Can't empty breast, will this lead to mastitis?

[clairebear3]

I have been Eping my 11 week old DD for about 9 weeks.  The last three days I can't seem to get all the milk out of my left breast.  I can feel a hard area around the side, which gets lumpy as the day goes on.  I have tried a warm face cloth and a heat pack but it doesn't seem to help.  I'm pumping about 10ml less than normal out of that side each time.

Is this how mastitis starts?  How do you know if you have it?  I have also read about plugged ducts, is this something that you can tell by looking at the nipple?

The first night I leant over my DD's crib whilst pumping and I managed to get it out but now it doesn't seem to work, the other side of the breast feels a bit sore, help!!

[GoBecGo]

Can the baby latch at all?  If you were nursing the advice would usually be to imagine the breast as a clockface and line the babe's chin up with the hard spot (as that maximises the suction on the related part of the nipple.  That worked for me when i was heading for mastitis with DD1 (although she looked at me like i was a maniac when i knelt over her upside down to nurse!).

If the baby won't nurse maybe you have a "bumpy" shield for your pump and could line the bumps up with the hard spot...?  Or a friend with a nursling who would cross nurse and help you out?  Other EPers will come and help i'm sure.

[MamatobabyA]

Is it sore?  Red and warm?  If not, then I would guess it's just a plugged duct.  Have you tried massage while pumping?  Sometimes that will empty the plug.  I know it sounds counter-intuitive but you might try some ice before you pump.  The ice will reduce swelling and make it easier to empty that duct. 

Good Luck Mama!

[clairebear3]

My baby can nurse a little but not for a whole meal (found out today it's because she has a very recessive chin) but I will try the clock thing.  I rang my midwife and she said to apply a hot compress before nursing or pumping, then a cold one and then cover breast in cottage cheese for 15mins!  Oh well I will try anything!

It's not red but it feels really heavy and generally sore, I tried massaging like crazy for the last two days but it just didn't help.  I will keep trying the hot and cold compresses but i'm not sure if I will BF at night, with that bottle feeding and pumping etc it will take nearly two hours... I have a flexi-shiel on the pump but I don't really think it has bumps on it.  The midwife is going to pop by tomorrow so I will let you know if she has anymore weird advice!  No fever yet so here's hoping I got it early enough.

Is there any other way to help a plugged duct?  I generally don't put any cream on my nipples, should I?  Is the plugged duct on the inside or outside?

Thanks!
 

[GoBecGo]

The plug is on the inside - sometimes you can feel a sort of tough spot or lump towards the nipple from the hard spot but rarely ON the nipple (i got one once and it was about an inch back from the margin of my areola, with the hard/full spot beginning almost right behind it and spreading out as it got farther back).  Sometimes applying heat and cold by turns can help it.  I would try to nurse the baby when she's hungry with her chin in line with it.  I have an avent isis pump, if you google images on it you'll see what i mean by bumps.

Also don't despair - it's not mastitis yet and it sounds like you are moving SOME of the milk each time, just not all of it.  Hopefully it'll resolve soon - i too was told that about cottage cheese (well, quark, which is pretty much the same).  I never had to use it as the chin/clockface thing worked for us, though it was a rough night sorting it out (i had to nurse her every hour from the bad side, while pumping the good side to keep it empty as she was only about 6 weeks old and couldn't manage 2 breasts every hour!).

Good luck!

[HappyHappyMommy]

Hi clairebear,

I EPed and did have mastitis twice and both twice, I ran a fever which increased quickly (e.g. in less than six hours), so I'm hopefully from what you've written that you don't have mastitis yet! It also sounds to me like a plugged duct (inside the breast) and I had those too and, after my first bout with mastitis, I was especially vigilant about trying to get rid of them because I didn't want to risk getting mastitis again. Because my DD couldn't directly breastfeed at all, I couldn't use the baby's chin technique. Here's what helped me:

--heat: warm compresses before and during pumping.

--massaging the lump while pumping, using my thumb and pressing on the lump and pushing toward the nipple.

--just pumping the breast with the lump for a few minutes and altering the suction and speed and seeing if that helped.

--hot showers: I had a hand held sprayer and would put that right near the lump. I did lose a bit of milk that way, so I tried the other techniques first.

I'm sending good thoughts your way!

PS For me, getting rest was always helpful to my pumping and to being able to take care of and enjoy my baby and getting other stuff done, so if I were in your situation, I would probably try the baby chin's technique during the day, but not at night, so that you can keep your nighttime feeding and pumping sessions shorter. That said, I didn't have the option of the baby's chin technique, so I'm just taking a best guess at what I would have done if that was an option.

PPS I never tried ice, so I can't advise on that, but if I was still pumping and had a lump, I'd give it a try!
 

[clairebear3]

Success!  The clock face thing really worked :)  I had been applying the compresses and cheese and had let her BF twice before she got too cranky and then at the last feed before bed, I sprawled myself out on the bed, held DD like a football under my left arm (the problem was left side of left breast) poor thing was nearly upside down and let her nurse.  She nursed surprisingly well but I still didn't think it would work until I took her off and felt my breast, it was completely gone!  No hard area of milk, no lump and no pain.  I couldn't believe it!  What a good job I posted here :)

I'm really glad I know what to do if it happens again as we are going to visit family in the UK in 10 days and am paranoid about having some kind of milk disaster when we are there.  I had bought a second hand pump to keep as a reserve and this happened after I had used that pump once, it couldn't be from that could it?  Maybe it was just a coincidence.

And yes it really does seem to make a difference to my pumping if I can get some rest or just half an hour to myself during the day, strange eh?

