MASTITIS (From www.askdrsears.com/html/2/T022200.asp)
Mastitis means that the breast is inflamed, and there is swelling, redness, tenderness and pain. There may be an infection, so it is wise to consult your health-care provider to determine whether or not an antibiotic is necessary. A breast infection can become a breast abscess that requires surgical draining, but this can almost always be prevented by treating mastitis promptly.
Signs of mastitis include:
* Part or all of the breast is intensely painful, hot, tender, red, and swollen. Some mothers can pinpoint a definite area of inflammation, while at other times the entire breast is tender.
* You feel tired, run down, achy, have chills or think you have the flu. A breastfeeding mother who thinks she has the flu probably has mastitis. Mothers with mastitis will sometimes experience these flu-like symptoms, even before they get a fever or notice breast tenderness.
* You have chills or feel feverish, or your temperature is 101F or higher. These symptoms suggest that you have an infection.
* You are feeling progressively worse, your breasts are growing more tender, and your fever is becoming more pronounced. With simple engorgement, a plugged duct, or mastitis without infection, you gradually feel better instead of worse.
* Recent events have set you up for mastitis: cracked or bleeding nipples, stress or getting run down, missed feedings or longer intervals between feedings.
PREVENTING MASTITIS
The best way to prevent mastitis is to avoid the situations that set you up for it.
* Relieve engorgement promptly. Milk that doesn't flow gets thicker and clogs the ducts, which is a set-up for mastitis.
* Breastfeed frequently. Don't restrict the length of feedings.
* If you feel your breasts getting full, encourage your baby to nurse. You don't have to wait for baby to tell you he's hungry.
* Avoid sleeping on your stomach or so far over on your side that your breasts are compressed against the mattress.
* Take care of yourself and get plenty of rest (both of mind and body).
REPEATED EPISODES OF MASTITIS
Problems with recurrent mastitis are usually the result of irregular breastfeeding patterns: missing feedings, giving bottles in place of breastfeedings, or skipping pumping sessions when separated from the baby. Recurrent mastitis may also mean that mother's immune system is generally run down, because of fatigue and stress. Mastitis is a sign that you need to take a closer look at your lifestyle and breastfeeding relationship and make some adjustments.
TREATING MASTITIS
Treating mastitis is much like treating engorgement only more urgent. Try these suggestions in addition to those listed under engorgement.
* Rest, rest, rest. Mastitis is an illness, so take a medical leave from all responsibilities other than breastfeeding. Take your baby to bed with you and nurse. Rest relieves stress and replenishes your immune system.
* Alternate warm and cold compresses on your breasts. Cold compresses relieve pain; warmth increases circulation, which mobilizes infection-fighters in the inflamed area. Lean over a basin of warm water, stand in a warm shower, or soak in a warm bath. Warm water or a warm, wet towel is more effective than the dry heat of a heating pad. For cold compresses, use crushed ice in plastic bags or bags of frozen vegetables, covered with a thin dishtowel to protect your skin.
* Gently massage the area of tenderness. This increases circulation, helps to loosen any plugged ducts in the area, and mobilizes local immune factors. Try doing this while soaking the breast in a warm shower or bath.
* Breastfeed frequently on the affected side. If it hurts to nurse the baby, start the feeding on the breast that is not sore, and switch to the sore side after your milk lets down. Breastfeeding is usually more comfortable when the milk is flowing. It's important to empty the inflamed breast. As in other parts of the body, fluid that is trapped can get infected. Your baby can empty your breast more efficiently than a breast pump. However, if your baby is not nursing well, you may have to use a breast pump or hand expression to get the milk out.
* Vary the baby's position at the breast, so that all the ducts are emptied.
* Take analgesics for fever and pain. Acetaminophen and/or ibuprofen are safe to take while breastfeeding. Unrelieved pain not only decreases your ability to produce milk, but suppresses your body's ability to fight infection.
* Drink lots of fluids, as you would if you had the flu. Fever and inflammation increase your need for fluids.
* Boost your immune system with good nutrition.
* Sleep without a bra. At other times, wear a looser fitting bra that does not put pressure on the affected area. Or if possible, go without a bra.
* Don't quit nursing at this point. Weaning increases the risk of a breast infection turning into a breast abscess that requires surgical draining. Continuing to nurse your baby is the best treatment for engorgement, mastitis and breast infections.
