mastitis – Pump Momma Pump

You might be hearing conflicting advice for treating clogged ducts or mastitis. You might even be hearing the phrase “new protocol/protocol 38” but what is this new protocol for mastitis, and how does it apply to pumping mommas?

First of all, what in the world is this creepy image. anyway? For those of you who are old enough, or have parents that like to frighten you around the holidays, you might recognize “HeatMiser” and “SnowMiser” from “The Year Without Santa Claus.” (Weird movie, do not recommend) It’s the first image I thought of when I opened up my laptop to write this post. The battle between heat and cold…. that’s what’s been going on for mastitis treatment. Should you apply heat, vibration, and massage? Or should you ice it and take medication? It’s truly been a battle of heat vs. cold.

The old advice: HEAT

The solution was once to use heat packs, vigorous massage, and vibration to treat clogged ducts and mastitis. This is no longer recommended. We now know that a “clogged” duct is not a solid piece of milk we must shove through. What is really happening, is that the duct has become inflamed and has narrowed, not allowing as much milk through. With the knowledge we have regarding inflammation, we know that HEAT and massage may make inflammation worse, not better.

The new advice: COLD

So how do we treat an inflamed milk duct? With ice and ibuprofen! Applying COLD to the breast can reduce inflammation, allowing milk to flow freely from the duct. Taking a nonsteroidal anti-inflammatory drug (abbreviated as NSAID) like ibuprofen may also help. (Tylenol/acetaminophen is NOT an NSAID, so opt for Advil/ibuprofen instead.) An ice pack designed for the breast, like this one by Lansinoh, or this multi-pack which can be used of little kid boo-boos long after breastfeeding!. You can also use a frozen bag of peas, which flexes nicely around the breast. Light, lymphatic massage may also be helpful, but refrain from applying vibration/vigorous massage to the affected area. And because I know you will ask… Yes, you can still feed baby your milk when you’re taking an NSAID anti-inflammatory medication or an antibiotic.

How do you know if you have mastitis?

The updated 2022 Protocol #36 guidelines from the Academy of Breastfeeding Medicine (ABM) published in May 2022 now assert that mastitis should be considered “a spectrum of conditions”, ranging from oversupply (hyperlactation) to inflammation, bacterial infection and abscess. LactApp covers it pretty succinctly in their post HERE . Mastitis can be:

Ductile narrowing/inflammation
Inflammatory mastitis (what we think of as unresolved “clogged ducts”)
Bacterial mastitis caused by Staphylococcus and Streptococcus
Phlegmon- suspected when mastitis worsens as a firm, mass without fluctuance
Abscess: An accumulation of infected fluid that needs to be drained
Infected galactocele- a significant volume of obstructed milk accumulates in a cyst-like cavity

… in easy-to-understand terms, please?
Contact your doctor if you are experiencing:

Prolonged unresolved clogs, or hard areas of the breast that don’t seem to be emptying when you nurse or pump
Redness of the breast (With darker pigmented skin, this may appear darker or a reddish-brown hue)
Burning sensation in the breast
Areas of the breast that are painful or warm to the touch
Any of these symptoms accompanied by fever and flu-like symptoms

Why has my milk supply gone down?

It’s normal to see a reduction in milk supply after a prolonged clogged duct or mastitis. Why? It’s actually your body trying to protect you! If milk has not be adequately emptied from one breast, it causes internal pressure inside the milk-making cells of that breast. This sends signals to your body to slow down production in that breast. These protective signals result in less milk being produced. For some mommas, this drop in supply is temporary. When the milk starts flowing again, the body often sends the message- “okay! milk is being removed, make more!” But sometimes that breast will remain at a lower output. This is why dealing with “clogs” as soon as possible is so important!

Implications for exclusive pumpers

The initial advice “not to pump” following the new protocol has confused exclusive pumpers (mommas who pump exclusively and do not latch baby at the breast). The protocol advises you to nurse on demand and not excessively pump. So, for exclusive pumpers, YES you’ll need to pump. I advise you to pump as you would normally pump- not longer or more often. Excessive pumping can lead to an upregulation of milk and a continued cycle of mastitis. Many mommas find that switching to a manual pump gives you more control and can help finesse the clog out. My advice regarding “clogged ducts” tailored for exclusive pumpers can be found HERE.

The short version:

In summary… The ABM protocol change in 2022 gave us a lot of think about, and in many ways, completely changes the way we treat clogs and mastitis. What we used to think of as a “clogged duct” is actually ductile narrowing brought on my inflammation. Mastitis is a spectrum of conditions in the breast, from inflammation which can be treated at home with ice and ibuprofen, to infection, which needs medical attention. Avoid intense massage and vibration. Choose a cold compress over a hot one. Nursing mothers should keep feeding on demand without adding additional pumping sessions. Exclusive pumpers are encouraged to stick to your pumping schedule as much as possible. Manual pumping or hand-expression is an excellent alternative in both cases.

SOURCES:

*This post is for informational purposes only. For medical advice or diagnosis, consult your medical provider.

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Chances are, you’ve heard some conflicting answers regarding clogged ducts lately…

Why all the different answers?

