An alternative approach to plugged ducts and mastitis

Anytime I’ve told somebody that I have an oversupply of breastmilk, I always get responses like, “you can’t have too much of a good thing” or “that’s a good problem to have”.

Those are half truths. But they also don’t make anyone feel any better. Yes, it’s true I have sufficient milk to feed my child, I am SO thankful for that. I can be thankful for what I have and still be frustrated with the consequences of what I’m experiencing. Even though I attended breastfeeding classes while pregnant, met with an IBCLC and read books on breastfeeding, I still didn’t fully understand the consequences of allowing my breasts to be fully engorged until it was too late.

Milk supply is a dynamic process so I hesitate to claim the “oversupply” title so directly. My child breastfeeds a lot. Then on some days, he breastfeeds less. It may take a couple days for my supply to catch up or to change my pumping schedule on the days I’m working. In the first 3 months postpartum, a new mom’s milk supply fluctuates drastically as the body adjusts to baby’s needs. I’m doing my best to be flexible while also meeting the needs of my child (and that means breastfeeding for more than just hunger. After all, 'I gave birth to a baby, not just a digestive system.’). As I’ve learned through The University of Motherhood (don’t you wish that was a thing?!), I gradually figured out how to adjust my feeding routines to reduce or increase my supply as needed.

Long story short, I’ve had plenty of opportunities to get plugged ducts and mastitis. Working so hard throughout preconception, pregnancy and postpartum to build and maintain a healthy microbiome for myself and my baby, I wanted to do my best to avoid using prescription antibiotics at all costs. I’m not against them if they are necessary, medicines always have their place, but if I can clear the infection before they’re needed then it’s a win-win: I’m out of misery and we both get to retain our healthy microbiomes.

Disclaimer: I recognize that I am not the top expert but many of these recommendations were learned from the experts: Naturopathic Doctors (ND), midwives, IBCLCs, herbalists, etc. I share these only to share what worked for me and the other mamas who I’ve shared these tips with. Please consult consistently with an educated holistic healthcare provider/IBCLC before taking any medicines (natural or not) or drastically changing your milk supply. Please follow your doctor’s orders should conventional medicine be necessary. The following are strategies I have followed to clear plugged ducts and mastitis.

My most recent bout of mastitis, caused because my 11 month old (at the time) came to the realization that solid food makes him more satiated than breastmilk :)

My most recent bout of mastitis, caused because my 11 month old (at the time) came to the realization that solid food makes him more satiated than breastmilk :)

Plugged milk ducts


A plugged duct (also called blocked duct) occurs when milk flow is cut off, like creating a dam in a river. The breast tissue where the block exists typically feels tender, warm, and lumpy. Clearing the duct is essential to preventing mastitis. This may sound like a lot of work but with

Rest! but balance with micro movements like range of motion, gentle massage and others listed below

Minimize pressure on the breast

  • Wear loose fitting bras/avoid tight bras

  • Avoid sleeping on the belly

  • Avoid wrapping baby too tightly to the chest 

  • Use the correct size flange for your breast pump if pumping.

  • Avoid pumping “too hard”. This is what caused most of my bouts of mastitis: I was in a rush at work and turned up the pressure on the pump. Trust me, whatever is rushing you can wait. It’s not worth the risk.

Stay hydrated

  • Cut down on caffeine (coffee and tea are the biggies)

  • Drink enough water or herbal teas (obviously ones that are safe during breastfeeding)

  • You may need electrolytes especially if you are following a lower carbohydrate diet. You can order some here.

Your baby is your best helper

  • The closer the lower jaw is to the plugged duct, the more likely it will get unplugged.

  • Vary nursing positions. See a how-to video here.

Use Contrast Hydrotherapy

Only heat it while you’re nursing or pumping because heat can increase flow (and thus production). Use cold to slow the flow once you’re done nursing or expressing milk.

