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Engorgement!
Engorgement!
October 10, 2024
One of the most frequent follow up questions I get is about Engorgement and Clogged Ducts. For whatever reason, oversupply, baby skipped a feed, baby slept late, baby was at home and grocery shopping took a little longer than expected…
Sometimes we don’t get to empty the breast effectively, fully, or as much as usual. There’s so many reasons why a clogged duct happens or engorgement happens. Let’s not get into that. I can preach what not to do all day, but if you’re reading this we’re past that and it’s happened, now your boob hurts!
Today we’re going to talk about engorgement and how to get through it. Plugged ducts are another beast. I’ll get to those another day. I swear.
What to do? For starters, keep feeding your baby!! Are you exclusively breastfeeding at the breast? Keep doing it, frequently! Exclusively pumping? Keep doing it, on your regular schedule for 15-20ish minutes. A good general rule of thumb would be a few minutes past the flow ebbing. So if you’re just seeing a spirt here and there or a trickle, give it another minute and then stop.
Sometimes your “milk comes in” (your milk has fully transitioned from colostrum to mature milk), it REALLY comes in and your body hasn’t had the chance to really regulate how much it needs to make yet. That 20ish minutes would be a good goal here.
Now, for what you really came for, how to make it feel better! Sorry I have no magic wand or magic fix, but here are a few steps to help give you some relief.
First up, ICE!!!
Yes, ice. While engorgement starts off due to milk stasis (milk isn’t moving or flowing), it usually leads to inflammation in the surrounding tissues, this is where the pain comes in. What do you do if you have a swollen ankle? An injured wrist? Ice! 15-20 minutes at a time (don’t freeze your boob off).
Ways to ice:
Ice pack - this is a little harder, literally. Ice packs are often a hard container and don’t form around the breast well. However, if it’s all you’ve got, then use it!
Frozen Peas - mark it and toss it back in the freezer to re-use, just make sure you mark it well so it doesn’t accidentally end up as dinner after being thawed and refrozen.
Cold diaper - Toss crushed ice in between the layers of a diaper and keep in the freezer, also great for the perineal area in the postpartum period
Cabbage leaves - crunch the leaf up a little and place the whole thing around your breast, throw it away when it gets warm. Replace and do this for 20-30 minutes. There's some science that says cabbage leaves help reduce inflammation. I also think the cool leaves fit perfectly around the breast and feel very soothing. Use a sleep bra or another loosely fitting bra to help hold the leaves around the breast.
Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Cabbage. [Updated 2024 Apr 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501774/
Kasarello K, Köhling I, Kosowska A, Pucia K, Lukasik A, Cudnoch-Jedrzejewska A, Paczek L, Zielenkiewicz U, Zielenkiewicz P. The Anti-Inflammatory Effect of Cabbage Leaves Explained by the Influence of bol-miRNA172a on FAN Expression. Front Pharmacol. 2022 Mar 24;13:846830. doi: 10.3389/fphar.2022.846830. PMID: 35401203; PMCID: PMC8987499. Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987499/#:~:text=In%20this%20paper%2C%20we%20have,proinflammatory%20activity%20of%20TNF%2D%CE%B1.
Next, Breast Gymnastics!!
It’s all the craze, you’ve probably heard of it. It’s simple, it’s easy, it’s relieving. Find a comfy position, lay down, sit up, whatever. Take your bra off and put some type of towel or blanket around you, it may get a little messy.
Now, GENTLY maneuver your breast to the left, then the right, then do a circle. Movements should be gentle, slow, and firm. Use your hands to cup and support the breast during movement. The idea is that you're getting the breast moving to help get the milk moving. Do this with both breasts a few times and alternate with light massage.
Now, Massage!!
Let’s talk massage. GENTLE massage. There are no muscles in the breast, you’re not trying to massage out knots like you do a sore muscle. Instead we’re trying to encourage milk flow and lymphatic drainage.
Lay flat on your back, with oiled hands, vitamin E, coconut oil, baby oil, whatever massage oil, just make sure to rinse your nipples off, slippery nipples are hard to latch to, 😁. You’re going to GENTLY slide your hands towards your armpits. Remember, it’s inflammation that is causing a lot of the discomfort. We want to encourage lymphatic drainage, and that needs to go towards the armpits.
