Mama—your health is just as important as your baby’s health.  If you are in pain, don’t ignore it; take care of yourself.

A Deeper Look:

Just as with a job, there are occupational hazards to being the Producer of Liquid Gold.  Sometimes those hazards can be a nuisance and sometimes they can be very painful.  If you are currently in pain or have any breast symptoms that concern you, please see your healthcare professional.

The following is a non-exhaustive list of potential sources of pain or conditions associated with pumping and/or giving birth:

• Milk bleb
• Nipple blister
• Ductal Narrowing or “Plugged ducts”
• Mastitis
• Breast Abscess
• Engorgement
• Vasospasm
• Yeast Infection
• Skin Conditions
• Baby Blues
• Peripartum Depression

Milk Bleb
A milk bleb is a blocked nipple pore that looks like a white or yellow spot (think a whitehead pimple) on your nipple.  This can happen for multiple reasons, but usually a milk duct became be clogged and the clog has settled at the nipple pore opening.  The longer the clog persists, the more the milk becomes thicker and harder and more noticeable either visually or through discomfort.  Dehydration, stomach sleeping, tight fitting bras or baby carriers, an oversupply of milk, a skipped pump session, and a too quickly dropped pump session can contribute to milk blebs.

If the bleb doesn’t hurt, you can let it be.  If it hurts, suggestions for relief include:

• Placing a warm, wet washcloth on the affected area for 10-15 minutes
• Reducing the clog by placing a cotton ball soaked with vinegar inside your bra on the affected area to loosen or dissolve any calcium deposits left by milk in a nipple pore
• Opening the bleb from the side of the bleb with a sterile needle, which should be done by a healthcare professional, and then gentle hand expression or pumping to remove the bleb.
• Softening the pore by doing one of the following:
  • Soaking your nipple in a cup of warm water with 2 teaspoons of Epsom salts*
  • soaking in a tub or shower then placing a cotton ball soaked in water, coconut oil, or olive oil inside your bra on the affected area
  • placing a cotton ball soaked in water, coconut oil, or olive oil inside your bra on the affected area and covering with heat from a warm washcloth, heat pack, or heating pad then massage the area on and around the hard spot of the clog.  Leave on for 10-15 minutes. 

*This can also be done with the Haakaa: add one to two tablespoons of Epsom salt to the Haakaa and fill with enough warm water to make contact with your nipple.  Stir!  Suction the Haakaa to your breast by pulling back the flange, squeezing the base, and centering your nipple in the opening.  Lean forward to allow gravity to help move the clog.  Leave on for 10-15 minutes.  May need to repeat for stubborn blebs. 

According to the Academy of Breastfeeding Medicine, nipple blebs associated with mastitis should not be opened or “unroofed,” and oral lecithin (such as sunflower lecithin) and a topical steroid cream (ex. 0.1% triamcinolone) can be used to reduce inflammation on the surface of the nipple.

Nipple Blister
Nipple blisters can be caused by continuous irritation from the friction of using a breast pump flange that fits improperly or is positioned improperly or when the suction on your pump is set too high.  

For information on finding the correct flange size, click here.
For information on how to pump, click here.

Ductal Narrowing or “Plugged Ducts“
While plugged ducts—which are more accurately described as inflammation and narrowing of the ducts in your breast—may result in the formation of a milk bleb as discussed above, you can also have a plugged duct that does not.  In this instance, the plugged duct may be noticeable to you because you feel a firm, tender spot on your breast.  It may be warm, look a little red, and be the size of a marble or much larger depending on where the plugged duct has occurred in the “pipelines” of your breast.  Plugged ducts may be the result of dehydration, stomach sleeping, tight fitting bras or baby carriers, an oversupply of milk, a skipped pump session, incomplete drainage of breasts, or a too quickly dropped pump session. Note that “dangle-feeding” is not recommended since “plugged ducts” are really the result of inflammation and not an actual obstruction in the duct. Similarly, it is recommended that you avoid heat, even though it may relieve some discomfort, because heat increases blood flow, which is not what you want to encourage near already-inflamed tissue.

A plugged duct can lead to mastitis and infection, to avoid this, you will want to: 

• pump only what is needed to feed your baby (minimize extra pumping and emptying your affected breast, which can signal your body to continue to produce more milk). Over-pumping from the affected breast may perpetuate a cycle of hyper lactation, which can result in more inflammation.
• cease pumping on the inflamed breast if the breast tissue is so inflamed that milk cannot be expressed. Resume pumping once swelling has subsided.
• use ice and cold compresses to help with inflammation and lymphatic drainage
• consider using NSAIDs, such as ibuprofen or acetaminophen to reduce inflamation
• wear a loser-fitting—but still supportive!—bra without underwire
• gentle, sweeping massage may be used as well as gentle compressions while pumping; however, use of vibrating or massaging devices is no longer recommended
• take sunflower lecithin (after consulting with your healthcare professional of course), which may make milk less “sticky” so that it is less prone to clogging. Suggested amount is 5-10 grams daily “to reduce inflammation in ducts and emulsify milk.”

