revised March 2014.
  2. Mohrbacher, N (2010).  Breastfeeding Answers Made Simple, 659, 682-686.

 

Copyright © 2017 Gloria Dudney, RN, BSN, IBCLC, RLC