You can do some sliding, gentle tapping, or finger walking, just remember to KEEP IT GENTLE. Do a few cycles, don’t do this for a prolonged period.
Lastly, Get an IBCLC!!!
Of course you knew that was coming. Book with me, or someone else, just book with SOMEONE! Especially if you haven’t met with one yet, or if this is a recurring problem, or if you just want a cheerleader.
May your milk flow and your latch be deep!
More Resources on FAQ topics
Clogged Ducts
Clogged Ducts
October 17, 2024
I talked about engorgement a little in my first blog. Engorgement is when the whole breast feels overly full and can be sore, tender to the touch, or downright painful. Today, I'm talked about plugged or clogged Ducts.
The idea that many have of a “clogged duct” is that the milk is stuck there in a duct. In reality it can be a number of things. Milk stasis (milk not moving), trauma to the breast, previous trauma or surgeries that cut off the duct from the exit point, or something as silly as the underwire in your bra repeatedly rubbing in the same spot can all cause a “clogged duct” or the feeling that we refer to as such.
Generally speaking, it's one spot that may feel tender, hard, painful, or even have a hard nodule. It may be red or swollen. like engorgement, plugged ducts can lead to mastitis if not treated properly.
So, what do you do? Lots of things! It's a gradual thing, no magic wand. Sorry. But do some or all of the following and hopefully there will be some relief!
It’s important to note, I am not a doctor. I am not a dietician. I am not a homeopathic practitioner. Like any product and treatment, you should be researching and deciding what would be best for you and your baby in collaboration with your providers.
If plugged ducts persist, turn to hard, red, or hot areas on the breast, you develop a fever, and/or flu like symptoms reach out to your health provider! It may be turning into mastitis. Untreated mastitis can turn into an abscess. Don’t let it get that far.
If you’re having recurring clogged ducts and engorgement REACH OUT TO A LACTATION CONSULTANT.
Heat vs Cold
I know you read it everywhere, warm compresses and heat packs. However, realistically if it's painful, you're past the point of needing a heat pack. If it feels better with heat, I won't begrudge you that, but limit it. Remember, just like engorgement, the inflammation of the surrounding tissues is causing a lot of the discomfort and what do you do for inflammation? Ice!
Yes, heat can help with milk flow in the beginning of a feed/pumping session, but remove it as soon as milk flows. The idea is to help with milk flow but not contribute to inflammation. Cold helps with inflammation.
Ice packs, cabbage leaves, all those things I talked about in my engorgement post.
Continue breastfeeding/pumping as you normally would. Breastfeed in different positions, gently massage the area, GENTLY. No deep tissue type massages.
Poultices
Yes, straight from the medieval times. Not everything they did was crazy! There are a few options for poultices. I just love saying that word. Makes me feel like a healer in a dungeons and dragons cosplay. Sorry, sidetracked. Right, POULTICES. Potato poultices, Castor Oil poultices, vitamin E poultices. They're all made essentially the same way.
Potato
Shred or slice a medium white potato
Gently wrap your shredded potato in a paper towel or cheesecloth, if slicing, just place slice slice directly on the breast
Place against the sore area and leave for 15-20 minutes or until dry
Do this several times throughout the day
Vitamin E/Castor Oil
Keep away from the nipple! it can give your baby stomach upset or diarrhea when ingested!!
Soak a soft cloth in vitamin E and place on the area
Cover the cloth and breast with plastic wrap to help contain the mess
Supplements
I AM NOT A DIETICIAN. All I can do is give you the names of some that I’ve heard of from other IBCLCs and have done limited research on. DO YOUR OWN RESEARCH. SPEAK TO A DIETICIAN.
Sunflower Lecithin
Can be taken in liquid or capsule form
Talk with a dietitian if you have inflammatory gut issues
Choline
A supplement recommended for pregnant women
Evidence that it can help with recurring clogged ducts
Again, talk to a dietician
Phytolacca
30cc every 2-3 times a day until noticeable improvement
Follow with a Homeopathic Practitioner for more information and assistance with homeopathic remedies
Time
A clogged duct does not resolve overnight. While you may get the milk to move, often before you’ve even begun to feel the discomfort of the inflammation, it takes time for the surrounding tissues to heal and go back to normal. It’s going to take a few days, sometimes up to a week to resolve completely.
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