Please note that squeezing or aggressive massaging of the “plug” is ineffective and may result in tissue trauma. If the plugged duct feels worse or you notice swelling, flu-like symptoms, or increased redness, please contact your healthcare professional immediately.  Similarly, if you have a persistent lump, see your healthcare professional.

Mastitis
Mastitis is an inflammation in the breast—ducts, alveoli, and surrounding connective tissue—that often presents with pain, redness, fever, and chills.  The Academy of Breastfeeding Medicine recently updated their clinical protocol regarding mastitis. In it, mastitis is described as “a spectrum of conditions resulting from ductal inflammation and stroll edema,” in which ductal narrowing and alveolar congestion (what we commonly refer to as plugged ducts) can result in inflammatory mastitis and lead to acute bacterial mastitis and potentially, an abscess. Although it can occur in both breasts at the same time, it usually only affects one breast.  Sometimes it involves an infection, sometimes it doesn’t.  Because there is no easy way to determine whether a particular case of mastitis involves an infection, antibiotics are often prescribed to be safe.  Mastitis can be the result of nipple damage (such as cracks or sores) that allow bacteria in, milk that isn’t removed regularly and efficiently (engorgement), anemia, infrequently changed breast pads.  You should follow your healthcare professional’s treatment plan, which may include antibiotics, resting, and frequent pumping.  You may find cold packs feel soothing on your inflamed breast or you may find heat more soothing.  There breast gel packs specifically designed to be chilled or warmed, and they fit in your bra and are easy to pump with.  Additionally, you may decide to try gently massaging your breast to encourage draining of your lymph vessels.  Late or incomplete treatment of mastitis can result in a breast abscess.

Because you remove milk less frequently whenever you decide to wean, mastitis can often result if you do not wean from the pump carefully.

Breast Abscess
A breast abscess is a pocket of pus that is trapped in the breast.  It likely presents as a painful, red, swollen lump and can be accompanied by a fever.  The lump itself can be hard or soft, and it does not change with pumping as a plugged duct would.  An abscess may result following poorly managed mastitis or from bacteria introduced into the breast through nipple damage.  You should follow your healthcare professional’s treatment plan, which often includes draining the abscess and antibiotics.

Engorgement
Simply put, engorgement is too much fluid built up in the breast.  Engorged breasts are temporarily swollen; they feel heavy, full, lumpy, hot, tender, throbbing or painful.  This feeling may extend to you armpit, which may have breast tissue.  You may experience engorgement in the week following birth as a result of the start of milk production and increased blood flow, but you can also experience engorgement if you miss a pump session.  Frequent pumping should prevent or alleviate engorgement.  Try pumping on a low suction setting to start and massaging your breasts.  Although cold packs made provide relief to the pain associated with engorgement, warm heat may exacerbate the pain.

Vasospasm
A vasospasm is a severe, sudden constriction of the blood vessels in the nipple that causes an intense stinging, burning, or shooting pain and a color change in the nipple.  Cold can make the vasospasm worse.  Pumping may induce a vasospasm but you may also experience a vasospasm between pump sessions.  Sometimes, the vasospasm is due to nipple trauma but it can also occur as a result of a syndrome known as Raynaud’s Phenomenon.  Addressing the source of the trauma to your nipple may resolve the vasospasm.  However, until you have addressed the source of the problem, warm heat is should help, as it should relax the constricted blood vessels (think: blow dryer, warm washcloth, rice heating pad).  

Yeast Infection/Thrush
Thrush is a kind of yeast infection of the nipples and may cause you to experience shooting pains in the breast or nipple discomfort during pumping.  Other symptoms of thrush you may experience include: cracked nipples, a shiny bright red or pink rash or red dotty rash on the nipples, peeling or flaky nipple skin, and a burning, itching, stabbing, or shooting sensation.  Check with your healthcare professional for treatment.

Skin Conditions
Skin conditions, such as eczema or nipple dermatitis may occur on the nipple or areola.  Nipple dermatitis can result from bacterial growth on the nipples or an allergy or sensitivity to products.  Common culprits include: nipple creams or lotions, shampoos, detergents, or fabric softener.  Your rash may be scaly, dry or weepy and feel itchy but you may also experience a burning pain.

Did you know your beast milk may help your skin condition?  Although application of breast milk to your nipple after pumping may not prevent a skin condition—you’ll want to determine the source of irritation for that— it may help heal some conditions because it can fight infection.  Sometimes, your healthcare provider may prescribe the All-Purpose Nipple Ointment (APNO).  It is a topical ointment that includes an antibacterial, and an anti-inflammatory, and an anti-fungal.  Sometimes the APNO it will include ibuprofen for pain relief. 

Baby Blues
Baby blues is a short-term form of depression that may last a few days to a week or two after giving birth.  According to the American Psychiatric Association, up to 70% of all new mothers experience the baby blues.  According to the Mayo Clinic, common symptoms of the baby blues include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Reduced concentration
• Appetite problems
• Trouble sleeping

If you have thoughts about death, suicide, or harming your baby, please get medical help immediately.

