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Lactation Issues

Updated: Aug 3


One of the biggest challenges that breastfeeding women face is overcoming the many common and uncomfortable lactation issues that can occur. In fact, breastfeeding pain and discomfort affect 1 in 3 women, especially in first time mothers. While breastfeeding challenges can happen to anyone, those who take antibiotics during the last trimester of pregnancy, birth or during early postpartum are at a significantly increased risk of developing lactation issues. 


A common problem lactating mothers face is plugged ducts, which happens when a blockage in the milk duct blocks the flow of milk, causing discomfort, pain, and inflammation. There are a variety of causes of plugged ducts, including oversupply, irregular feedings, tongue/lip ties, improper latch, sudden weaning, and excessive stress. If untreated, it can lead to mastitis, a painful bacterial infection, so taking care of plugged ducts as soon as symptoms arise is key.




Fortunately, there are many ways to help release plugged ducts. We are extremely lucky to have Breanna Duncan, Owner and Lactation Consultant at The Mama Mantra, LLC, and winner of Austin Birth Award for “Best IBCLC/Lactation Consultant Practice” in both 2017 and 2018, share with us her top tips for treating plugged ducts naturally. 






Things to take orally


1. Daily probiotic - Probiotic supplementation has been shown to significantly improve breast comfort during lactation. 

  • Garden of Life Women's Probiotic has been shown in many studies to have 2 specific strains (Lactobacillus Fermentum and Lactobacillus Salivarius) that assist with plugged ducts/mastitis.

  • Our Mother Nutrient Breastfeeding Probiotic also includes Hereditum Lc40, a targeted probiotic strain that has been clinically proven to provide greater support compared with antibiotic therapy and offers short term and long term nursing benefits

2. Vitamin C (upper limit ~2000mg), Vitamin D, Echinacea (as directed on package), raw garlic 2-3 cloves daily (up to 4-5 cloves per day) during acute plugged duct. Continue these remedies after the duct has cleared for about one week.

3. Homeopathic Remedies:

Homeopathic Phytolacca for when breasts are firm, lumpy, or when you experience radiating pain, especially when baby latches. Take as directed on the bottle or as directed by homeopathic practitioner.

- Homeopathic Belladonna for plugged ducts/mastitis that has an acute onset of fever, chills, and throbbing pain. Take as directed on the bottle or as directed by homeopathic practitioner.

4. Happy Ducts Tincture - A liquid herbal blend tincture that includes Poke root, which is very helpful for plugged ducts/mastitis.

5. Lecithin: The recommended dose is 1200mg 3-4x daily. After every week or so of ducts being released, decrease by 1 capsule (1200mg). For recurrent plugged ducts, mother may need to continue to take 1-2 capsules a day to keep plugs at bay.

6. Iron supplement for any history or symptoms of anemia, as anemia can exacerbate plugged ducts



Therapies to try:


7. Laser therapy or therapeutic ultrasound treatment - If your blocked duct has not resolved within 48 hours or so, therapeutic ultrasound is a great option that helps break up the blocked duct. Most local physiotherapy or sports medicine clinics can provide this therapy for you. However, very few are aware of this use of ultrasound to treat blocked ducts so it is best to see an ultrasound therapist with experience in this technique. One ultrasound treatment is typically sufficient to help resolve your pain and discomfort. If two treatments on two consecutive days have not helped resolve the blocked duct, it is likely more treatments will not help. Your blocked duct should be re-evaluated by your doctor or by an IBCLC at The Mama Mantra. Ultrasound therapy may also prevent recurrent blocked ducts that develop in the same part of the breast. The recommended dose of ultrasound is 2 watts/cm² continuous for five minutes to the affected area, once daily for up to two treatments (from International BreastFeeding Centre).

  • Dr. Katherine Melot at Precision Chiropractic in Southwest Austin performs a hot laser therapy for plugged ducts and it works WONDERS. The treatment is fast and affordable. 

  • Sullivan Physical Therapy also offers ultrasound therapy for plugged ducts.

8. Acupuncture can also be helpful to relieve pain and encourage healing for mastitis and plugged ducts. Dr. Danielle Martinez of Danielle Martinez Acupuncture is a Licensed Acupuncturist that focuses on women's health and postpartum care. Her practice is based in Austin, TX.