  • Warm compress, bath or shower 10 min, frequently throughout the day

  • Contrasting compresses: freeze grated potato then put that on the plugged duct(s) immediately after a bath/shower/hot compress. Allow your body to heat up the frozen potato then remove and apply heat. Alternate for at least 24 hrs or until the duct clears. (The grated potato helps draw out the inflammation and loosen the rigidity of the duct. Potato also holds on to cold temperature well like cabbage leaves but doesn’t directly decrease production like they do.)

Adjust milk supply, if necessary

  • Block nursing to decrease supply: Nurse from one side for 3 hours then switch to the other side. It’s all about feedback inhibition: if your breast is full, it will signal the body to decrease production. On that note, if you keep pumping, you will continue producing excess. So there’s a fine balance between allowing your breasts to stay full enough to signal slower production but not too full that it promotes plugged ducts.

  • Cold Cabbage leaves can be used to decrease supply but they can work quickly so be mindful to only use them as necessary. I once used them while alternating heat for 24 hours and saw a significant reduction in my supply, which was desired but also shows how powerful they are.

Herbal Remedies /Supplements

To support lymphatics, milk flow, milk thickness, and immune response.

  • Herbal tincture: “Happy Ducts” by Wish Garden, promotes lymph flow. 2-3 droppersfull in hot water 3-4x/d

  •  Galium (Cleavers) tincture 1 tsp 3-4x/d. I recommend the Wise Woman Herbals brand, offered in my online dispensary.

  • Essential oils (see below)

  • Vitamin C- 500 mg 3x/d or to bowel tolerance. I use liposomal Vitamin C for better absorption and less impact on bowels (offered in my online dispensary).

  • Colostrum- 2 capsules/d (offered in my online dispensary)

  • Sunflower lecithin may impact the viscosity of the milk, possibly reducing recurrent plugged ducts though it may not do much in terms of treating an already plugged duct. For prevention: 3600-4800 mg lecithin per day or 1 capsule (1200 mg) 3-4x/day. You can purchase one through my online dispensary here, categorized under the “women’s health” favorites.

Manual Therapy

  • Massage gently from the sore area toward the nipple 

  • Massage lavender, tea tree and/or Dottera OnGuard essential oils into the lymph nodes near your armpit and the plugged ducts, 3 drops each when you apply heat. I like to this immediately after a shower/bath.

  • Use a dry skin brush to promote lymph flow. Watch a tutorial here.

  • Cupping may prove beneficial for helping to clear the plugged duct. Work with a trained provider (acupuncturist or massage therapist). I recommend Thrive Integrative Health locally.

Mastitis

Milk stasis can occur if flow does not resume promptly after the duct has become plugged. Just like a body of water that remains still with no inflow or outflow of water, bacteria from your skin can enter the duct and stimulate flu-like symptoms. You may feel like your life is ending, I know I did. The headaches, joint-pain, fever and weakness were so debilitating, I could hardly get out of bed. This is the body’s way of making you rest, so listen!

This is the protocol I used:

  • Work diligently to clear the plugged duct

  • 20-40 drops echinacea tincture 6x/d. For prevention: 10-15 drops 2x/d for at least 5 days. You can purchase one through my online dispensary here, categorized under the “women’s health” favorites.

  • Anti-inflammatories like ibuprofen and/or curcumin at therapeutic doses (I used these only if I was having trouble sleeping due to massive headaches) please consult your doctor, especially if you choose to take these .

  • Pulse Electro Magnetic Field (PEMF) Flex Pulse on continuous mode at 10 Hz, applied to the site of the plugged duct

Closing Thoughts

I don’t wish mastitis upon any woman. Though, I imagine if you’ve made it this far, you’ve needed these suggestions and you’re not just reading it for pleasure. I’m sorry.

Every day I’m working with mamas-to-be and new mamas to optimize health and minimize illness. Nutrition can be a major piece in the wellness puzzle. If you think our philosophies might be congruent and you’d like to work with me, consider scheduling an appointment. If you found this article helpful, please share in the comments below what tips helped most and share this post with a mama in need.

