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I dont want to stop but I think I have to.
November 19, 2012 at 6:44 PM

I am currently suffering from mastitis for the 5th time in 4 months. I cant afford to call in sick or go to the drs or pay for my medicine once a month for atleast a year. I guess I can supplement but I was hoping so much to ebf this baby like I did with my oldest. I just dont know what to do.


  • larissalarie
    November 19, 2012 at 7:19 PM
    I'm sorry you are struggling! I've never dealt with mastitis, but I think you are a hero for persisting this long considering. If breastfeeding is making you unhealthy, then you should do what you need to do!

    I'm not certain about this, but I've heard of lechtin(sp?) supplements being very good for those prone to plugged ducts. You might give them a try if you've got it left in you to risk another bout of mastitis.
  • Treatments for recurrent plugged ducts or mastitis
  • References and additional information
  • Risk factors for recurrent plugged ducts or mastitis

    Most mothers do not have repeated bouts of mastitis or plugged ducts, but when there is a history it’s always a good idea to look at additional risk factors. Make sure that you are aware of the symptoms of plugged ducts and mastitis so you can start treatment immediately. See Mastitis and Plugged Ducts for more information.

    Risk factor: Inadequate treatment of previous mastitis

    • A major risk factor for recurring mastitis is failure to completely recover from a previous bout of mastitis due to slow treatment, incorrect treatment (wrong antibiotic, for example), or treatment that was not long enough. Has the treatment of previous bouts of mastitis been delayed, inadequate or incomplete? If you were treated for a previous bout of mastitis, did you take a complete course of antibiotics? Have you had repeated prescriptions for the same antibiotic? Amoxil is often ineffective against the bacteria that causes mastitis. Some of the drugs “of choice” for treating this are Keflex, Dicloxacillin, and Erythromycin. Treatment should continue for 10-14 days. See the links below for additional information.
    • In addition, some moms get recurrent plugged ducts due to inflammation from an ongoing subclinical case of mastitis.
    • A related risk factor is a previous plugged duct. The duct can be deformed (“stretched out” a bit) at the location of a previous plug, which can put that particular area more at risk for plugging in the future. To reduce this risk, be vigilant about keeping the milk flowing well after a plugged duct is resolved.

    Risk factor: Poor milk drainage

    • Are latch-on and positioning optimal? Problems with either can affect milk drainage, and whenever the milk flow is hindered you are at risk for plugged ducts and mastitis. Always go back to the basics when you are having problems.
    • Are you supporting the breast from underneath? This is not always needed, particularly after the first few weeks. However, if you are having problems with plugged ducts or mastitis, lifting the breast from underneath can increase milk drainage.
    • Are you interrupting feedings or cutting them short (due to outdated advice to limit nursing duration, a busy schedule, taking care of other children or family members, etc.)? This can lead to a backup of milk in the breast and thus increases the risk for engorgement, plugged ducts, or mastitis.
    • Do you press down on the top or side of your breast to make extra breathing space for baby? This should not be necessary (baby’s nose is designed so baby can breathe while nursing) and can cause plugged ducts and/or sore nipples.
    • Look for anything that results in consistent pressure on the breast tissue — this can block milk flow and lead to plugged ducts. See if you can associate any of the following things with the location of the plug(s): Are you sleeping on one side or on your stomach a lot? Do you carry a heavy purse or bag on one side? Are you carrying the baby in a front carrier or sling? Do you wear an underwire bra that presses in one area? Are you wearing any type of bra that does not fit well? Do you wear a sleep bra that stays pushed up or to the side for much of the time at night? Are you wearing constrictive clothes?
    • Are you having problems with oversupply or engorgement? Do you feel that you have too much milk? Does your baby choke, gag, strangle when nursing because of a fast milk flow? Do you leak a lot? Remedying the oversupply will help to reduce your risk for plugged ducts and mastitis.
    • Do you use a nipple shield? Use of a nipple shield can result in poor milk drainage from the breast.
    • Sometimes moms who pump often (to replace missed nursings) are more prone to plugged ducts because a breastpump simply cannot drain the breast as effectively as the baby. You might try slightly moving the breastshields around to different quadrants of the breast so that these areas will be softened more efficiently.
    • Any kind of exercise that involves repetitive motions of the upper arm may lead to plugged ducts or mastitis.
    • Have your breasts been operated on, scarred, bumped, handled roughly, or otherwise injured? Any breast surgery can cause scarring and/or pressure on milk ducts. Other things that can cause plugged ducts/mastitis are an anatomical problem or variation in a particular duct, breast lumps or cysts, past injuries. In any of these cases, mastitis will recur in the same area of the breast. Recurring mastitis in the same location is one of the warning signs of a breast tumor (but this is rare cause of recurring mastitis).