Massaging the breast


9. Perform therapeutic breast massage every day to help with lymph flow and release the buildup of milk

  • Perform manual compressions/massage while breastfeeding or pumping of any plugged areas in the breast

  • Use the back of an electric toothbrush on the affected area as a massage tool to break up the blocked duct. 

  • Massage coconut oil onto the affected area and use a wide tooth comb to sweep over plugged areas from back to front to help release.


10. Other tips

  • Nurse frequently! Nurse around the clock, ensuring deep latch with proper positioning, and try to do skin to skin/resting with baby as much as possible.

  • Stay hydrated - increase your water intake. Fresh pineapple juice (not from concentrate), which contains enzymes called bromelain, can help reduce inflammation. 

  • This electrolyte powder contains minerals that help keep your body stay hydrated, contains very little sugar, and is sweetened with stevia. 1 package dissolved in 1 glass of water = 3 glasses of water.

  • Eat more probiotic foods like kefir, sauerkraut, and fermented foods. 

  • Decrease the amount of sugar, salt, saturated fat, and dairy in your diet and increase anti-inflammatory foods like green leafy vegetables, fatty fish, nuts, and blueberries. 

  • Potato poultice - Place either grated potato or raw slices directly on the breast to ease pain and swelling. Leave on for about 20 minutes and repeat several times a day. More detailed info here.

  • Dangle nursing or dangle pumping - Let gravity help encourage the milk to flow and massage the area as you pump or nurse.

  • Wear loose clothing to avoid compression of breast area.

  • REST! Take time for yourself each day, as stress and emotional upheaval can cause an increase in occurrence of plugged ducts. 


Things you can do if you have a milk bleb (if you see a white pore/milk blister on the nipple):

  • Gentle exfoliation 1-2x per day with a warm washcloth.

  • Massage from behind the bleb (directly on the nipple) in shower with warm water running after exfoliation.

  • Use a sterile needle to prick the bleb to aid in releasing the blocked milk if needed (ask your provider to do this for you, ideally not done at home).

  • Saline rinses at least 3x daily with epsom salts (soaking 3-5min) - a Haakaa is very convenient for this!

  • After 3 or more nursing sessions per day, apply warmed extra virgin olive oil on a cotton ball and wear it in a nursing bra over the bleb until the next feeding (ideally this is done after a saline soak).

  • Apply prescription Triple Nipple Ointment 2-3x daily or more for 10 day span or 10% hydrocortisone cream 2-3x per day to thin the skin until it breaks naturally. You can get the Triple Nipple Ointment from your OB/midwife and it is filled at a compounding pharmacy.


If you are trying to reduce your milk supply, try the following:

  • Take herbs: sage, jasmine, parsley, peppermint, lemon balm, spearmint. These can be taken as a tea. Have 1-2 cups per day while reducing supply. 

  • Use cabbage leaves - Use washed, chilled or room temperature green cabbage leaves and leave on the breast until they wilt. Repeat as often as needed. 

  • Express just enough milk to relieve your discomfort.



Wow, what a wealth of knowledge and information from Breanna Duncan, BSN, RN, IBCLC, RLC! Through her work as an IBCLC at The Mama Mantra, she has been providing a wide range of breastfeeding support for her clients. 


The mission of The Mama Mantra is:

"to provide exceptional care to help you reach YOUR goals with guidance, compassion and encouragement so that your breastfeeding journey is enjoyable and optimal. Breastfeeding can be a challenge for both mom and baby. We provide care for every situation, for full-term infants, pre-term infants, infants with breastfeeding challenges due to many reasons and for their mother's who experience difficulties."

My own breastfeeding journey

Breanna is who I credit for helping me on my induced lactation journey for Luca. I can personally attest to her incredible dedication, compassion, and knowledge, and it has been amazing to continue working with her. 


If you are breastfeeding and need support, don't hesitate to seek support from a lactation consultant. Contact The Mama Mantra to get more information about consultations, online support and classes, inducing/relactation services, and LGBTQIA services


You can also find Breanna on Instagram @theboobieninja


With support, we can navigate and overcome breastfeeding challenges and feel empowered!


Did you experience any breastfeeding challenges? What helped you? Please share in the comments!



