There’s a lump in my boob
Oh fuck. It’s warm, and uncomfortable, and it’s solid. And it’s in my fucking boob. Oh fuck fuck fuck.
I fell asleep on the sofa with Robert, and River in the basket next to us. Normally, he’d have woken us up by midnight, and we make the preparations to move to our night routine. But he had slept until 2am, causing me to miss my midnight pump. And I’d fallen asleep directly on the left boob. It was engorged. I fed River straight away, being careful to fully drain it, and off to bed I went, hoping by morning it would be better. I was in total denial.
I woke up, and there it was. Worse than before. I pumped and fed on my regular schedule, but now even with the shields I was using for nipples that were on the edge of total destruction, feeding him directly from the boob was agony. Tear inducing agony. I tried to feed through it, as I knew his suck was stronger than the pump, and the best chance I had at clearing the blockage. And then came the chills. I knew this was mastitis. In an ordinary world, I’d have run to the GP straight away, as it’s only a 30 second walk from my front door. However, the surgery was closed and combined with a larger surgery in a different town because of COVID-19, and even then, all appointments were over the phone. I phoned, but to speak to the doctor I’d have to call back at 8.30am the next day. So I struggled through the rest of the day, attached to my pump, in and out of the bath massaging the boob and hand expressing, mainlining ibuprofen, using hot and cold compresses- anything I could find. I tried dangle feeding, which is where you lay your baby on their back, and on all fours, lower the nipple into their mouth. If you have a strong let down like I do, I truly recommend using a towel, this was a fucking mess, and River wouldn’t have it anyway.
I had to stop feeding him from it. I was only getting around 1oz in a 40 minute pump session, where I’d previously been getting between 3 and 6oz per boob in half the time! That was the scariest thing, thinking I might not have enough to feed him (worth mentioning that this experience was coinciding with his 3 week growth spurt which was hitting us a couple of days early, and he was eating more than usual). Out came the emergency formula- thank god he doesn’t turn his nose up at it.
The dr prescribed antibiotics the next day, but I was worried about taking them as I was so worried about thrush, or any other adverse effects in River. I knew they were safe for him, but still wanted to avoid diarrhoea, antibiotic resistance, and all the other shit things that were risks. My fluey symptoms had cleared up, so I deduced that the mastitis had been kept at bay, and I just had to work on clearing the blocked duct. The antibiotics wouldn’t have cleared the duct anyway, so I collected them from the pharmacy, but shelved them at home.
My step-mum is a health visitor, and she offered to put me in touch with a lactation consultant that she works with. I had 2 long FaceTime sessions with her, which were great. She showed me how to relieve the pressure that was now building up in my areola, and told me about jelonet to help with the fast healing of my nipples. During the second session she watched me feed River, and said that the latch looked like it had become a little shallow, probably as a result of me using the shields and him becoming lazy. She watched me pump, that was all fine. So armed with a couple of new tips, and confidence in what I was already doing, we went on with our journey.
But the blockage didn’t clear, and then another sprung up in the other boob. And then that one got mastitis. And it was worse this time. I spent a good 4 hours on the sofa absolutely wailing- my first and (so far) only mum meltdown. I just felt like absolute crap, because I was going to have to take the antibiotics. The pain of feeding off either boob was now almost as bad as some of my latent phase contractions, to the point that my body was shaking trying to feed him through them, and I couldn’t keep him latched for more than a minute because of the intensity. So then I felt bad because he would cry for more, and I couldn’t give it to him. And because of the blockages, I couldn’t pump as much as I was used to, and could only make one small feed after pumping both boobs for 40 minutes. I took the first tablet with a heavy heart, and went to bed for the night, exhausted and tearful, leaving Robert with the last of the breast milk bottles and instructions on how to make formula should he need it.
I felt better the next day, both physically and emotionally. I had a plan of attack, and I was going to stick to it come hell or high water. And over the course of a couple of days, things started to get better (a new problem was just around the corner, but at least *this* concern was dealt with). I’ll outline everything I did/tried/failed at/bought/used in a review post, but let it be said that I have no idea if any of it worked. It could have been one of them, a combination, or absolutely none of them, and just time and luck.
