LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
Lisa Marasco IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 10 Oct 1997 19:30:57 -0700
Content-Type:
text/plain
Parts/Attachments:
text/plain (44 lines)
> I have a client who has had an apparent
>plugged duct lower quadrant of left breast since saturday. Visible
>plugged nipple pore, extreme discomfort, sore localized area, no temp,
>flu symptoms, etc..  Tried all usual methods to clear plug, Dad even
>tried.  Had some relief from these methods but plug not totally resolved
>and became painful again quickly.

I am starting to become more aggressive in my recommendations and
treatment of plugged ducts. First, of course, is the usual--- warm
compresses, gentle massage, chin towards the lump, etc.  I often throw in
cabbage on the affected area and ibuprofen for reducing the swelling;
the moms have been very successful in clearing plugs this way.  But, if
the plug is accompanied by a blocked nipple pore, either blister or
filled duct, I suggest that they do a saline soak of the nipple before
each feeding/pumping session.

If these measures have not helped at home and the mother comes to see me
in person, I am starting to become braver about doing some stripping.
I've read several articles on stripping of plugged areas and how it can
prevent mastitis, and it makes sense to me; the only issue is of who
should perform such a technique.  The article was written by doctors, and
how I wish they lived near me, because I would refer to them!  They
mention some cases that require local anesthesia for the pain,  though
many cases do not. My own feeling is that if the mother can tolerate my
efforts, I'll give it a try first; they have been desperate and willing,
and I don't know anyone else who will do anything useful for the mother
besides say "keep trying" and maybe throw some antibiotics at her.  So, I
am a practicing clinical LC and I'm going to do that which no one else is
available to do.

 In essence, I do assertive but gentle hand-expression of the area right
behind the nipple to help force things through. I also break any blister
and peel enough away to prevent the area from re-sealing itself. I
palpate the breast until I find the area that corresponds to the affected
pore, and I use breast compression and stripping-massage to help apply
pressure forward for clearing out the duct. If there is exposed raw
nipple tissue (as with the blister), I ask mom to dot it with neosporin
after every feed for a day or two, covering over with lansinoh.  So far,
so good.  I know I'm a little "out there" compared to some, but when I
know that no one else is going to help these moms,  I'd rather try than
send them home without.

-Lisa Marasco, BA, IBCLC

ATOM RSS1 RSS2