Tips to manage mastitis and blocked ducts during breastfeeding

If you have mastitis or blocked ducts, you should not stop breastfeeding or expressing as this could make matters worse.

Here are five tips to help you manage these conditions:

  • Position the baby with the chin or nose pointing to the hard lumpy area while breastfeeding. This will help to drain the plugged duct.
  • Massage the breast before and during a feed to stimulate the flow of milk. The massage can be directed from the blocked area towards the nipple.
  • After a feed, express any remaining milk by hand or pump to drain the breast fully if the baby is unable to do so. Regular expressing may also be needed if the affected area is near the areola. An engorged areola makes it difficult to latch the baby.
  • Pain or anti-inflammatory medication such as ibuprofen can be taken to relieve any pain. This may also facilitate the milk ‘let down’ reflex, which will help clear the blockage.
  • Increase your fluid intake and take fever medication (antipyretics) if you have a fever.

In addition, a warm compress can be applied to the affected area before feeding or expressing to promote drainage once the milk starts to leak after massaging. The warm compress helps to increase blood flow to area.

However, if you are unable to stimulate the milk ‘let down’ reflex, avoid using warm compresses as it may cause further congestion due to increased blood circulation and increased milk supply, says Ms Cynthia Pang, Assistant Director of Nursing and Senior Lactation Consultant at the Lactation Clinic, KK Women's and Children's Hospital (KKH), a member of the SingHealth group.

Seeking medical help for mastitis and blocked ducts

A mother should seek help from a lactation consultant if she is unable to resolve the blockage by herself after a couple of feeds or expressing breast milk. Further medical help may be required in some cases.

  • In the case of a milk blister, a doctor or lactation consultant will have to drain the blister with a sterile needle. Alternatively, massaging the nipple and feeding the baby can help to burst the blister. “Sometimes a toothpaste-like substance can be squeezed out from the affected nipple. The duct will be unblocked once this substance is completely squeezed out,” says Ms Pang.
  • For mastitis, a doctor may need to prescribe antibiotics. The antibiotics which target the common organism causing mastitis include cloxacillin, amoxicillin-clavulinic acid, cephalaxin and clindamycin. These are compatible with breastfeeding.
  • If an abscess develops, fine needle aspiration under ultrasound guidance or surgical incision and drainage by a breast surgeon may be required.

Why you should continue breastfeeding

Ms Pang says it is important for a woman to continue to breastfeed her baby after developing blocked ducts or mastitis.

“Sudden cessation of breastfeeding is not advisable in the presence of blocked ducts and mastitis,” Ms Pang explains. “This can increase the risk of a breast abscess developing.”

However, a breastfeeding woman who suffers from blocked ducts or mastitis and plans to stop breastfeeding is encouraged to gradually wean her baby off breastfeeding to prevent the recurrence of these conditions. But this weaning off breast milk should be carried out only after the blockage and mastitis have been resolved.

Last tip: Cold compresses or cold cabbage leaves can be applied in between a feed or expressing session, to help reduce swelling, warmth and pain.

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Ref: S13