* If baby refuses to nurse on the affected breast, it may be because inflammation of the milk glands increases the sodium content of your milk, giving it a salty taste. Most babies either don't notice or don't mind, and go right on nursing. Some may object to the change and fuss or refuse to nurse from that side. Try starting the feeding on the unaffected side and finishing on the salty side. As the inflammation subsides, your milk will soon return to its usual taste.
DO YOU NEED ANTIBIOTIC TREATMENT?
You can experience the pain and inflammation of mastitis without necessarily having a bacterial infection. Yet it is often difficult to tell whether mastitis has become a breast infection. Consult your healthcare provider as soon as you suspect mastitis. In our medical practice, we operate on the principle of better to treat mastitis earlier than later. Mothers who are given antibiotics too late in the course of mastitis are more likely to wean their babies from the breast, to have a more severe infection, and to have the infection recur.
The following guidelines can help you both determine whether or not you need an antibiotic.
You may not need an antibiotic in the following situations:
* You do not have a history of frequent episodes of mastitis.
* You don't feel that sick.
* You have not gotten progressively sicker over the last few hours.
* Your fever is not rising.
* The breast pain and tenderness is not increasing.
* You can easily correct whatever factors may have set you up for engorgement in the first place.
Signs suggesting you do need antibiotic treatment:
* A history of frequent mastitis
* A fever that is rising.
* You are feeling progressively sicker as the hours go by.
* Your nipples are cracked, which allows bacteria to get into your breast tissue more easily.
Which antibiotics are best? The type of bacteria involved in mastitis is usually staphylococcus, and the two safest and most effective classes of antibiotics against this organism are cloxacillins and cephalosporins. Other frequently prescribed antibiotics are Augmentin or erythromycin. All of these antibiotics are safe to take while breastfeeding. Even though you will feel better after a few days of taking antibiotics, be sure to complete the full course of antibiotics prescribed by your doctor (usually ten days); otherwise you run the risk of the mastitis returning. If you don't feel better after two or three days on antibiotics, call your doctor. He or she may wish to prescribe a different medication.
CANDIDA (YEAST OR THRUSH) INFECTION ON NIPPLES (From www.askdrsears.com/html/2/t028100.asp)
Candida (also called yeast, monilla or thrush) is a fungus that thrives in warm, dark, moist environments, such as the mucus membranes of the mouth and vagina, the diaper area, skin folds, bra pads, and on persistently wet nipples.
Suspect candida as the cause of your sore nipples if:
* Your nipples are extremely sore, burning, itching, red, or blistery.
* You experience shooting pains in your breasts during or just after feeding (especially during your milk ejection reflex).
* The usual remedies for sore nipples aren't working.
* Baby has oral thrush (white, cottage-cheese-like patches on the tongue and sides of the mouth) and/or a yeasty diaper rash.
* Your nipples suddenly become sore after a period of pain-free breastfeeding.
* You are taking, or have just finished taking, a course of antibiotics. Yeast infections are common following antibiotic treatment.
Here are some simple suggestions that may help prevent a yeast infection on your nipples, or cure a mild case of yeast infection:
* Yeast organisms hate sunlight, so give your bra and breasts a sun bath. Expose your nipples to sunlight for several minutes several times a day. After washing them, dry your bras in the sunlight.
* Air-dry your nipples after each feeding
* Avoid plastic-lined breast pads that irritate skin and trap leaked milk.
* Change nursing pads after each feeding.
* Wear 100 percent cotton bras and wash them daily in very hot water.
* Thoroughly wash pump parts that come in contact with your breasts in a bleach solution and boil them in water for five minutes daily.
TREATING CANDIDA: INFECTION OF THE NIPPLE
If the simple home remedies listed above don't bring relief, consult your healthcare provider about the following treatments:
* Apply an antifungal cream (mycostatin, clotrimazole, myconazole) to your nipples as suggested or prescribed by your doctor.
* If you have a candida infection in your nipples, baby should be treated for thrush even if you can't see any white patches in the mouth. Your healthcare provider will prescribe an oral antifungal suspension that should be painted on baby's tongue, roof, and sides of the mouth three or four times a day for a couple of weeks.
* If baby has a candida diaper rash, treat it with an over-the-counter antifungal cream.
* Eat lots of yogurt (the kind with live active cultures) and take oral acidophilus. This encourages good bacteria to live in your gut and discourages the growth of yeast.
* If the candida is resistant to the standard treatments described above, in consultation with your healthcare provider, try a 0.25 - 0.5 percent solution of gentian violet applied to your nipples twice a day for three days. Gentian violet is effective, but messy. Also, apply a small amount once a day to baby's mouth, but be aware that overuse of gentian violet may irritate the sensitive oral mucus membranes of baby's mouth. Apply Vaseline to baby's lips before using the gentian violet to avoid purple stains.