DisclaimerThese should not be a replacement for seeking medical care (and having your care provider “ok” the supplements you desire taking) or a replacement for assistance from a knowledgeable IBCLC to determine the best course of treatment based on personal history and to ensure there isn’t another primary reason that plugged ducts are happening (like tongue ties, infrequent feeding, incomplete milk removal, etc.), as those things should be ruled out/fixed first prior to utilizing any specific course of treatment.



Updated: Oct 2, 2019



We have all heard that “breast is best” and while many new mothers think that breastfeeding should be natural, the truth is it can be very, very hard to breastfeed. New mothers are often unprepared and discouraged with the challenges that come with breastfeeding their newborns. I know I was. After multiple rounds of mastitis, latching issues, nipple confusion and pumping mishaps at work, I got halfway through my goal of two years. What kept me motivated during that year was knowing the wonderful benefits we were both getting with nursing. This is the reason why I want to share these benefits with you.


Breast milk is the perfect food for your baby and a powerful medicine as well.

Its calorie content and composition changes with the baby’s needs, even across each feeding (1). It contains the ideal composition of nutrients, as well as antibodies like Immunoglobulin A to help fight off viruses and bacteria (2). Your milk is your baby’s best medicine.


Did you know that breast milk consistency changes during a feeding?

When your baby starts to nurse, the breastmilk (called foremilk) tends to be watery to quench the baby’s thirst, but as the feeding progresses, the breastmilk (called hindmilk) becomes thicker and more nutrient-dense. This progression during feeding is why it is important to empty one breast completely before switching sides.


Breastfeeding can protect your health.

The list of benefits for baby is extensive, but it doesn’t stop there! Research has indicated that nursing can also protect you from diseases like breast and ovarian cancer (3).


Lactation changes your body in big ways.

Breastfeeding affects your hormones tremendously. Thanks to that feel-good hormone oxytocin that is released right after birth and while nursing your baby, your uterus contracts to help in recovery. Right after birth, breastfeeding mothers generally lose less blood and their uteruses return to their normal size faster (4). Oxytocin is also associated with increased bonding, relaxation, and caregiving, which can all contribute to a lower risk of developing postpartum depression.

Nursing also suppresses ovulation, which means estrogen levels are low, resulting in potential vaginal dryness, night sweats, hot flashes, and low libido. But don’t be alarmed! As your menstruation cycle returns, these symptoms will become less severe.


Breastfeeding is a workout!

Don’t get me wrong, you won’t get toned abs by breastfeeding, but nursing is hard work! Making milk requires more energy, so you typically need to obtain about 500 more calories per day to keep up with the demands (5). While a few nutrients in breastmilk are unaffected by your diet, most of them may be directly impacted (6). That means it is even more important to eat a nutrient-dense varied diet that is rich in whole foods.


Producing high-quality breast milk requires lots of nutrients. The nutrient content of breastmilk depends on the foods you consume. A clear example is vitamin D. Most pediatricians will recommend vitamin D supplementation for breastfed babies. Why? Because the vast majority of the population is deficient. When a mother does not have adequate amounts of vitamin D, she can’t provide it to her baby through her breastmilk. However, a study of American mothers concluded that “maternal vitamin D supplementation with 6,4000 IU/day safely supplies breastmilk with adequate vitamin D to satisfy her nursing infant’s requirement and offers an alternate strategy to direct infant supplementation” (7).


How can you make sure that your milk is as nutritious as it can be without draining your nutrient stores?

If we could get ALL of our nutrition from foods that would be ideal, but the truth is, it’s extremely difficult nowadays. In fact, most postpartum women become nutrient deficient as a result of pregnancy and birth, and increased lactation needs do not help with this issue.

Fortunately, that’s where supplementation can come in to help support the process of healing and breastfeeding. While taking supplements should never replace a good diet, it can help improve overall health for you and baby during the postpartum and breastfeeding period.

A complete postnatal multivitamin like our Prenatal, Postnatal & nursing support can provide the essential vitamins and minerals that you may be lacking in your regular diet. The following 5 nutrients are particularly important (and scarce) during your breastfeeding journey:


1. DHA

DHA is an important fatty acid that supports cardiovascular, neurological, and immune functions. DHA levels in breastmilk can vary hugely depending on the mother’s consumption. Several studies have shown the impact of DHA on children’s brain development and cognitive function (even years down the road) (8). DHA is also crucial for mom’s brain and can improve symptoms of depression(9).