Sometimes it’s unavoidable. You’ll miss a pump, you’ll fall asleep on your front, whatever it may be. But being prepared to deal with it will do you a world of good. And, above all else, realising that you can’t be the best parent you can be if you don’t take care of yourself. I felt selfish for taking antibiotics, or for not feeding him from my boob, because that is what I believed was best for him. But it wasn’t best for me, and so really, it was almost more selfish for me to try and stick to that. As soon as I adjusted my mindset, my parenting was stronger. And that’s more valuable than anything else.
This post is for all the women like me, who were pushed to the breaking point with either blocked ducts, mastitis, or both. While I have my personal experiences, I’m not a medical professional (clearly). So, I’ve partnered with the brilliant Rachel Gallimore, a midwife and lactation consultant. She’s agreed to delve deeper into the symptoms and causes, the differences between the two, and what you can attempt to do about it. (You might see me pop up in bold throughout, with a few lockdown tips!)
I eventually managed to clear my very STUBBORN blocked duct, and mastitis. I tried pretty much every technique, product, and routine I could find, from the obvious to the downright weird, and I’ve listed them all at the bottom of this post. Now, because I threw so much shit at the wall, it’s hard to know what stuck in my case, but women I’ve spoken to have had success with each of the methods listed when used exclusively, while others had success with a mix.
The main aim of this article is to help you. If you’ve found this post, you’re likely having a really crap time with your boobs. I know your pain (physically and emotionally!) I really hope you find what you’re looking for- likewise, if you think something worked for you and you don’t see it listed, I’d love to hear about it!
So Rachel, What *is* a blocked duct?
Your breasts are amazing! They are full of ducts which are essential in the transfer of milk from you to your baby. A blocked duct is simply a duct with a milk obstruction.
How can it occur?
A blocked duct occurs when the breast is making more milk than the amount drained by the baby (or pump). Sometimes we get a blocked duct when our milk first comes in, usually around day 3 or 4. It can also occur if we begin to feed on a schedule and not responsively to our baby or our body. A poor latch can cause a blocked duct too, as can an ill-fitting bra.
How do I know if I have one?
First you usually notice a harder area in the breast, often only on one side. Sometimes it is accompanied by redness and engorgement, and it is likely to feel quite sore and tender. It might be painful to feed on this side and you might even be tempted to avoid feeding (don’t!).
How do I treat it?A blocked duct doesn’t usually require medical treatment and can usually be resolved at home with the right information and support. Treatment for a blocked duct is very easy to do yourself;
-before a feed grab a flannel, soak it in warm water, wring it out and place it over the blocked duct. It’s helpful to do this before each feed. Having a hot shower has the same effect, but you’re unlikely to do this before every feed!
- during the feed, firmly massage the blocked duct. Start in a circular motion behind the lump and work your way forwards towards the nipple.
- Aim to feed responsively. This means feeding your baby whenever he/she shows feeding cues (waking up, bringing their hands to their mouth or opening their mouth) AND whenever you want to, particularly if your breasts are feeling full or uncomfortable.
- Continue to feed from the affected side, just as much as from the other.
- Look after yourself! Keep hydrated, rest well and take analgesia.
- Get the latch checked to ensure baby is feeding effectively, (ideally by someone who knows breastfeeding and is able to take the time to watch an entire feed). I know, I know- you’re saying, Melissa, we’re in a lockdown, how can I do this! Never fear, Rachel offers FaceTime/Zoom consultations where this can be achieved.
How can I prevent a blocked duct? I really don’t want another one!
Avoid bras with underwiring, get fitted and don’t guess your size! Feed responsively and not to a set schedule, who eats at the same time every dayanyway? At each appointment with your Midwife or Health Visitor, ask them to check that your baby is latching onto the breast correctly. Again, you may find that your Health Visitor appointments can be done via FaceTime during lockdown. I had to ask, but mine was more than happy to so a video call rather than the scheduled voice call that my appointments are at the moment.
So now, what is mastitis?
Mastitis is the inflammation of a milk duct.
How does it occur?
Inflammation in the milk duct can result from a blocked duct which isn’t resolved. Or sometimes it occurs when bacteria enters the breast through damaged nipples, often due to a poor latch.
How do I know if I have it?