* Warning gentian violet has been used for many years to treat thrush. A recent study done in Australia has linked gentian violet to cancer of the mouth. However, many other professionals around the world believe that it is safe, and continue to recommend it. For this reason, we suggest you use this remedy sparingly, and for as little time as possible.
* If your baby has thrush but your nipples are not yet sore, apply the prescribed medicine to baby's mouth just before feeding so that your nipples get the preventive benefit of the medication as well.
* If your healthcare provider advises you to wash the creams off your nipples prior to breastfeeding, do so gently with warm water.
* While nursing on a candida-infected nipple can be exquisitely painful, it is necessary to keep the affected breast empty to prevent mastitis, or even a candida infection deeper into the breast tissue. Pay particular attention to proper latch-on and easing your baby off your nipples at the end of the feeding, since infected nipples are more sensitive and prone to injury from improper sucking patterns.
Yeast infections can be very persistent. Use the full course of medication suggested by your doctor, and continue using the home remedies for several weeks so that the infection will not reoccur.
PLUGGED MILK DUCTS (From www.askdrsears.com/html/2/t022100.asp)
Sometimes a milk duct leading from the milk-making cells to the nipple gets plugged, resulting in a tender lump beneath the areola. There may also be a wedge-shaped area of redness extending from the lump back towards the wall of the chest. Unlike mastitis, the pain comes and goes with a plugged duct, and unless the duct is infected, you will not feel generally ill. If left untreated, however, a plugged duct may become infected, resulting in mastitis, infection, or a breast abscess.
To unplug the duct and prevent subsequent infection, try these suggestions:
* Continue to breastfeed on the affected side. By any means, get the milk out! This is the golden rule of preventing engorgement, plugged ducts, and mastitis. Use a breast pump or hand expression if baby is unwilling to nurse.
* Breastfeed on the affected side first. Baby's sucking is strongest at the beginning of the feed, so he is more likely to dislodge the plug when he starts on the affected breast.
* Vary the baby's position at the breast, so that all of the milk ducts are drained. Be sure the baby is latched-on well, so that he can nurse efficiently. Try the clutch hold or side-lying position. Before each feeding, massage the affected area by kneading your breast gently from the top of the breast down over the plugged duct toward the nipple.
* Drain the affected breast better by positioning baby so his chin "points" to the area that is sore. For example, if the lump is around 4 o'clock, use the clutch-hold and position baby's chin around this point on the nipple clock. The lower jaw is often most effective at getting milk out of the breast.
* Apply moist heat compresses for a few minutes before feeding or pumping, or soak the affected breast in warm water or in the shower as described under Engorgement
* Rest. Lie down with the baby and nap-nurse.
* If you notice a small, white dot at the end of the milk duct on your nipple, that is the end of a plugged nipple opening. Apply moist heat on this white blister and with a sterile needle gently pop the blister. If this pore stays plugged, it could block milk drainage and lead to a plugged duct and mastitis.
* Try a pressure massage on the area of your breast that is swollen and painful because of a plugged duct. This may help to loosen the plug. With pressure massage, you do not actually move your hand over the skin as you would with a normal massage. You simply press more and more firmly with the heel of your hand to move the plug in the duct down closer to the nipple.
To do pressure massage, start at the edge of the lumpy area closest to your chest wall. Apply pressure to that area with the heel of your hand to the point just before it becomes too painful. Hold the pressure at that level until the pain eases off. Then increase the pressure again, (without moving your hand) and hold it until the pain eases. Continue to gradually increase pressure at that same site until you are pressing as hard as you can. Then pick your hand up, move it down toward your nipple about a half inch, and repeat the pressure massage in this area. Continue moving your hand a half inch and repeating the massage until you get all the way down to the nipple.
You may see the dried milk come out from an opening in your nipple. Even if the plug doesn't actually come out, you will at least have dislodged it and moved it toward the nipple so that when baby goes to the breast and sucks, he will remove it with his suction. Always put baby to the breast on the plugged side first, when his sucking will be the strongest.
PREVENTING PLUGGED DUCTS FROM RECURRING
* To prevent plugged ducts, feed baby in different positions with his nose pointing "around the nipple clock," so that you empty all the milk sinuses and ducts.
* Studies have shown that taking a tablespoon a day of oral granular lecithin or a capsule of 1,200 mg lecithin capsule three to four times a day is helpful in preventing and treating plugged milk ducts.
