pumping, blocked ducts, and other challenges

[myk]

help! my baby is 4 days old. my milk came in yesterday, and i was able to pump enough to feed her without supplementing. but i'm having problems now!

first, she was born via emergency c/s due to preeclampsia. i have severe edema which includes breasts that are gigantic (a 40L bra is way too small), dimpled like grapefruit skin, extremely heavy, and sore. add to that the fact that my nipples, under normal circumstances, are flat. and they invert if they are stimulated. as it is right now, with the edema, you can't tell where my nipple is unless you really look for it. latching is impossible.

the only way i can get any milk at all is if i use reverse pressure softening to make the areola soft enough to compress. hand expressing has limited success. yesterday i had success with a hospital grade pump. because my nipples are so inverted, i decided to try medela breast shells to draw them out. bad idea! they pushed the areola back, but in doing so, i believe they compressed the ducts too much.

i now have extremely painful, lumpy breasts. there are red hot spots in a few areas. last night i was able to pump just over 3oz from the left breast in 15 mins, and just over 2oz in the right one in the same time frame. not bad for barely 3 days post caesarean birth. since wearing the shells i can get about a teaspoon of milk from the left breast in 20 minutes of pumping, and about one ounce from the right one in 20 minutes. hand expression does almost nothing for both breasts.

normally for blocked ducts i'd recommend nursing with the baby's chin toward the block.. but she can't latch at all. pump only. massaging the breast hurts, and seems to help very little (but i do it anyway, because a little help is still positive). i do NOT want this to turn into mastitis, especially so early in the breastfeeding relationship. please, anyone, if you have suggestions for any of the following please share!

-helping relieve edema in breasts and other areas where fluids pool

-releasing a blockage from a duct where there is no visible bleb, blister, etc.

-how to use a hospital grade pump to effectively drain a breast with a blocked duct

-what supplements or medications help relieve the pain and/or address the cause

-anything else you think is helpful!

[moongazer]

 Oh my!  You certainly are having a rough start :(  I am hoping things will improve for you soon!

I had a plugged duct while I was EP for my ds who was born with a birth defect.  The LC at Children's Hospital suggested using a warm, wet compress before pumping.  A disposable diaper works well because it holds the heat from the water and doesn't drip.  I used as hot as I could stand.  She also suggested massaging the lump WHILE pumping.  Using some sort of lotion made it easier.   I also took Soy Lecithin capsules 3 times a day.

Hope that helps! And congrats on the birth of your daughter!!

[anj_rn]

I went from a 36 c to a 36 H with my DS (no edema), so I know how you feel.

If you are still having that much edema, ask your OB if they can put you on a diuretic temporarily to get rid of the fluid (although you may have to pump and dump for a feed afterward). 

For the lumps, I second the warm moist compresses, they did wonders for me.  I would apply them for 15 minutes prior to pumping.  Then pump away.  For me the child's suction was better than the pump.  Have you tried pumping for 10-15 minutes and then trying to latch on, usually after pumping a while your nipples start pointing out.  (I have been EPing for 17 months now and I think mine might never be flat again).

I would also massage during the pumping, but after about 5 minutes.  The other thing was towards the end of my pumping session to lean forward so my breasts hung down more.  This helped me empty them.

If none of that works, put your DP to work.  After you pump, have your DP latch on to give your breast the sucking stimulation it needs to clear the duct.

[myk]

thanks! well, i got mastitis alright. 3 days of IV antibiotics followed by a week of oral abx. and my incision is infected too, sigh. but. since getting the antibiotics i've been able to pop several (7?) lumps in the left breast and (5?) in the right. there might still be some but i can't find any as of this afternoon. it was so gratifying.. pumped like crazy just after to try to flush out whatever was in there.

i tried latching her again today.. not the least bit interested, she arches her back and clamps her jaw shut. even though i say "milk" in the same voice i use when i give her EBM. it's a bit discouraging but i just can't give up..

i can't imagine EPing for 17 months! wow! what an accomplishment.. way to go mama!

[myk]

thanks! well, i got mastitis alright. 3 days of IV antibiotics followed by a week of oral abx. and my incision is infected too, sigh. but. since getting the antibiotics i've been able to pop several (7?) lumps in the left breast and (5?) in the right. there might still be some but i can't find any as of this afternoon. it was so gratifying.. pumped like crazy just after to try to flush out whatever was in there.

i tried latching her again today.. not the least bit interested, she arches her back and clamps her jaw shut. even though i say "milk" in the same voice i use when i give her EBM. it's a bit discouraging but i just can't give up..

i can't imagine EPing for 17 months! wow! what an accomplishment.. way to go mama!

[Orionsmama]

So sorry to hear this. Dont give up! It gets easier. When I went back to work I was pumping 2x a shift (or trying to, I'm a nurse and it can be very difficult to get the time) Because of the rush for time when pumping, I was ending up with clogged ducts and Ugh! they are so painful. I dont think the pump was emptying my breasts completely which was contributing to the problem. I found that placing a warm compress to both breasts about 10 minutes before pumping really helped with let down and seemed to help with a more productive amount of milk with each pump. Also make sure you have the correct size of breast horns for the pump. They come in small to x-large. If you have large areola and the horns are too small it can be very painful and fruitless. Most places that sell breast pump supplies have all different sizes. (check Target)  I often use a little olive oil to grease the horns before nursing, it makes the suctioning of the breast much more bearable especially for the first few weeks of nursing.

As for the clogged ducts a super super hot long shower with water directly to the breasts helps me a lot. 

[myk]

i actually have relatively small nipples - the standard size horn that comes with pumps is at least 2mm larger than my nipple. i don't know if that makes it a poor fit or if that's close enough. i think i've gotten rid of the majority of blocks.. they pop like blisters when they release.. oddly gratifying.

[PatioGardener]

I did warm (HOT actually) before pumping and ice and advil (ibuprofen) after to decrease inflammation (bless you LLL leader who suggested the ice and advil!)

ps nak, but feeling your pain and wishing you all the best for a good latch soon!