Fermented Ketchup recipe

When I started making fermented foods, I dove right into making all the things. I loved the idea that for thousands of years, this was how people preserved their harvest.

I’m often encouraging my patients to increase probiotic foods in their diet but am sometimes faced with comments of “but I hate sauerkraut!” Or “but I can’t eat dairy”. I get excited when I can share with people the fact that there are LOTS of options. You don’t have to like sauerkraut to enjoy the plethora of fermented foods.

Most people like ketchup and my guess is you’re probably looking for a way to “sneak” some probiotic foods into your kids diet too, am I right?

The way I’ve made my fermented ketchup over the years has evolved but this is the way I enjoy it best. I use either sauerkraut brine (sometimes kimchi brine) or whey (liquid runoff from yogurt) as the probiotic culture. You can use some from store-bought fermented veggies or you can purchase the brine separately from your natural foods market, make sure they are labeled “raw” or “probiotic” and are from the refrigerated section.

fermented ketchup

Fermented Ketchup

Ingredients

  • 2 6-oz cans tomato paste

  • 2 tbsp raw apple cider vinegar

  • 3 garlic cloves, pressed

  • 4 tbsp sauerkraut brine or whey

  • 1/4 cup raw honey

  • 2 tsp sea salt

  • 1/4 tsp onion powder

  • 1/4 tsp ground allspice

  • 1/4 tsp ground clove

Preparation

  1. Stir all ingredients into a pint-sized jar and blend fully with a hand blender/immersion blender.

  2. Cover loosely and allow to sit at room temperature for 24 hours.

  3. Cover tightly and refrigerate.

Note: If you are following the 21-Day Sugar Detox, see this recipe for a 21DSD friendly ketchup recipe that uses slow cooked green apples as the sweetener.

Quince Sauce + Cough Remedy

Last week I picked about 50 lb of quinces from a neighbor’s tree. For those who are unfamiliar, quince is like a blend between an apple and a pear with the fuzziness of a peach, typically consumed well-cooked. In Persian cooking, it’s commonly preserved as a jam “moraba” or made into stews “khoresh”. Using the flavors of my Persian heritage, I’ve been making this quince sauce all week.

If you’re interested in buying quince but not sure where to find it, check your neighborhood first but you may also find it at a Persian market (like Sahand Persian Grocery in Kirkland or Oskoo Market in Bellevue, locally) during the Fall. Sometimes a natural foods store like PCC Community Markets carries them as well.

quincetree

Quince Sauce

Ingredients
5 lb quince (okay to mix in apples if you’d like)
2 tbsp rosewater
1 cinnamon stick
2 tsp freshly ground cardamom
1 tsp ground ginger
1 Star anise
1 tsp vanilla extract
2 tbsp maple syrup (optional)
Juice of 1 lime or 1 dried lime (limu omani-available at a Persian market)

Preparation

  1. Chop quinces into quarters, using an apple corer to remove the seeds. Reserve the seeds for later.

  2. Add all ingredients to a slow cooker or heavy bottomed stovetop cooking pot. 

  3. Cook on low (stirring occasionally to prevent sticking to the bottom of the pot) for 12-24 hours or until the quince have turned from yellow to jewel red. The fruits should mash up naturally.

  4. Remove the cinnamon stick, star anise and dried lime (if using) before serving.

  5. Enjoy warm or store in jars in the fridge for up to a week.

Quince Seed Cough Remedy

Quince seeds are naturally high in pectin. See the gooeyness around the seeds in the photo below? Quince seed “tea” is a traditional Persian cough remedy because it creates a highly viscous fluid that coats the throat just like marshmallow root or slippery elm would. Because of these same properties, this could be a helpful remedy for supporting the lining of the GI tract if you struggle with gut inflammation or intestinal permeability/leaky gut.

quinceseed

Preparation

Mix fresh or dried quince seeds in warm water and stir until the pectin is dissolved. Strain out the seeds and drink the viscous fluid.

If you want to save your seeds to use for later in the cold/flu season, dehydrate them fully and store in an airtight container.