Mastitis means that the breast is inflamed, and there is swelling, redness, tenderness and pain. There may be an infection, so it is wise to consult your health-care provider to determine whether or not an antibiotic is necessary. A breast infection can become a breast abscess that requires surgical draining, but this can almost always be prevented by treating mastitis promptly.
Signs of mastitis include:
* Part or all of the breast is intensely painful, hot, tender, red, and swollen. Some mothers can pinpoint a definite area of inflammation, while at other times the entire breast is tender.
* You feel tired, run down, achy, have chills or think you have the flu. A breastfeeding mother who thinks she has the flu probably has mastitis. Mothers with mastitis will sometimes experience these flu-like symptoms, even before they get a fever or notice breast tenderness.
* You have chills or feel feverish, or your temperature is 101F or higher. These symptoms suggest that you have an infection.
* You are feeling progressively worse, your breasts are growing more tender, and your fever is becoming more pronounced. With simple engorgement, a plugged duct, or mastitis without infection, you gradually feel better instead of worse.
* Recent events have set you up for mastitis: cracked or bleeding nipples, stress or getting run down, missed feedings or longer intervals between feedings.
PREVENTING MASTITIS
The best way to prevent mastitis is to avoid the situations that set you up for it.
* Relieve engorgement promptly. Milk that doesn't flow gets thicker and clogs the ducts, which is a set-up for mastitis.
* Breastfeed frequently. Don't restrict the length of feedings.
* If you feel your breasts getting full, encourage your baby to nurse. You don't have to wait for baby to tell you he's hungry.
* Avoid sleeping on your stomach or so far over on your side that your breasts are compressed against the mattress.
* Take care of yourself and get plenty of rest (both of mind and body).
REPEATED EPISODES OF MASTITIS
Problems with recurrent mastitis are usually the result of irregular breastfeeding patterns: missing feedings, giving bottles in place of breastfeedings, or skipping pumping sessions when separated from the baby. Recurrent mastitis may also mean that mother's immune system is generally run down, because of fatigue and stress. Mastitis is a sign that you need to take a closer look at your lifestyle and breastfeeding relationship and make some adjustments.
TREATING MASTITIS
Treating mastitis is much like treating engorgement only more urgent. Try these suggestions in addition to those listed under engorgement.
* Rest, rest, rest. Mastitis is an illness, so take a medical leave from all responsibilities other than breastfeeding. Take your baby to bed with you and nurse. Rest relieves stress and replenishes your immune system.
* Alternate warm and cold compresses on your breasts. Cold compresses relieve pain; warmth increases circulation, which mobilizes infection-fighters in the inflamed area. Lean over a basin of warm water, stand in a warm shower, or soak in a warm bath. Warm water or a warm, wet towel is more effective than the dry heat of a heating pad. For cold compresses, use crushed ice in plastic bags or bags of frozen vegetables, covered with a thin dishtowel to protect your skin.
* Gently massage the area of tenderness. This increases circulation, helps to loosen any plugged ducts in the area, and mobilizes local immune factors. Try doing this while soaking the breast in a warm shower or bath.
* Breastfeed frequently on the affected side. If it hurts to nurse the baby, start the feeding on the breast that is not sore, and switch to the sore side after your milk lets down. Breastfeeding is usually more comfortable when the milk is flowing. It's important to empty the inflamed breast. As in other parts of the body, fluid that is trapped can get infected. Your baby can empty your breast more efficiently than a breast pump. However, if your baby is not nursing well, you may have to use a breast pump or hand expression to get the milk out.
* Vary the baby's position at the breast, so that all the ducts are emptied.
* Take analgesics for fever and pain. Acetaminophen and/or ibuprofen are safe to take while breastfeeding. Unrelieved pain not only decreases your ability to produce milk, but suppresses your body's ability to fight infection.
* Drink lots of fluids, as you would if you had the flu. Fever and inflammation increase your need for fluids.
* Boost your immune system with good nutrition.
* Sleep without a bra. At other times, wear a looser fitting bra that does not put pressure on the affected area. Or if possible, go without a bra.
* Don't quit nursing at this point. Weaning increases the risk of a breast infection turning into a breast abscess that requires surgical draining. Continuing to nurse your baby is the best treatment for engorgement, mastitis and breast infections.
* If baby refuses to nurse on the affected breast, it may be because inflammation of the milk glands increases the sodium content of your milk, giving it a salty taste. Most babies either don't notice or don't mind, and go right on nursing. Some may object to the change and fuss or refuse to nurse from that side. Try starting the feeding on the unaffected side and finishing on the salty side. As the inflammation subsides, your milk will soon return to its usual taste.
