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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.

When was the last time you cracked a nut?

When was the last time you cracked a nut? 🤔

When people ask me “How many nuts is it okay to eat in one sitting?” I tell them “as many as you would crack yourself”.

When we think about our sedentary culture, we forget about all of the non-exercise movement behaviors that we’ve outsourced.

When you enjoy a jar of almond butter, there was energy input by someone/something else, somewhere else to grow, collect, crack and grind those almonds; energy that you had the privilege not to perform. As a result, you are at a movement deficit and then need to perform structured movement (exercise) elsewhere in your day to essentially make up for the lack of movement in obtaining your calories.

wholenuts

Now, I’m not saying everyone needs to crack their own nuts every time you want almond butter or to source their own food for all their meals, this is the benefit of a modern society where we can each choose an occupation that suits our talents and skills. BUT this does not negate the necessity for our bodies to move! 

Regardless of our career choice, movement is a necessary part of life. And arguably, the excess of calories we consume would be considered nonessential given the lack of physical demand. 

What are ways you think you can realign your body’s need for movement with the foods you choose to eat?

For some ideas, check out this step-by-step post by Katy Bowman, author of Move Your DNA and Movement Matters,  to see what it means to live a movement-rich lifestyle and practical ways to reintroduce movement into your life without taking additional timeout of your day to “exercise”.

On that note, if this concept intrigues you, Katy Bowman recently published a paper in the Journal of Evolution and Health titled “Move Your DNA: Movement Ecology and the Difference Between Exercise and Movement”. Click here to read.

Interested in finding out other ways to holistically approach lifestyle change?

I'm seeing clients in-person at Cascade Integrative Medicine in Issaquah (request an appointment here) or online!

Let me know in the comments below how you are trying to move more!

Always Tired? Maybe It's Iron Deficiency

Because my patient population involves primarily women of child-bearing age, I see iron deficiency A LOT.

We've been told for many years that we should be avoiding red meat and opting for more plant-based food options to be "healthier". Naturally, health-conscious women begin reducing or completely eliminating red meat from their diets. Depending on what their levels were before the diet change, it may take a couple years for iron to get so low that they start exhibiting symptoms.

Depending on the age this diet change was made, a woman may have no clue that this may be impacting her menstrual cycle. I can tell you from my own experience (and I see this reflected in my patients) that period cramps were extremely painful when I was iron deficient. I was vegetarian from the time I was in high school all the way through college, I was both extremely tired AND had heavy and painful periods. Oddly enough, the female body tends to lose more blood when a woman is iron deficient, further worsening the cycle.

Technically, a woman is not considered iron deficient unless her Ferritin is at 15 ng/mL or below. I can tell you from personal and clinical experience that every patient that I've had who had a Ferritin below 20 ng/mL really struggled to stay awake during the day.

This is one of the reasons why men typically do far better on a plant-based diet because their iron needs are much lower. Women often crave burgers and steaks as they are about 5 years into a vegan/vegetarian diet. Why? Because the body knows best! These cravings point our bodies in the direction of nutrient density.

It took me about two years to increase my iron stores from 32 ng/mL in 2013 to 56 in 2015. And that was while eating liver and red meat regularly (just not enough)!

So why do we need iron?

Iron's main role in the body is to carry oxygen on red blood cells. You've all heard of Lance Armstrong blood doping with EPO to increase his red blood cells right? Well, the reason why he benefited from more blood cells is because he had more oxygen carrying capacity! So think of it like this: If you become iron sufficient, how much better would you be able to perform in athletics, at work, or in school?!

If you've been exhausted and requiring caffeine and/or a nap to make it through the day, consider seeing me in my office so I can help determine what might be causing your fatigue. There are too many good things in life to go through it with sub-optimal energy!