If you have mastitis you are likely to have pain in the breast which is tender to touch and may appear red on the skin. It is often hot to the touch, and you may have a fever. Mums with mastitis often feel unwell, and they can experience flu-like symptoms.
What are the treatment options?This will depend on the severity, the cause and how quickly it develops. Contact your midwife, health visitor or GP if you think you have mastitis.They are likely to recommend;
- Using a warm compress on the affected area before and during a feed, and a cold compress afterwards.
- Feed from the affected side as much as possible, without neglecting the other side! Aim to feed responsively.
- Keep hydrated and take regular analgesia. If you have mastitis, you really need to rest.
- See a breastfeeding specialist as soon as possible so someone can check your baby’s latch.
If you have a fever or these treatments above don’t work then you may require antibiotics.
What is the difference between a blocked duct and mastitis?
Mastitis is the inflammation of the blocked duct, essentially Mastitis is what can happen to the breast if a blocked duct isn’t resolved.
Rachel is a Midwife and Lactation Consultant who usually offers at home support in SW London. Due to current Covid19 madness she is offering 1:1 or group zoom support, contact her on Instagram @Rachel_Gallimore_IBCLC or call 07554473381.
Things I Tried
*REMEMBER! I AM NOT A HEALTHCARE PROFESSIONAL!*
Soya lecithin- This was recommended to me by the lactation consultant I spoke to. You can also use sunflower lecithin. I continue to take just one tablet a day even now (1200mg) , rather than the 3 a day I took while suffering. The idea is that by increasing the amount of polyunsaturated fats in the milk, you ‘thin’ the milk and stop it ‘sticking’.
*As with any medication, no matter how safe, check with your midwife/HV/LC/GP though, especially if breastfeeding/pumping, just to be sure.*
Lactation massage Roller- I found massaging with my hands was more painful than with this roller, made specifically for lactation massage of the breasts. This was also less taxing on the massaging hand, and you can use multiple parts of the instrument to get different types of massage. You’ll also get use out of this when not trying to work out a blocked duct, and I actually use it at most feedings/pump sessions, to make sure I get every last drop out and effectively drain the boob.
Reverse Pressure Softening- There was a lot of pressure built up in my areola, which was painful, but also meant that River could barely latch at all, let alone well. A tip I learned was to place your fingertips around the nipple, on the areola, and gently press in and hold for ten seconds. Then lightly twist (it’s not a painful twist, I promise!) and release. The swelling was immediately reduced. I did this before each feed/pump.
Epsom salt in the bath- I couldn’t quite get the angle to dangle my boobs in a sink of water with Epsom salt, so just threw a load in the bath. It’s supposed to help draw our impurities and inflammation in the body.
Best washes NBC- The peppermint in this body wash was cooling on my nipples, and I found that I could massage by boobs much easier when they were a bit sudsy!
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Hand expressing under water- I could apply a little more pressure while they were under water. Also, being able to see the milk come out in jets helped me work out how much pressure I needed to apply to potentially clear the block. If anything, it relieved engorgement well, which pumping and feeding weren’t doing.
Dangle feeding/pumping- On all fours above your baby, you lower your boob straight into their gob and feed them like that. The idea is that gravity combined with the sucking motion will help to clear it. LOTS of women have success with this. I did not. If you have a kid with a great latch I think it massively helps.
Massaging boob with pump- I found this mainly just ruined the suction the pump creates.
Hot pack on boob while pumping/feeding- Definitely helped to get a few more drops out.
Ibruprofen- I don’t know if this cleared the duct, but it certainly helped me handle the pain! But since ibruprofen is an anti-inflammatory, I would imagine it did some of the work.
Ice pack after pumping/feeding- Solely for pain in my case, and at least numbed the area.
Shampoo massager- I didn’t have a wide toothed comb (which is what is recommended), so used this scalp massager. You run the teeth over the blockage towards the nipple, a little like you’re trying to comb it out.
Shower jet- Hot water and the pressure of the jet combined are supposed to help break the blockage down so it can flow.
Cabbage when engorged- Only keep these on your boobs (with your nipples out, so cut a little hole, or layer leaves so that it’s still exposed) for 20 minutes if you don’t want to affect your supply. I only did it once a day as my supply was more important to me. Throw the leaves away after. If they don’t work, they’re at least nice and cool!