Food Sources: fatty fish like wild salmon, sardines and mackerel, eggs, and algae

Supplementation: Take a daily omega-3 supplement with at least 240 mg DHA and EPA. You can skip the supplement on days you eat DHA from food sources. Mother Nutrient offers a highly-purified Omega 3 DHA + EPA supplement that can help support both mom and baby.

Note: check the label on your prenatal / postnatal supplement, as most don’t include DHA. Omega 3’s coming from flax seeds contain ALA which needs to be converted into DHA. The National Institute of Health says “your body can convert some ALA into EPA and then to DHA, but only in very small amounts. Therefore, getting EPA and DHA from foods (and dietary supplements if you take them) is the only practical way to increase levels of these omega-3 fatty acids in your body.”


2. Vitamin D


Vitamin D requirements during lactation are increased compared to pregnancy. Vitamin D supports calcium absorption and bone growth and helps maintain healthy glucose levels, neuromuscular function, and cognitive performance. Very few foods contain vitamin D, but humans can “manufacture” it when our skin is exposed to the sun. However, most people living in countries in the northern hemisphere do not get enough (or strong enough) sun exposure and therefore the majority of the population is deficient. Individuals with darker skin have even higher requirements. I had mine tested and sure enough, I was deficient even though I eat plenty of seafood, so I started supplementing.

Food Sources: fatty fish like salmon, tuna and mackerel are the best source. Egg yolks, beef liver, and butter have a small amount.

Supplementation: Most pre/postnatal multis include small amounts of vitamin D, but not enough. Take 4,000 – 6,400 IU of vitamin D3 (not D2) daily, preferably with fats as vitamin D is a fat-soluble vitamin. Our liquid Vitamin D3 comes already mixed with MCT oil (coconut oil) for easy absorption. We also offer Vitamin D3 + K2 capsules that provides 5,000 IU.


3. Choline


Lactating mothers have the highest choline requirements - even more than during pregnancy or any other time in their life - at 550 mg per day. This need is most likely due to the fact that large amounts of choline are passed to the infant through breast milk. Choline is a key nutrient for baby’s brain and nervous system development and one of those nutrients directly affected by maternal levels. A 2010 study found that “existing data shows that the majority of pregnant (and presumably lactating) women are not achieving the target intake levels and that certain common genetic variants may increase requirements for choline beyond current recommendations.” (10)

Food Sources: eggs, beef liver, grass-fed raw dairy and cruciferous veggies

Supplementation: Take a daily choline supplement to complement your daily food intake. Check your postnatal multivitamin as most do not include choline. Mother Nutrient’s Complete Postnatal with Nursing Support multivitamin contains 175 mg of choline.


4. Probiotics

What can’t they do? These good bacteria powerhouses can help resolve digestive issues, protect from yeast infections, support the immune system and even improve your mood. I recommended them to all mothers but in critical need are those who had C-section deliveries, or were given antibiotics for GBS, mastitis or other reasons during pregnancy, birth or lactation.

The benefits of probiotics are still amazing for mothers who didn’t take antibiotics. One study found that women who were given probiotic supplements from 4 weeks before birth and throughout breastfeeding had more than double the levels of immuno-protective factors in their milk, than those who received a placebo. The benefits translated to their babies in a significant reduction in risk of eczema, as only 15% developed eczema, compared to 47% of infants whose mothers did not receive the probiotics (11). If you have a colicky baby, probiotics might help too!

For baby, supplementing with infant probiotics helps populate the baby’s gut with beneficial bacteria for better digestion, avoiding thrush, and strengthening the immune system.

Food sources: sauerkraut, kimchi, kefir, yogurt, kombucha, beet kvass, raw fermented cheeses, raw apple cider vinegar

Supplementation: Take a daily probiotic of 20 Billion CFUs or more. Mother Nutrient offers a whole line of probiotic supplements to support mothers and babies, including the Women's Probiotic 40 Billion and our new hypoallergenic infant probiotic powder containing 10 strains of bacteria.


5. Iodine

As is the case with most nutrients in this list, iodine requirements are highest for postnatal and lactating women, and your breastmilk levels are directly impacted by your consumption. Iodine is important for your thyroid, brain, and metabolic health and for the infant’s proper neurodevelopment as well as their thyroid storage (12). As I discuss in my autoimmunity blog post, thyroid malfunction is very common during the postpartum period and can affect your energy levels, weight regulation, and fertility. A meta-analysis looking at thirty-six articles found that iodine levels in breastmilk were adequate in the United States, China, and Iran, but were low in most European countries (13).

