Kelly Smith worked for years to get pregnant. When her twins finally arrived, she knew she would breastfeed them—but she had no idea how intense that would be. “I was an overproducer so even after feeding twins,” she explains, “my boobs would still be engorged.” She faced a terrible cycle: She just wanted to empty her breasts, but if she pumped, it stimulated more milk production. So she basically had to ignore the engorgement, which led to chronically clogged milk ducts. “I’d get hard walnut-sized nuts. In a regular breast, you’d think, Oh my God, I have cancer.” She’d spend the next 24 hours touching her boob and trying to massage out the clogged duct with her thumbs, an electric toothbrush, or a vibrator. An electric pump was too stimulating, so she used a hand pump in the shower, while the hot water worked to break up the clogged duct. Kelly, of course, knows how lucky she was to be able to breastfeed her babies, but there was a downside to being chronically engorged for 14 months—other than the sheer discomfort and the many, many experiences with clogged milk ducts. “You can’t talk about it because you’re an overproducer,” she explains. “Everyone is complaining about being an under-producer. Even my lactation consultant would say, ‘You should thank your lucky stars,’ and I’d think, No, I’m in horrible pain all the time.” Your experience may not be this extreme, but clogged milk ducts are not uncommon. “50 percent of the women I work with develop this during their breastfeeding journey,” explains the L.A. Lactation Lady, Julie Matheney, international board-certified lactation consultant (IBCLC). “Some women are simply more prone to clogs because they have a higher fat content in their milk. The fat separates and clogs the duct more.”
What are clogged milk ducts?
“A milk-clogged duct is an obstruction in the ductal system of a lactating breast,” explains Rowan Smith, IBCLC, a doula based outside of Montreal. A clog can happen anywhere inside the breast—from deep inside, all the way to the nipple pore. When you get a clogged milk duct, it means that the milk has sat in the breast for too long. And it’s not just milk—it’s milk fat that creates the obstruction. “A mother’s breast milk is like milk sitting in the fridge,” Matheney explains. “Cream rises to top. The fat floats so it can separate. The fat thickens and sits in the ducts and they clog.” When it’s pushed through—which can really, really hurt!—it can look like a curd, a string, or a chunk.
Why is this happening to me?
In all cases, a clogged milk duct is caused by milk stasis, that is, milk sitting too long in your breast. Not enough milk is being removed, and when excess milk accumulates, it thickens and has a hard time coming out. Beyond that there are two main categories of problems:
Infant Causes of Clogged Milk Ducts
- Your baby is not emptying your boob well enough. This can be due to prematurity (the baby is teeny tiny and can’t suck well) or immaturity (the baby hasn’t quite gotten the hang of the whole breastfeeding thing yet).
- There is a latch problem. This is so, so, so common, and there are myriad reasons for it. Maybe there’s a tongue-tie restriction; maybe the baby has some nerve and muscle restriction from being cramped up for nine months. “Most moms are told they have a good latch,” says Rowan, “but if it doesn’t feel good, something is wrong.” Lactation consultants are Godsends when it comes to this stuff.
- The baby is sleeping too long. Yes! There’s such a thing (early on)! This, too, lets your milk accumulate and can cause clogged milk ducts.
Maternal Causes of Clogged Milk Ducts
- You may not be feeding enough. Maybe you’ve gone back to work and can only pump once or twice a day. Or perhaps you have meetings or errands that keep you away from the baby and off your breastfeeding routine. Basically, your poor boob isn’t getting enough opportunities to be drained.
- Your sleeping position may be the problem. If you sleep on your stomach, your milk can’t flow properly and can cause a clogged milk duct. Try lying on your side instead.
- Your bras are too tight. Give your boobs some room to breathe and for the milk to flow! If you can, visit a shop that specializes in nursing bras. It is well worth the expense. You’ll be living in these suckers for a few months (or years), and they should fit you properly.
- You’re holding your breast too tight while you’re feeding. Your boob doesn’t need as much support as your baby’s head! Ease up on your grip and see if that helps ease the clogged milk ducts.
- Your baby carrier might be the culprit. If it’s squishing your boobs, it’s preventing the flow of milk.
How I can prevent clogged milk ducts?
“The best way to prevent clogged milk ducts is to frequently empty the breast well,” says Matheney. If you’re committed to breastfeeding, this means your baby will pretty much glued to you: “In first few weeks, feed consistently around the clock,” Matheny advises. True, you probably won’t be able to get a single thing done, but it won’t last—before you know it, your baby will be eating food and walking and talking. Establishing a good latch and proper supply is key to a successful breastfeeding experience, so for your own sanity, it’s wise to just give yourself over to it. “Most women have enough milk at the beginning,” explains Rowan, “but your breasts need lots of stimulation. The books say eight to 12 times day, or every three to four hours—but it’s actually much more frequent.” When she teaches prenatal classes, Rowan asks soon-to-be parents to write down everything they ate or drank in the last 24 hours—including sucking on candy—to give them a sense of feeding frequency. Her students will say they ate between six and 35 times a day. “Adults, like babies, get comfort from food. We’re grownups and expecting babies to conform to eight to 12 times a day! I hear so many moms say, ‘He can’t be hungry, he ate 30 minutes ago!’ Go ahead and feed. Not doing so can cause the milk to get clogged.” If you have to go back to work during those prime breastfeeding months, pump as often as you can with a high-quality pump to prevent clogged milk ducts. Rowan also recommends a few minutes of breast massage and compression (essentially deep massage) before doing your regular pumping routine, followed by one or two minutes of hand expression. “You can think of your breast like toothpaste tube—you don’t want to start squeezing or emptying it in the middle!” Matheney says. Start from the back of breast and move to the nipple, and then all the way around breast without missing any ducts. She also suggests familiarizing yourself with your boobs to figure out where the ducts are so you can do compression behind the lumps. “Squeeze the milk down to the nipple to encourage it to flow,” she explains. A few other ways to keep your breasts free of clogged milk ducts:
- Change up nursing positions.
