The challenges of breastfeeding, part 2

Burning in your nipples. An ache deep in your breast. And a reasonable question: I already got the latch sorted out. What now?

Pain that arrives after things were going well is telling you something different than the early pain we covered in part one. It usually comes down to one of three things.

Plugged ducts

The clue is location: pain in one specific spot in the breast.

With a plugged duct there’s no redness, no fever, no body aches. You may feel a lump — but a plug can sit deep enough that you feel nothing lumpy at all. And if you notice a small white bump on the tip of your nipple after a feed or a pumping session, that’s a milk bleb, which can lead to a plug of its own.

The usual triggers are ordinary life:

• Your baby started sleeping longer at night and you slept through it too, so the breast stayed full.
• You have an oversupply and your body was used to a certain number of feeds or pumps a day — then one got skipped.
• Real sleep loss, above the ordinary newborn kind. Someone was up teething, you went to that friend’s wedding, you hosted Christmas.

None of those are mistakes. They’re just what a full life looks like, and your breasts notice.

Clearing a plugged duct

Work through these together rather than picking one — the combination is what moves it.

1. Keep feeding or pumping at least every three hours. Don’t rest the breast.
2. Between sessions, put a cool or cold pack on the painful area. Less inflammation means faster relief.
3. Before you feed or pump, hand express in several different directions around your areola.
4. While feeding or pumping, massage very gently toward the nipple, starting just in front of the lump.
5. Ibuprofen helps, as do anti-inflammatory foods — pineapple, blueberries, leafy greens.
6. Cabbage leaves are worth trying for comfort and swelling. Rinse a leaf and tuck it into your bra against the breast.
7. Sunflower lecithin can help, especially with repeat plugs. KellyMom has a good overview of dosing.

Mastitis

Mastitis can start out feeling like a plugged duct, then turn into something else entirely.

What separates it:

• Fever
• Body aches
• Feeling flu-ish
• A red area on the breast that’s painful and warm to the touch
• Fatigue beyond the usual

Don’t wait on this one. If those symptoms are present, reach out to an IBCLC right away so we can intervene before it progresses. If things haven’t improved within 24 to 36 hours, follow up with your healthcare provider.

Thrush / Yeast

Thrush is a yeast overgrowth — you may also hear it called candida.

It can take hold in your baby’s mouth as well as on you, which is why it shows up as sore nipples and pain in your breasts at the same time. If you’ve recently been treated with antibiotics, you’re more susceptible to it. Because it passes back and forth between you and your baby, both of you generally need treating at once — which is the part that gets missed when only one of you is looked at.