    Risk factor: Nipple problems

    • Look for dried milk secretions on the nipple. If you notice this, apply a warm cloth to the nipple until the dried milk peels off and then try to express some milk. Sometimes this can cause a plugged duct because the duct cannot empty well through the nipple.
    • Have you had any nipple damage? Sore, cracked, or bleeding nipples can offer a point of entry for bacteria. Secondary staph infections may be responsible for delayed healing.
    • Milk blisters can cause repeated plugged ducts.
    • Secondary infections such as thrush (yeast/fungal infection) can cause inflammation within the milk ducts which increases the risk of plugged ducts or mastitis. Moms who are experiencing recurrent plugged ducts or mastitis due to thrush may benefit from taking an anti-inflammatory medication (like ibuprofen) to reduce the inflammation.

    Risk factor: Mother’s overall health

    • Have you been very tired or busy, worried or stressed? Many times mothers who have recurring bouts of mastitis are not getting enough rest or are trying to do too much. Mastitis is often the body’s way of telling Mom to “slow down.”
    • Have you been ill? Might you be anemic? Lowered resistance to infection or anemia can cause or contribute to recurrent plugged ducts. A blood test for anemia is a good idea when there is a history of repeated mastitis. Increasing foods containing natural sources of iron (or supplemental vitamins with iron) and a Vitamin C supplement may be helpful.
    • Are bouts associated with hormonal changes (ovulation or menstruation)?
    • Do you have food allergies? According to La Leche League’s Breastfeeding Answer Book, food allergies occasionally result in plugged ducts that occur either premenstrually or before ovulation:
    • In her book Breastfeeding Matters, Maureen Minchin theorizes that if a mom has allergies, recurring mastitis/plugged ducts might be caused by the “complex immune responses” that occur when she is exposed to an allergen. In a group of food-intolerant women, Minchin observed that their plugged ducts, “which rarely progressed to overt infection and which often recurred either premenstrually or before ovulation,” were “often accompanied by other symptoms of allergy intolerance.”

    • Do you smoke? Smoking can lower your resistance to infections.

    Risk factor: Mother’s diet

    • Are you eating regularly, and eating plenty of fresh food and vegetables? This will help to increase your resistance to infection.
    • Are you drinking to satisfy thirst? Lack of sufficient fluids can contribute to plugged ducts. Make sure you are drinking something each time you sit down to nurse or pump.
    • Too much saturated fat in the diet can be a problem. Reduce animal fats / limit your fat to polyunsaturated fats and take one tablespoon of lecithin (a dietary supplement available at most pharmacies, health foods stores, etc.) Adding lecithin to the diets of moms with recurrent plugged ducts has been shown to be very effective.
    • Either too much salt or too little salt in the diet has been linked to this problem.

    Risk factor: Baby’s health

    • Has your baby been ill? Occasionally, baby can have the bacteria in the back of his throat and be reinfecting mom with mastitis. This can be determined by swabbing the baby’s throat. If the culture is positive, then baby should be treated along with mom. A culture of your milk can also help your health care provider better determine the best treatment (antibiotic-wise).