- Don’t wear bras as often—you’re taking them on and off so much, why not just let your breasts breathe? If you’re home alone with the baby, let ’em hang free.
- Drink lots of water.
- Rest as often as possible.
Help! How can I fix my clogged milk ducts?
Okay, so despite all your best efforts, you’ve got a clogged milk duct. We know it’s painful—so painful! But ignoring the problem only makes it worse and can lead to a real infection (see below), so it’s best to go at it aggressively now. Here are a few things to try:
- “Heat melts the fat, like butter in a pan,” says Matheney, so a hot shower or hot compress is always a good place to start. Massage the crap out of it while you’re in there.
- Clogged milk ducts respond well to vibration, so pull out that vibrator or electric toothbrush to break up the fat.
- If the clog is in the nipple—ouch, indeed!—this is called a milk blister or a bleb. It’s usually on the tip of the nipple and looks like a whitehead. Put olive oil or coconut oil on a cotton swab and make slow circular motions to break down the fat.
- If you’re a chronic overproducer, some women find success supplementing with sunflower lecithin, which is a fat emulsifier that can thin the milk. Discuss with your doctor before starting any supplements.
- Nurse a lot on the side that’s clogged—in fact, start on that side. Whatever you do, don’t ignore it, because it could turn into mastitis.
- This is rather, uh, controversial but some women—like Kristen Bell—have their husbands suck out a particularly clogged duct. Seriously. That said, if your husband can get it out but your baby can’t, there might be a bigger problem (you think?): It could indicate an issue with your little one’s latch since the baby should be able to.
If You Have an Oversupply…
Moms’ boobs are magical because they generally produce exactly what your particular baby needs. But sometimes—like in Kelly’s situation—you have way more milk than you know what to do with. Remember: The more you pump, the more you make, so even though it might be tempting to pump to “empty out”—or check on how much you’re producing—you’re only signaling to your body that it needs to produce more milk, which exacerbates the cycle. If it’s coming out like water out of a fire hose, express a tiny bit before to soften the breast and slow the velocity of the milk, Rowan suggests. Matheney recommends eliminating pumping completely to stop the signals to your body to keep producing so much. But Rowan says in extreme cases—particularly for women with chronic problems or ducts that are verging on mastitis—you can try pumping both breasts first thing in the morning (and not again) so they can really soften. Matheney also suggests drinking tea with peppermint leaves (which dries up supply), and placing cabbage leaves in your bra to decrease supply and regulate your output.
So can clogged milk ducts be a problem for moms with a low supply?
Totally. “It can happen to anyone who waits too long,” says Matheney. And in fact, volume doesn’t matter as much as how often you’re removing it. “Think of your breasts as different-sized Tupperware—they have different storage capacity.” If you have less storage, you may need to nurse more often. No matter how much milk you’re producing, you still run the risk of a clogged milk duct.
What’s the difference between clogged milk ducts and mastitis?
Mastitis is a full-fledged infection, and it feels like one. It’s usually caused by a milk duct that’s been clogged way too long. You can also get mastitis when bacteria from your baby’s mouth enters in through the pores of your nipple and infects the breast. If you have the following symptoms, it’s really important to call your doctor because mastitis can get worse quite quickly:
- Serious tenderness or warmth to the touch
- Flu-like symptoms—you feel worn down, achy, and lethargic
- Fever of 101° or higher for more than 24 hours
- Breast swelling
- Red wedge-like shape on breast
- Continuous pain, even while breastfeeding
A dose of antibiotics will usually make you feel better within two days. If you don’t feel better during that time, get back in touch with your doctor to rule out a more serious infection.
Is there anything worse than mastitis?
Yes. If you ignore the clogged milk duct and it turns into an infection that you also ignore—or if you refuse to go on antibiotics—mastitis can turn into an abscess. Basically, the breast gets a pus-filled cyst, and the only intervention is to have it drained by a trained breast surgeon in order to get the bacteria and fluid out. It takes six to eight weeks to recover after the corrective operation, and sometimes the surgeon has to leave a drain in until all the fluid and pus comes out. You might be able to breastfeed during this time, but often the other breast needs to do the bulk of the work, which is not much fun.
This sucks. I want to stop breastfeeding.
“When women say they want to stop feeding because of a clogged milk duct, I listen and empathize,” Rowan says. “If they stop that moment, though, it will likely develop into mastitis or an abscess. So I recommend we get through this hump and then we can discuss stopping. But first we have to deal with the problem.” The moral of the story here is: If you think something is wrong, get it checked out ASAP. Women tolerate pain differently, so it’s sometimes hard to gauge the severity of the problem, but trust your gut on this one. And be aggressive early on—a clogged milk duct is painful, but much less painful than it will be if it turns into something more serious.