Our knowledge of breast anatomy/”clogged ducts” is continuously expanding, helping lactation professionals find ways to help their clients feel better, faster.

AMB Protocol #36

The Academy of Breastfeeding Medicine put forth the following protocol regarding Mastitis Spectrum in 2022. LactApp covers it pretty succinctly in their post HERE and HERE. Don’t want to dig into it yourself? I’ll give you the quick’n’dirty version here:

The ABM changed the verbiage from “clogged duct” to “ductile narrowing” to describe the way milk ducts can become inflamed and swell/narrow, not allowing the milk to fully evacuate that area of the breast.

They are NO LONGER recommending:

Vigorous and deep massage to the affected area
Use of massage tools/vibration directly to the affected area
Extra pumping or nursing
Applying heat to the area
Using castor oil or Epsom salts

They ARE recommending:

Nursing on demand
Reducing any extra pumping
Using anti-inflammatory drugs to reduce pain/inflammation (like Advil)
Icing the area to decrease inflammation
Supplemementing with subflower lecithin
Adding a probiotic into your diet
Light, gentle massage
Lymphatic drainage techniques

Taking an anti-inflammatory like ibuprofen can reduce swelling and allow milk to flow

(Disclaimer- The updated 2022 clinical guidelines from the Academy of Breastfeeding Medicine (ABM) published in May 2022 now assert that mastitis should be considered “a spectrum of conditions”, ranging from oversupply (hyperlactation) to inflammation, bacterial infection and abscess. The new clinical protocol from ABM outlines several key changes that significantly shift what we thought we knew about the condition, namely that plugged ducts are more accurately described as “ductal narrowing,” that ice and other anti-inflammatory treatments should be used to manage mastitis instead of heat, and that extra pumping and other measures used to increase drain the breast will only hurt, not help.
⚠️*****This advice seems directed at nursing mothers experiencing mastitis, NOT exclusively pumping mothers with incorrectly emptied breasts, and does not account for the additional reasons pumping mothers get clogs. (actually, they advise against pumping- obviously not going to work for exclusively pumping mommas, right?)⚠️Though they changed the verbiage and don’t use “clogged ducts” anymore, I believe that clogs are real and my advice has been proven to work to relieve clogs in my clinical practice.)

Pump Momma Pump’s advice for treating clogged ducts

*My advice is for pumping mothers who have discovered, after a pumping session, that part of the breast has not emptied and has remained hard and full of milk.* This often occurs due to incorrectly sized or off-centered flanges. If this happens frequently, please look into getting sized for a correctly fitting flange and use a quality pump that you respond well to.

So what if you discover a clog?
😖Try to clear it ASAP, as it can develop into mastitis if left untreated
😖I find that a slow squeeze of a manual pump works extremely well, especially if you purposefully off-center the flange toward the clogged area
😖Take an anti-inflammatory medication Like advil
😖Soak the affected breast into a bowl of warm epsom salt water before pumping
😖Pump on all fours, called “dangle pumping”
😖Use vibration between your nipple and the hardened area of the breast before pumping
😖Gently massage the breast away from the nipple toward the chest wall- look up “therapeutic breast massage” on youtube to see examples of this
😖You can try latching baby (or your partner, honestly) to clear the clog

Let’s sum this up with some DOs and DONTs:

👍DO– Apply ice and take an over the counter anti-inflammatory medication.
DO– Soak the breast in warm epsom salt or a warm shower before pumping.
DO PUMP! (Obviously!) I suggest using my advice for unclogging using a manual pump, found in my Manual Pump highlight.

OPTIONAL– Apply gently vibration between the nipple and the clog, but this wouldn’t be my first suggestion. Look up “therapeutic breast massage” and gently do that. Dangle-pump. Latch if you can/want to (baby or partner, honestly)

👎DON’T– Apply heat, vibration, and harsh massage directly to the clogged area of the breast.

💡 MOST IMPORTANTLY– Work with a lactation professional to figure out why you keep getting clogged ducts- could be as easy as a flange-sizing issue!

When to see a doctor

You are free to contact your healthcare provider at any point- open communication about your body and your health is encouraged. PLEASE call your doctor if:

You develop a fever (could be Mastitis and your doctor may prescribe antibiotics)
Abscess forms and needs care (Symptoms can include pain to the touch, warmth in the affected area, a breast lump, nipple discharge, and fever and flu-like symptoms.)
You need help removing a bleb on the tip of your nipple
The clog remains unressolved for multiple days (The doctor may be able to relieve it with therapeutic ultrasound)

Prevention is so important!

I have found, in my own clinical practice, that exclusive pumping mommas usually develop clogs for the following reasons (some of which may be unique to pumping mommas as opposed to nursing mommas)

Flanges that are too large
Flanges that become off-centered while pumping
Pump that inadequately empties the breast
Not replacing your valves regularly, which reduces suction power of pump
Skipped pumping sessions (milk left in the breast for much longer than you are used to)
Prolonged pressure on the breast (sleeping on your side/stomach, extra tight underwire bras)

Tag: mastitis

Hot or Cold for Mastitis?