As a registered nurse, lactation consultant, and mother of 4, I understand the challenges that come with breastfeeding and pumping. To breastfeed is a beautiful and natural way to nourish your baby, but it can also present challenges like milk blebs, clogged ducts, engorgement, mastitis, thrush and Raynaud’s Syndrome. Don’t worry, these are common and there are ways to overcome them while continuing your breastfeeding success! Whether you are exclusively breastfeeding, pumping, or practicing combo feeding, this information will help you on your journey.

MILK BLISTERS/BLEBS

Milk blisters, also known as milk blebs, present as a white/yellow colored spot on the nipple and almost resembles a pimple. This happens when ductal inflammatory cells move to the outside of the nipple and block milk flow. Do not try to pop or open milk blebs. This could more trauma and make the duct even smaller. 

Some ways to manage milk blebs or milk blisters include applying cool compresses on the nipple. Nursing from the unaffected breast first and nursing or pumping according to baby’s demand (no extra pumping) can help. A possible oversupply may also need to be addressed. Other options to treat milk blebs can include taking oral lecithin capsules or applying a topical steroid cream to reduce inflammation. Please do this with healthcare provider’s approval and/or prescription. Using a topical steroid cream is safe for breastfeeding and can be wiped off before breastfeeding. As always, please consult with your healthcare provider or lactation consultant prior to starting any medications/supplements.

ENGORGEMENT IN BREASTFEEDING

Early postpartum engorgement is a process of your “milk coming in” along with increased blood flow in the breasts. This typically occurs between days 3-5 postpartum but can also occur as late as 9-10 days. Factors that can affect how soon or how late you experience engorgement or “milk coming in,” include (not all inclusive) how many babies you have birthed, if you breastfed before, or if you experienced any labor & delivery complications. Engorgement can also occur when there are prolonged periods between feeds. 

Symptoms of engorgement include breast pain, fullness, swelling, areolas that feel firm and/or appear swollen, a puffy areola (rather than firm), is thought to be due to tissue swelling possibly contributed by IV fluids given during labor and delivery.

Some ways to manage engorgement include nursing on demand (do not nurse or pump more than what baby needs). If needed, pump small amounts before nursing to help baby latch, and/or after nursing to soften the breast to comfort. Applying cool compresses after nursing will help to alleviate pain and inflammation. Breast massage, lymphatic drainage, and reverse pressure softening are techniques to decrease swelling and excess fluids surrounding the breasts and areolas. Over the counter pain relievers and anti-inflammatories can also help manage the discomforts of engorgement. Frequent breastfeeding is key!

DUCTAL NARROWING AND BREASTFEEDING

We’ve moved away from calling them clogged/plugged ducts and now use “ductal narrowing” to describe the condition. Current research by the ABM (Academy of Breastfeeding Medicine) has shown that a “clogged duct” is not a collection of a “milk plug,” but rather an inflammation and narrowing of the milk ducts related to the expansion of milk sacs or an imbalance in the bacteria in the breasts. 

A hard, tender and painful lump in the breast could be a ductal narrowing. Cool compresses before and after feeds, gentle massage (avoiding aggressive techniques), and continuing to nurse on demand can help. The goal to relieve ductal narrowing is to reduce inflammation/swelling and temporarily decrease milk production just slightly, on the affected side. This is because more milk production can equal more inflammation and congestion in an already inflamed breast. 

MASTITIS WHEN BREASTFEEDING

If ductal narrowing worsens with fever, fatigue, and redness for more than 24 hours, you may have mastitis. Mastitis is a painful inflammation of the breast tissue. This requires a doctor’s visit and often antibiotics. Keep breastfeeding (milk may taste salty but is still safe). Pumping can be helpful too, but only as often as your baby feeds.

Potential causes of mastitis are oversupply, milk stasis, infection (from cracked or bleeding nipples), stress, fatigue, weakened immune system, altered maternal gut microbiome, or previous history of mastitis. To ensure your baby gets enough milk while protecting your supply and reducing the risk of complications, initiate pumping only as often as your baby feeds (no extra pumping). If your baby refuses to nurse due to the salty taste, pace bottle feed the pumped milk.

THRUSH WHEN BREASTFEEDING

This yeast infection caused by the Candida Albicans yeast can affect both mom and baby. Signs include nipple pain, white patches in the baby’s mouth that do not easily wipe away or a diaper rash with a red scalded bottom. Symptoms of thrush in mothers often include nipple pain or burning sensation, itching, and sometimes sharp shooting pain deep within the breast. 

Managing thrush typically involves medications for both mother and baby. It is important to practice proper hygiene, frequently wash and sterilize any items that come in contact with mother’s breasts and the baby’s mouth, such as breast pump parts, breast pads, bras, pacifiers, and bottles. 

RAYNAUD’S PHENOMENON AND VASOSPASM

Some people have a condition called Raynaud’s Syndrome where their blood vessels get a little too sensitive to cold or stress. In breastfeeding moms, this can cause the tiny blood vessels in the nipples to tighten up too much, which can be uncomfortable. This can cause significant discomfort and pain during breastfeeding or pumping. 

Symptoms typically include sharp, burning, or throbbing pain in the nipples, which can occur before, during, or after nursing sessions. Nipple color changes, such as turning white, blue, or purple, are also common.

Breastfeeding mothers with Raynaud’s syndrome can manage symptoms by keeping their nipples warm. This can be achieved through using warm compresses before and after feeds, and wearing well-insulated clothing. Stress reduction techniques can also be beneficial. In severe cases, healthcare professionals may recommend medications or dietary supplements to improve blood circulation.

While breastfeeding and pumping are incredibly rewarding experiences, each journey is unique. You want to ensure success by equipping yourself with knowledge and the preparation to address any challenges you might encounter. As a parent, I know life can throw some curveballs just when everything is getting back to “normal,” or your “new normal.” 

You’ve got this! Knowledge empowers you to make informed decisions for your baby and yourself. Don’t hesitate to seek help from healthcare professionals and lactation consultants. They are there to guide you on your breastfeeding journey.

Take a look at my feeding services or book a connection call where we will discuss your specific challenges and how I can support you.