DO YOU NEED ANTIBIOTIC TREATMENT?
You can experience the pain and inflammation of mastitis without necessarily having a bacterial infection. Yet it is often difficult to tell whether mastitis has become a breast infection. Consult your healthcare provider as soon as you suspect mastitis. In our medical practice, we operate on the principle of better to treat mastitis earlier than later. Mothers who are given antibiotics too late in the course of mastitis are more likely to wean their babies from the breast, to have a more severe infection, and to have the infection recur.
The following guidelines can help you both determine whether or not you need an antibiotic.
You may not need an antibiotic in the following situations:
* You do not have a history of frequent episodes of mastitis.
* You don't feel that sick.
* You have not gotten progressively sicker over the last few hours.
* Your fever is not rising.
* The breast pain and tenderness is not increasing.
* You can easily correct whatever factors may have set you up for engorgement in the first place.
Signs suggesting you do need antibiotic treatment:
* A history of frequent mastitis
* A fever that is rising.
* You are feeling progressively sicker as the hours go by.
* Your nipples are cracked, which allows bacteria to get into your breast tissue more easily.
Which antibiotics are best? The type of bacteria involved in mastitis is usually staphylococcus, and the two safest and most effective classes of antibiotics against this organism are cloxacillins and cephalosporins. Other frequently prescribed antibiotics are Augmentin or erythromycin. All of these antibiotics are safe to take while breastfeeding. Even though you will feel better after a few days of taking antibiotics, be sure to complete the full course of antibiotics prescribed by your doctor (usually ten days); otherwise you run the risk of the mastitis returning. If you don't feel better after two or three days on antibiotics, call your doctor. He or she may wish to prescribe a different medication.
CANDIDA (YEAST OR THRUSH) INFECTION ON NIPPLES (From www.askdrsears.com/html/2/t028100.asp)
Candida (also called yeast, monilla or thrush) is a fungus that thrives in warm, dark, moist environments, such as the mucus membranes of the mouth and vagina, the diaper area, skin folds, bra pads, and on persistently wet nipples.
Suspect candida as the cause of your sore nipples if:
* Your nipples are extremely sore, burning, itching, red, or blistery.
* You experience shooting pains in your breasts during or just after feeding (especially during your milk ejection reflex).
* The usual remedies for sore nipples aren't working.
* Baby has oral thrush (white, cottage-cheese-like patches on the tongue and sides of the mouth) and/or a yeasty diaper rash.
* Your nipples suddenly become sore after a period of pain-free breastfeeding.
* You are taking, or have just finished taking, a course of antibiotics. Yeast infections are common following antibiotic treatment.
Here are some simple suggestions that may help prevent a yeast infection on your nipples, or cure a mild case of yeast infection:
* Yeast organisms hate sunlight, so give your bra and breasts a sun bath. Expose your nipples to sunlight for several minutes several times a day. After washing them, dry your bras in the sunlight.
* Air-dry your nipples after each feeding
* Avoid plastic-lined breast pads that irritate skin and trap leaked milk.
* Change nursing pads after each feeding.
* Wear 100 percent cotton bras and wash them daily in very hot water.
* Thoroughly wash pump parts that come in contact with your breasts in a bleach solution and boil them in water for five minutes daily.
TREATING CANDIDA: INFECTION OF THE NIPPLE
If the simple home remedies listed above don't bring relief, consult your healthcare provider about the following treatments:
* Apply an antifungal cream (mycostatin, clotrimazole, myconazole) to your nipples as suggested or prescribed by your doctor.
* If you have a candida infection in your nipples, baby should be treated for thrush even if you can't see any white patches in the mouth. Your healthcare provider will prescribe an oral antifungal suspension that should be painted on baby's tongue, roof, and sides of the mouth three or four times a day for a couple of weeks.
* If baby has a candida diaper rash, treat it with an over-the-counter antifungal cream.
* Eat lots of yogurt (the kind with live active cultures) and take oral acidophilus. This encourages good bacteria to live in your gut and discourages the growth of yeast.
* If the candida is resistant to the standard treatments described above, in consultation with your healthcare provider, try a 0.25 - 0.5 percent solution of gentian violet applied to your nipples twice a day for three days. Gentian violet is effective, but messy. Also, apply a small amount once a day to baby's mouth, but be aware that overuse of gentian violet may irritate the sensitive oral mucus membranes of baby's mouth. Apply Vaseline to baby's lips before using the gentian violet to avoid purple stains.
