Plugged ducts are a common problem that can happen any time over the duration of breastfeeding – some have trouble with this in the beginning as milk supply is adjusting to baby’s needs, some over time as schedules and demand shifts, and some during weaning. And an unlucky few, like me, have persistent plugged ducts. However, understanding why plugged ducts occur and being prepared with what to do about them in advance, can keep things at the level of nuisance rather than problem.

Plugged ducts are simply that – a hardening or plugging of milk within a milk duct. They can occur anywhere in the breast, including right behind nipple tissue, or all the way to the rear of the breast, which can sometimes make them tough to isolate. It’s important to know that any sort of “pinchy” feeling or hard spot in the breast can signal this problem. I’ve made the mistake of thinking a plugged duct was just a discomfort from how I slept and ended up with trouble.

Why do we get plugged ducts?

Many believe that stress or lack of sleep can make women more prone to this problem – that it’s the body’s signal to slow down and get some rest. A tough order sometimes for a new nursing mom, especially one with a second or subsequent baby. If you’ve got a plugged duct, consider it serious – cancel your plans for the day, or at least a few hours and try to rest with your baby.

Some plugged ducts can be caused by a poorly fitted or low quality nursing bra that pinches or presses unevenly on the breast and causes the milk to become stuck. Some come as a result of an altered feeding schedule or a missed feeding. And some women are just prone to this problem no matter what they do – perhaps something to do with body chemistry or genetics or milk composition.

When you get a plugged duct, try to isolate where in the breast the plug is. This sounds simple, but sometimes it can be tricky to pinpoint. Once you think you’ve got it, here are some common remedies:

• Nurse more frequently, do not skip feedings. Definitely do not stop nursing. Start all feedings from the side with the plug, as the baby nurses more vigorously at the start of the feeding. If the baby is not nursing frequently or well, you can use a breast pump to fully empty the breast after the baby has eaten.
• Apply gentle pressure from behind the plug while nursing or pumping. I have sometimes used a little baby oil or calendula oil to make it a little easier on my skin.
• Position the baby so that the nose or chin points to the plug. Sometimes this means lying the baby down on their back on a bed and crouching over him or her on all fours turned to that position (don’t you love some Mommy moments!).
• Apply a warm pack (not too hot!) to the plug just before nursing or pumping. Commercial warm packs are fine, or make your own with rice or flaxseed (I use an old sock that I knot closed. Warm it in the microwave in short intervals until you reach the temperature you want.) Or even better, get in the shower and cascade the warm water on the plug while gently massaging the milk forward from the back of the breast towards the front.
• For persistent plugged ducts, some lactation consultants recommend taking Soy Lecithin. This has definitely worked for me – once I started using it with my first baby, the plugged ducts mostly stopped, and when I got lazy about it once with my second baby, I had a plug within a couple days. See my reference to The Pump Station plugged duct information sheet for information on dosage and use.

When using massage on the plug, be careful to be as gentle as you can while getting the job done. If you are too rough, the tender breast tissue can become swollen and it can be hard to tell if you’ve cleared the plug. A few mothers I’ve known have actually reported seeing stringy milk ejected from the breast, but more commonly you will see no obvious sign, but the pain and plug will disappear. If you aren’t sure if remaining discomfort is the plug or swollen tissue, give it a short time, and then try to assess if you still feel the specific plug where you felt it before.

Continuing to work gently at the plug in these ways will often do the trick. However, if the plug fails to clear, the problem can quickly progress to mastitis, a bacterial infection of the milk ducts. The most common symptoms of mastitis include:

• Red streaks, in the painful area, creating a sort of triangle that points toward the nipple from the plug.
• Fever and/or flu-like symptoms
• Increasing pain or radiating heat from the breast in the painful area

Mastitis is a serious problem that may require antibiotics or other alternative treatments. See my article Breast Pain - Mastitis (listed in Related Links at the end of the article) for a more complete discussion.

For more information on plugged ducts:

"Plugged Ducts" by The Pump Station (includes Soy Lecithin usage details)

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