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
(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)