    Treatments for recurrent plugged ducts or mastitis

    These treatments should be used in addition to your efforts to find and remedy the source of the problem. Keep in mind that if the source of your recurrent plugged ducts or mastitis is something fixable (for example: oversupply, infrequent nursing, too tight bra, etc.), then solving the underlying problem is the most effective thing you can do.

    Treatments: Dietary supplements and diet

    A Vitamin C supplement can be helpful for any mom suffering with recurrent plugged ducts or mastitis.

    Many moms have found that taking lecithin (a dietary supplement) can help to resolve and prevent recurrent plugged ducts.

    It is also helpful to make sure that you’re getting enough liquids, and to reduce the amount of saturated fat in your diet.

    Treatments: Homeopathic remedies

    Some moms with recurrent plugged ducts or mastitis have also had good luck with the followinghomeopathic treatment — 2 doses Hepar Sulphur and 2 doses of Phytolacca (allow pellets to dissolve in mouth). The doses are to be taken as follows:

    First, take Hepar Sulphur 30C – 3 pellets; 
    3 hours later, take Phytolacca 30C – 3 pellets;
    3 hours later, take Hepar Sulphur 30C – 3 pellets;
    3 hours later, take Phytolacca 30C – 3 pellets.

    Treatments: Acupuncture

    Acupuncture has also been used successfully for recurrent plugged ducts or mastitis.

    Treatments: Long-term, low-dose antibiotics

    If you follow the complete course of treatment with an appropriate antibiotic and the mastitis continues to recur, Dr. Ruth Lawrence (Breastfeeding: A Guide for the Medical Profession, page 281) suggests long-term, low-dose antibiotics for 2-3 months or even the duration of lactation. This type of treatment has broken the cycle of repeated mastitis for some women. If this treatment is chosen, it’s also a good idea to have an antifungal medication prescribed along with the antibiotic and/or to supplement the mother’s diet with acidophilus to lessen the risk of thrush.

    Treatments: Time

    If you are relatively early postpartum and your recurrent plugs/mastitis seem to be tied to an overabundant milk supply, a little more time may be the best remedy. Hormonal changes occur by about 12 weeks (give or take a bit) that make milk supply more stable and you may notice less of a tendency to get the plugs.

  • K8wizzo
    by K8wizzo
    November 19, 2012 at 7:33 PM

    Forceful Let-down (Milk Ejection Reflex) & Oversupply

    AUGUST 20, 2011. Posted in: SUPPLY WORRIES

    By Kelly Bonyata, BS, IBCLC

     Is forceful let-down the problem?

    Does your baby do any of these things?

    • Gag, choke, strangle, gulp, gasp, cough while nursing as though the milk is coming too fast
    • Pull off the breast often while nursing
    • Clamp down on the nipple at let-down to slow the flow of milk
    • Make a clicking sound when nursing
    • Spit up very often and/or tend to be very gassy
    • Periodically refuse to nurse
    • Dislike comfort nursing in general

    If some of this sounds familiar to you, you probably have a forceful let-down. This is often associated with too much milk (oversupply). Some mothers notice that the problems with fast letdown or oversupply don’t start until 3-6 weeks of age. Forceful let-down runs the gamut from a minor inconvenience to a major problem, depending upon how severe it is and how it affects the nursing relationship.

    What can I do about it?

    There are essentially two ways you can go about remedying a forceful let-down: (1) help baby deal with the fast flow and (2) take measures to adjust your milk supply down to baby’s needs. Since forceful let-down is generally a byproduct of oversupply, most moms will be working on both of these things. It may take a couple of weeks to see results from interventions for oversupply, so try to be patient and keep working on it.