Peripartum Depression (formerly Postpartum Depression)
Peripartum depression, formerly known is postpartum depression, is a more severe, long-lasting form of depression that is a complication from pregnancy and giving birth.  It is emotionally and physically debilitating and, among other symptoms, may involve feelings of extreme sadness, indifference, and/or anxiety, and changes in energy, sleep, and appetite.  Peripartum depression is treatable—please click here for more information. 

If you have thoughts about death, suicide, or harming your baby, please get medical help immediately.

The EP&Me Take:

This post has a whole lot of doom and gloom huh?  I hope you are reading this because you are curious at some of the pitfalls to pumping and not because you are in pain.  If you are in pain, please take care of yourself.  Make time to get medical attention or however else you wish to proceed.  You are important too.  I know how easy it is to unintentionally always put your self last.  Sometimes, putting yourself last is putting yourself into a position where you may be in pain later.

You plan to do just one more thing before taking a nap while your baby is napping, but it turns into five or ten more things and your baby wakes up five minutes after you lay down at the same time you wonder—have I had any water today?  Or you pump, and feed and rock your baby to sleep, then wash your pump parts and store the remaining milk before starting to eat your dinner—which is now cold by the way—only to realize its time to pump again.  Or how about this one?  Your baby starts screaming in the middle of your pump session (which always seems to happen) and you can’t pick them up, so you try to soothe them as best you can with your hands but you realize you aren’t pumping well because you are so stressed, which is inhibiting more let-downs, and you have no hands to massage or compress to help with milk removal, so you cut your pump off early and whip the flanges off to cuddle your baby.  But really, it’s a relief anyway, because pumping hurts—you know it’s probably because the flange size isn’t right or because you haven’t had a change to figure out what suction is best for you, but you haven’t just haven’t had the time for either.  Or maybe you keep telling yourself, I’ll pump in just a minute—just as soon as the baby is sleeping or calm.  Only that never happens and suddenly it has been 8 hours since your last pump.  Do any of those scenarios sound familiar?  The mama described above may be a little dehydrated, sleep deprived, stressed, undernourished, engorged, with nipple damage.  This mama has a future with reoccurring plugged ducts, continued nipple damage and maybe an infection or abscess.  I want to hug this mama.  

I felt like this mama.  My pumping journey started off with a lot of pain because I was still working with my Little on latching in the hopes we could make nursing work for us.  I tried as had as I could at the time, but I always felt like I was a step behind everything I needed to know and there was just Not.  Enough.  Time.  As a result, I had a lot of nipple damage when I began pumping, and the damage did not improve much because I was pumping with a flange that was much too big for me.  I had no idea and even once I suspected the root of my pain, it took longer than it should have for me to find the time to measure myself.

What I did learn early on was that ductal narrowing/”plugged ducts” and breast infections were things not to mess around with.  As soon as I felt a small lump in my breast, I worked that lump out through gentle massage in a pump session and paid careful attention to the spot for the next few days to make sure the lump didn’t return.  I also began taking sunflower lecithin, which I think really helped me prevent the inflammation that leads to ductal narrowing.  I know the lecithin certainly made a difference in how easily the milk was expressed from my breast.  

Another thing I did to avoid dealing with plugged ducts (which again, are not actually plugged, just inflamed) was to drop pumps very slowly.  I pumped at specific times each day, and when I was ready to drop a particular pump, I would push that pump session fifteen minutes later every day until it ran into the next pump session.  For example, if I pumped at 10am, 12pm, 2pm, and 4pm for thirty minutes each session, and I wanted to drop my 12pm pump, I would pump drop the pump like this

Day 1: 10am, 12:15pm, 2pm, 4pm
Day 2: 10am, 12:30pm, 2pm, 4pm
Day 3: 10am, 12:45pm, 2pm, 4pm
Day 4: 10am, 1:00pm, 2pm, 4pm
Day 5: 10am, 1:15pm, 2pm, 4pm
Day 6: 10am, 1:30pm (and pump for 45 minutes instead), 4pm
Day 7: 10am, 1:45pm, 4pm
Day 8: 10am, 2:00pm, 4pm

So it would take me eight days to drop the 2pm pump in this scenario.  This method may absolutely have been overkill, but I never had a real problem with plugged ducts (they were always gone within a day) as a result of dropping pumps or weaning.

One situation I found incredibly hard was pumping while I was sick.  My Little was in daycare when I returned to work and within the first week, she was already sick and that cold hit me HARD.  I really struggled to pump while sick (it’s such an icky feeling to pump while you have chills and are achy) and to ingest enough water.  Not only did my milk supply struggle when I was sick, but I know I felt a bit engorged or had a few clogged ducts with some illnesses.  I know it’s tempting to hydrate less and pump less when you are sick, but try to resist the urge.  You do not want to encourage inflammation and possible mastitis and infection.  Take care of yourself mama!