6 Tips to Avoid Engorgement and Mastitis with Allyson Murphy, IBCLC

As any breast/chest-feeding parent knows, feeding a baby with your body can be beautiful— but it's also not always a walk in the park! Aside from the aches or tingling of 'let down' and the distinctive discomfort of cracked nipples, many also have to deal with engorgement, plugged ducts and mastitis. According to the Mayo Clinic, engorgement when milk is not fully removed from your breasts (for example, while weaning or if your produce more than your baby consumes). Engorgement can result in plugged ducts which present as hard lumps or localized areas of pain and swelling. Mastitis is inflammation and infection of the breast tissue (often associated with clogged ducts, skin irritation or cracked nipples). And, well, it's painful too. Thankfully, there's relief! We consulted with International Board Certified Lactation Consultant Allyson Murphy on her best advice for avoiding and treating engorgement and mastitis.

A big source of stress during breast or chestfeeding is engorgement, clogged or plugged milk ducts, and mastitis. It's normal to feel uncomfortably full (engorged) when mature milk first "comes in" around day 3-5 postpartum. The chest may feel warm, very firm, and warm to the touch. This usually lasts for about 24 hours. Engorgement can re-occur as you are weaning or if your baby does not fully consume the milk you produce. This can result in clogged or plugged ducts. Clogged ducts tend to progress gradually, resulting in further engorgement and ultimately a hard spot in the breast or chest that does not go away after nursing or pumping. It's a blockage in the 'tunnel' of the milk duct that prevents all the milk behind it from clearing.

Unresolved plugs can lead to infection (or mastitis) and inflammation of the tissues in the breast or chest. Symptoms include fever, chills, body aches, soreness, and redness over the affected area on lighter skin tones. Antibiotics are prescribed to treat mastitis and frequent milk removal can help.

Below are International Board Certified Lactation Consultant Allyson Murphy's tips for avoiding engorgement, clogged ducts, and mastitis:

1. Feed on demand, not on a schedule

One of the best rules for nursing is to "watch the baby, not the clock.” It's normal for newborns to eat frequently—sometimes more than 12 times a day. Their bellies are small and they need to feed often. Never limit their time at the breast to a certain number of minutes. Watch your baby and nurse them every time they are cueing—opening the mouth, sticking tongue out, putting hands to mouth.

When parents try to 'train' their babies to eat on a schedule or go long stretches between feedings, it often messes with the communication between our bodies and theirs. This can lead to engorgement.

2. Avoid underwire bras

Always choose nursing and pumping bras that do NOT have underwires. The wires can press against the breast/chest tissues and cause clogs. Likewise, choose a bra with a proper fit, but not too tight as it can also put too much pressure on the chest. Check out Nyssa's FourthWear Postpartum Recovery Bralette. Super soft and nursing/pumping-friendly, it is empathetically designed to hold ice or heat packs over the entire breast and chest for relief from engorgement and the discomfort associated with feeding, pumping, weaning, or lactation suppression.

3. Using the right flange size and pump settings

Proper flange fit helps with effective removal of milk from your pump. The nipple should move easily in the tunnel of the flange without rubbing on the edges. There also shouldn't be too much space around the nipple so that the areola gets pulled in too. Using a flange that's too big or small can contribute to engorgement if milk remains in the breast/chest. A lactation consultant can help fit you for the right flange size.

Also, vary the speed or cycles of your pump so that you're going back to the faster 'stimulation mode' several times in a session rather than just remaining on the slower 'expression mode.' This can trigger multiple letdowns and help release more milk.

4. Treat clogs as soon as they appear

It's not uncommon to experience a clog or engorgement from time to time. Treating them as soon as they arise is the best way to avoid mastitis.

— Feed very frequently on the affected side.

— Pump for 10-15 minutes immediately after nursing to remove as much milk as possible. Use hand compressions, massage, and warm compresses such as Nyssa's Breast & Chest Reusable Ice/Heat Packs. If you're an exclusive pumper, pump more frequently.

— During feeding or pumping, use the handle of your electric toothbrush or your vibrator over the effective area—sounds crazy, but it really helps.

— Hand express or use a manual pump in a hot shower—the heat helps with letdown.

— Try a 'dangle feed' by lying your baby on the floor and kneeling above them with the nipple dangling down into their mouth. The combination of suction and gravity works really well. You can also try the "dangle pump" and lean forward.

— Some people find that taking sunflower lecithin can help with stubborn clogs. Kellymom.com has great info on this.

— If you feel flu-like symptoms (fever/chills/body ache) call your OB/midwife right away as these are signs of infection.

5. Work with an International Board Certified Lactation Consultant (IBCLC) to check your latch

If clogs and engorgement seem to keep coming back, seek out the help of a professional. The way your baby latches affects milk removal—a wide, deep latch allows your baby to be most effective. So if the latch is shallow, they can leave milk behind regularly.

IBCLCs are trained to assess how your baby latches and sucks—also called oral motor function. Sometimes babies have issues like tongue tie or difficulty coordinating the suck/swallow/breathe rhythm which make latching harder. A lactation consultant will assess your situation and give you a care plan to improve latch, protect milk supply, and avoid plugged ducts and infection.

6. When weaning, go slowly

When you're ready to be done with nursing and pumping, drop one session at a time and give your body 3-5 days to adjust. Pump fully at the other sessions and don't cut the baby's time at the nipple short. Once you've adjusted, drop one more session and wait 3-5 days again. When weaning if you're feeling uncomfortably full, it's ok to express just enough milk between sessions to help you feel comfortable.