* Warning gentian violet has been used for many years to treat thrush. A recent study done in Australia has linked gentian violet to cancer of the mouth. However, many other professionals around the world believe that it is safe, and continue to recommend it. For this reason, we suggest you use this remedy sparingly, and for as little time as possible.
* If your baby has thrush but your nipples are not yet sore, apply the prescribed medicine to baby's mouth just before feeding so that your nipples get the preventive benefit of the medication as well.
* If your healthcare provider advises you to wash the creams off your nipples prior to breastfeeding, do so gently with warm water.
* While nursing on a candida-infected nipple can be exquisitely painful, it is necessary to keep the affected breast empty to prevent mastitis, or even a candida infection deeper into the breast tissue. Pay particular attention to proper latch-on and easing your baby off your nipples at the end of the feeding, since infected nipples are more sensitive and prone to injury from improper sucking patterns.
Yeast infections can be very persistent. Use the full course of medication suggested by your doctor, and continue using the home remedies for several weeks so that the infection will not reoccur.
PLUGGED MILK DUCTS (From www.askdrsears.com/html/2/t022100.asp)
Sometimes a milk duct leading from the milk-making cells to the nipple gets plugged, resulting in a tender lump beneath the areola. There may also be a wedge-shaped area of redness extending from the lump back towards the wall of the chest. Unlike mastitis, the pain comes and goes with a plugged duct, and unless the duct is infected, you will not feel generally ill. If left untreated, however, a plugged duct may become infected, resulting in mastitis, infection, or a breast abscess.
To unplug the duct and prevent subsequent infection, try these suggestions:
* Continue to breastfeed on the affected side. By any means, get the milk out! This is the golden rule of preventing engorgement, plugged ducts, and mastitis. Use a breast pump or hand expression if baby is unwilling to nurse.
* Breastfeed on the affected side first. Baby's sucking is strongest at the beginning of the feed, so he is more likely to dislodge the plug when he starts on the affected breast.
* Vary the baby's position at the breast, so that all of the milk ducts are drained. Be sure the baby is latched-on well, so that he can nurse efficiently. Try the clutch hold or side-lying position. Before each feeding, massage the affected area by kneading your breast gently from the top of the breast down over the plugged duct toward the nipple.
* Drain the affected breast better by positioning baby so his chin "points" to the area that is sore. For example, if the lump is around 4 o'clock, use the clutch-hold and position baby's chin around this point on the nipple clock. The lower jaw is often most effective at getting milk out of the breast.
* Apply moist heat compresses for a few minutes before feeding or pumping, or soak the affected breast in warm water or in the shower as described under Engorgement
* Rest. Lie down with the baby and nap-nurse.
* If you notice a small, white dot at the end of the milk duct on your nipple, that is the end of a plugged nipple opening. Apply moist heat on this white blister and with a sterile needle gently pop the blister. If this pore stays plugged, it could block milk drainage and lead to a plugged duct and mastitis.
* Try a pressure massage on the area of your breast that is swollen and painful because of a plugged duct. This may help to loosen the plug. With pressure massage, you do not actually move your hand over the skin as you would with a normal massage. You simply press more and more firmly with the heel of your hand to move the plug in the duct down closer to the nipple.
To do pressure massage, start at the edge of the lumpy area closest to your chest wall. Apply pressure to that area with the heel of your hand to the point just before it becomes too painful. Hold the pressure at that level until the pain eases off. Then increase the pressure again, (without moving your hand) and hold it until the pain eases. Continue to gradually increase pressure at that same site until you are pressing as hard as you can. Then pick your hand up, move it down toward your nipple about a half inch, and repeat the pressure massage in this area. Continue moving your hand a half inch and repeating the massage until you get all the way down to the nipple.
You may see the dried milk come out from an opening in your nipple. Even if the plug doesn't actually come out, you will at least have dislodged it and moved it toward the nipple so that when baby goes to the breast and sucks, he will remove it with his suction. Always put baby to the breast on the plugged side first, when his sucking will be the strongest.
PREVENTING PLUGGED DUCTS FROM RECURRING
* To prevent plugged ducts, feed baby in different positions with his nose pointing "around the nipple clock," so that you empty all the milk sinuses and ducts.
* Studies have shown that taking a tablespoon a day of oral granular lecithin or a capsule of 1,200 mg lecithin capsule three to four times a day is helpful in preventing and treating plugged milk ducts.