    Help baby deal with the fast milk flow

    • Position baby so that she is nursing “uphill” in relation to mom’s breast, where gravity is working againstthe flow of milk. The most effective positions are those where baby’s head and throat are above the level of your nipple. Some nursing positions to try:
      • Cradle hold, but with mom leaning back (a recliner or lots of pillows helps)
      • Football hold, but with mom leaning back
      • Elevated football hold – like the football hold, but baby is sitting up and facing mom to nurse instead of lying down (good for nursing in public).
      • Side lying position – this allows baby to dribble the extra milk out of her mouth when it’s coming too fast
      • Australian position (mom is “down under”, aka posture feeding) – in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom. Avoid using this positioning frequently, as it may lead to plugged ducts.
    • Burp baby frequently if she is swallowing a lot of air.
    • Nurse more frequently. This will reduce the amount of milk that accumulates between feedings, so feedings are more manageable for baby.
    • Nurse when baby is sleepy and relaxed. Baby will suck more gently at this time, and the milk flow will be slower.
    • Wait until let-down occurs, then take baby off the breast while at the same time catching the milk in a towel or cloth diaper. Once the flow slows, you can put your baby back to the breast.
    • Pump or hand express until the flow of milk slows down, and then put baby to the breast. Use this only if nothing else is working, as it stimulates additional milk production. If you do this, try to express a little less milk each time until you are no longer expressing before nursing.

    Adjust your supply to better match baby’s needs

    • If baby is gaining weight well, then having baby nurse from only one breast per feeding can be helpful.
    • If baby finishes nursing on the first side and wants to continue nursing, just put baby back onto the first side.
    • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
    • Avoid extra breast stimulation, for example, unnecessary pumping, running the shower on your breasts for a long time or wearing breast shells.
    • Between feedings, try applying cool compresses to the breast (on for 30 minutes, off for at least an hour). This can discourage blood flow and milk production.
    • If nursing one side per feeding is not working after a week or so, try keeping baby to one side for a certain period of time before switching sides. This is called block nursing.
    • Start with 2-3 hours and increase in half-hour increments if needed.
    • Do not restrict nursing at all, but any time that baby needs to nurse simply keep putting baby back to the same side during that time period.
    • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
    • In more extreme cases, mom may need to experiment a bit with time periods over 4 hours to find the amount of time per breast that works best.
    • Additional measures that should only be used for extreme cases of oversupply include cabbage leaf compresses and herbs.

    Even if these measures do not completely solve the problem, many moms find that their abundant supply and fast let-down will subside, at least to some extent, by about 12 weeks (give or take a bit). At this point, hormonal changes occur that make milk supply more stable and more in line with the amount of milk that baby needs.

    Sometimes babies of moms with oversupply or fast let-down get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months. Even though your let-down may not be truly slow, it can still seem that way to baby. See Let-down Reflex: Too Slow?for tips.


     Additional Information

    Too Much Milk? by Becky Flora, IBCLC

    Oversupply by Kathy Kuhn, IBCLC

    Tips for taming a monster milk supply by Kathy Kuhn, IBCLC

    Gaining, Gulping, and Grimacing? by Diane Wiessinger, MS, IBCLC

    Oversupply: Too Much Milk by Anne Smith, IBCLC

    Colic in the Breastfed Baby by Jack Newman MD, FRCPC

    Am I making too much milk? from La Leche League International

    Fighting the Battle Against Oversupply  by Vanessa Manz

    Finish the First Breast First by Melissa Vickers (LEAVEN, September-October 1995, p. 69-71)

    Overactive Let-Down: Consequences and Treatments by Mary Jozwiak (from LEAVEN, September-October 1995, pp. 71-72)

    Common Side Effects of an Overactive Let-Down by Mary Jozwiak (from LEAVEN, September-October 1995, p. 69)

    Too Much of a Good Thing by Kate Drzycimski, from New Beginnings Vol. 19 No. 9, July-August 2002, p. 129.

    PDF Resolution of Lactose Intolerance and “Colic” in Breastfed Babies by Robyn Noble & Anne Bovey, presented at the ALCA Vic (Melbourne) Conference on the 1st November, 1997

  • aehanrahan
    November 19, 2012 at 7:48 PM
    Kate posted all of the information that you need. You most likely have an oversupply that needs to be reduced by block feeding. Start with 4-6 hour blocks on each breast and increase the blocks if needed. Some moms have to go to 12 hour blocks to get it under control.
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