I'm definitely going to be more vigilant now when I pump and massage absolutely everything out.

Thanks so much for your advice!
 

[GoBecGo]

YAY!  What a great update mama, well done! :D

It could have been the other pump in the sense that it might have missed a bit (due to unfamiliarity with it, or it being a slightly different shape or whatever, i have an avent isis (manual), a medela swing (electric) and a tommee tippee (electric).  I get fab results with the swing but cannot get a letdown with the isis (though it empties well if i nurse from the other side as i pump) and literally cannot get a single drop out with the tommee tippee even if i already have letdown) and then the bit that was left got blocked a tiny bit and you, unaware of it at the next pumping, missed it a second time so it made a proper blockage.

I would just be mindful if you're using the other pump that you massage that side and rotate the pump a little when you use it, to try to make sure you get it empty.  Honestly if you have your babe with you and she can manage the chin-aimed-unblock i wouldn't worry, you know just what to do if it happens again. :D

[clairebear3]

Yeah i'm so glad!  I'm going to try the other pump again at some stage and then maybe use my regular pump straight afterwards to see if i'm really empty or not.

My midwife gave a tip today, in addition to the cottage cheese that a good idea would be to grate some fresh ginger into a pan of water and let it boil/steep, then dip a face cloth into it (regularly refreshing it) for 15 mins, it's also meant to help really well...
 

[HappyHappyMommy]

Originally Posted by clairebear3 

Success!  The clock face thing really worked :)  I had been applying the compresses and cheese and had let her BF twice before she got too cranky and then at the last feed before bed, I sprawled myself out on the bed, held DD like a football under my left arm (the problem was left side of left breast) poor thing was nearly upside down and let her nurse.  She nursed surprisingly well but I still didn't think it would work until I took her off and felt my breast, it was completely gone!  No hard area of milk, no lump and no pain.  I couldn't believe it!  What a good job I posted here :)

I'm really glad I know what to do if it happens again as we are going to visit family in the UK in 10 days and am paranoid about having some kind of milk disaster when we are there.  I had bought a second hand pump to keep as a reserve and this happened after I had used that pump once, it couldn't be from that could it?  Maybe it was just a coincidence.

And yes it really does seem to make a difference to my pumping if I can get some rest or just half an hour to myself during the day, strange eh?

I'm definitely going to be more vigilant now when I pump and massage absolutely everything out.

Thanks so much for your advice!
 

That's great, clairebear!

In terms of the pumps, I had 2 and one was better at emptying my breasts than the other. I usually used the one that was better, but if I needed to use the the other one several pumps in a row (e.g. when I was traveling), I did extra massaging to make sure I was emptying. Also, I found that as long as I was regularly emptying (with either pump), I was ok, so if I needed to do a pump where I couldn't fully empty, I was ok. That came in handy when I was traveling because I was comfortable pumping (with a nursing cover) at the airport, but not pumping and massaging at the airport!

[clairebear3]

Another day another plugged duct   Well it seems to be the same one, I noticed it last night, I tried to BF her in the night but it didn't work.  I had trouble getting her in the right position but I think maybe it worked last time because it had only been 3 hours since I pumped so I didn't have that much milk, this time at the night feed it had been 6 hours and because my LO can't BF for very long I think she just sucked the rest of the milk and it didn't help the duct.  I'm going to try at the next feed, then it will have been 3 hours and hopefully she can get it out!  I am hopeful though because at least this is the first day of the problem this time and my whole breast isn't killing me yet.

I hadn't used the new pump so that can't be the problem but I made a hands free pumping band from my cesarean tummy band.  I though this was super handy because I could pump/eat/type etc but i'm thinking that may be the problem because it's super tight.  The horns are really squished into my breast so i'm going to stop using it.  It's a shame because it was saving me so much time.  I have tried just using hair bands to hook upto my bra but that feels really insecure...

So i'm covered in cottage cheese again

[GoBecGo]

Can you try an old t-shirt?  One that is snug but not skin tight and quite thin...?  Just cut a slit (or two) for the backs of the horns to come through.  I did it when i was pumping for a friend after i had DD2 - you have to hold it in place while suction gets established, but then the tee is enough to keep it all in place.

[clairebear3]

Yeah that might work, I want to figure something out because it was so handy.  I also have the type of horns that don't detach by themselves, they remain attached to the screw top like this...

http://www.google.com/imgres?um=1&hl=en&client=firefox-a&rls=org.mozilla:nl:official&biw=1392&bih=720&tbm=isch&tbnid=GMe9ChP0vBkLIM:&imgrefurl=http://www.thefind.com/family/browse-ameda-breast-pump-replacement-parts&docid=kUAvJxTmCbiiOM&imgurl=http://i.tfcdn.com/img2/_wmPXEwAY3I04WbIzkwpjk_MS4lPS8zNzKlkyCgpKbDS18_MTUxPLdYrzsgvKCrXS87P1XfNy84vSvUGKtcviDc2NDG3jDc0NjI1NHLUyypIBwA*/fyVMtP8A&w=180&h=180&ei=03IJUJfFIMK1hAe7ysj-CQ&zoom=1&iact=rc&dur=492&sig=109299849982097075377&page=1&tbnh=144&tbnw=144&start=0&ndsp=19&ved=1t:429,r:3,s:0,i:84&tx=121&ty=77

so you need to have quite a big slit to fit the whole horn through...
 

[GoBecGo]

Hmmmm....too annoying to pop horn through then assemble the whole thing...  Big slits and safety pins to keep them shut when the horns are in?