Food Sources: mostly found in seafood and seaweed

Supplementation: Guidelines for breastfeeding mothers recommend taking a multivitamin containing 150-250 mcg of iodine daily. Our Complete Postnatal with Nursing Support supplement includes 175 mcg.



If you're suffering from mastitis...

Mastitis is the extremely painful inflammation of the breast that can be caused by infection, obstruction, or allergy. and is one of the most common lactation issues postpartum mothers experience (20% of Western mothers experience postpartum mastitis). Aside from the symptoms themselves, mastitis can lead to a cascade of other problems, including the negative impact on the nutrient intake of baby and the depletion of good bacteria in both mom and baby during antibiotic use.


For mothers with mastitis or who have had repeated bouts of mastitis, getting the proper rest, treatment, and nutrition is paramount to a smooth recovery. A balanced nutritious diet and supplementation with a large dose of vitamin C and a probiotic can help replenish depleted gut flora in both mom and baby. Fortunately, we have a new Breasting Probiotic that is designed to help prevent and support mastitis and other lactation issues in mothers while supporting the immune health of the baby.



Other things to remember during your breastfeeding journey:

  • Drink plenty of fluids - nursing sucks away your moisture so staying hydrated is key to prevent issues like constipation

  • Ask for help - Take advantage of help from lactation consultants who can problem solve issues relating to lactation and from organizations like La Leche League. Your partner, family, and friends are also valuable resources to reach out to so that you can focus on recovery after birth and establish a positive nursing relationship with your baby.

  • Lower your expectations - Let’s face it: life after baby is not going to look or feel the same, so try to reframe your expectations to revolve around the basics. Take a break and relax! Everything else can wait!

  • Find your “village” - Finding a community you can feel connected with is a great way to feel supported and commiseration during the challenging moments. There are many places to look for these communities, whether it’s through your gym or pre/postnatal classes, baby groups, or even local groups online.



Want to know other ways you can support your postnatal journey? Mother Nutrient can help you!

Sign up for our mailing list to get promotions, discounts, and access to awesome nutrition tips and recommendations. When you join, you will receive a free postnatal nutrition guide!


If you're not sure where you stand nutritionally, take our free 3-minute free wellness quiz for a customized nutrition report, including targeted diet, lifestyle, and supplement recommendations based on your results.

Do you have questions on how to improve your breastfeeding journey? What is your biggest challenge during breastfeeding? Tell me in the comment section below! If you know a mama who can benefit from this post, click the dots next to the title!



Content found on this website is not considered medical advice. Please consult with a physician before making any medical or lifestyle changes.

References

1. Ballard O, Morrow A. Human Milk Composition. Pediatric Clinics of North America. 2013;60:49-74.

2. Hurley W, Theil P. Perspectives on Immunoglobulins in Colostrum and Milk. Nutrients. 2011;3:442-474.

3. Ip S. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality; 2007.

4. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129:e827-e841.

5. Butte N, Hopkinson J, Mehta N, Moon J, Smith E. Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation. The American Journal of Clinical Nutrition. 1999;69:299-307.

6. Allen L. B Vitamins in Breast Milk: Relative Importance of Maternal Status and Intake, and Effects on Infant Status and function. Advances in Nutrition. 2012;3:362-369.

7. Hollis, Bruce et al. (2015). Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics volume 136 / Issue 4

8. Raffelock D, Roundtree R. A natural guide to pregnancy and postpartum health. New York: Avery; 2002.

9. Horrocks L, Yeo Y. Health Benefits of Docosahexaenoic Acid (DHA). Pharmacological Research. 1999;40:211-225.

10.Caudill M. Pre- and Postnatal Health: Evidence of Increased Choline Needs. Journal of the American Dietetic Association. 2010;110:1198-1206.

11.Rautava S, Kalliomäki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. Journal of Allergy and Clinical Immunology. 2002;109:119-121.

12. Nichols L. Real food for pregnancy: The science and wisdom of optimal prenatal nutrition. Lily Nichols; 2018.

13. Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clinical Endocrinology. 2009;70:803-809.

Content found on this website is not considered medical advice. Please consult with a physician before making any medical or lifestyle changes.

© 2019 Mother Nutrient

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