Breast pain is any pain that you feel in your breast tissue, as opposed to your areola or nipple. It falls into two main categories: Pain accompanied by visible symptoms and pain without visible symptoms.
When you can see or feel a troublesome spot and you feel breast pain, there are a few potential issues to consider: Engorgement, plugged ducts, and/or mastitis. More on these below.
Engorgement
Shortly after your milk comes in, around three to four days postpartum, you may notice both of your breasts become very firm and tender.
- The skin on your breasts may feel very tight and your nipples and areola may flatten, and because your breasts are so full and the areola is so taught, you may find that baby has a difficult time latching or that latching has become newly painful.
- You may also develop a low-grade fever.
- After baby has nursed well or you have pumped your breasts, they still don’t feel soft.
This is engorgement. You may also experience engorgement after the first week of breastfeeding if you go longer than usual between feedings, such as if the baby unexpectedly sleeps a longer stretch than usual.
Plugged Ducts
A plugged duct can happen any time during breastfeeding. Sometimes, milk doesn’t drain well from your breast and it becomes “clogged.” The result is a firm section of your breast that may be tender to the touch.
- Some describe this as a sphere, like a walnut, a golf ball, or even a tennis ball.
- Others feel it as a long tube from their chest wall to their nipple.
- Others may experience a whole section of their breasts that just feels “hard.”
This is a plugged milk duct.
If you have a plug that lasts for more than four days without getting any smaller, go to your midwife or OB and have them look at it. Plugged ducts can turn into mastitis if not drained in a timely fashion. If you develop redness and pain at the site of the plug, and/or a fever, and/or flu-like symptoms, follow instructions for mastitis and notify your on-call OB/midwife.
Understanding Plugged Ducts: When milk doesn’t drain well from the breast and it sits stagnant, a coagulation of milk can form a thin layer, blocking its ability to flow out of the breast (kind of like when you warm up a cup of milk and there is “milk skin” on top). To make matters worse, when milk builds up, your body doesn’t like it, so the tissue in the milk duct swells. So, now you have a lot of milk and a smaller, swollen milk duct. Baby may need a little help to get this out!
When you have a plugged duct you must:
- Move milk
- Decrease swelling
Move Milk
Before breastfeeding/pumping:
- Five to ten minutes before breastfeeding/pumping, warm the plugged area with a warm compress such as a warm washcloth, a warm rice sock, or a heating pad. A nice hot shower can also be really helpful.
- For stubborn plugs, try applying five minutes of vibration on and around the plug. If you don’t have a handy vibrator in your bedside table drawer, you can use an electric toothbrush or razor handle. There are also breast massagers made for this purpose.
- Try Therapeutic Breast Massage and chest opening stretches.
- Look for signs of blebs or milk blisters. Sometimes there can be a tiny blockage in the tip of your nipple that can prevent milk from draining. This is often accompanied by focused, needle-like pain in the nipple.
During breastfeeding:
- Continue to apply warmth to the plugged area.
- Massage downward toward the nipple at the site of the plug. Try also using constant pressure behind the plug on the side of your body. Try the massager while pumping or feeding.
- Try to position the baby’s chin at the site of the plug. If that means the baby will be upside down, try laying the baby on the bed or floor and, on hands and knees, dangle your breast in the baby’s mouth so his chin is at the plug. Enlist the breastfeeding support person here to help support the baby! If you can’t make this happen, just try shifting the baby into different positions.
- If, after breastfeeding, the plug has not decreased in size, try pumping for 10-15 minutes, continuing to use warmth and massage. Pump just the affected breast and experiment with increasing the suction. Try different positions while pumping including dangling your breast. If you have a larger sized flange, try pumping with that. Get creative here, but don’t hurt yourself.
- Take a break. After working on your plug for 30-60 minutes, stop. It is really easy to get trapped in a boob tunnel. Try again in two to three hours.
Note: Warmth and massage moves milk, but it also makes swelling worse, so only use warmth five to ten minutes before and during breastfeeding/pumping. Do not use excess warmth when you are not actively trying to move milk.
Decrease Swelling
After and between breastfeeding:
- Take 600 mg Ibuprofen every six hours around the clock.
- Apply ice to the plug for 20 minutes on, then 20 minutes off. Don’t put ice directly on your skin. Rather, try using a bag of frozen peas or a frozen ice diaper with one layer of fabric on your skin.
Note: The plug most likely won’t come out all at once, but decrease in size after a number of breastfeeding sessions. After the plug has softened, it’s okay to stop taking the ibuprofen. Know that your breast may feel tender and bruised (like you were punched in the boob) and that is okay; that is because the plug caused tissue trauma. It is also common for the milk supply in the affected breast to be lower after a plugged duct or mastitis. The baby most often fixes this by nursing more often over the subsequent days.
Add a fat emulsifying supplement: Soy or sunflower Lecithin has been found to help treat and prevent plugged ducts and milk blisters. Dose: 1200 mg 1-4 capsules per day
Mastitis
Also known as a breast infection, mastitis often feels like the flu.
- You may have body aches and chills.
- You may have a fever of 100.4 or higher.
- One breast or both breasts may be red and tender to the touch.
- Mastitis often comes with or after a plugged duct, but you don’t have to feel a plug to get mastitis.
If you are at all suspicious that you may have mastitis, especially if you have a fever, call your midwife or OB on call. Yes, this is an emergency. No, you aren’t bothering her. Call. Mastitis can turn into an abscess, which can require a breast surgeon. Let’s avoid that, okay? Please call.
“I feel like I’ve been hit by a bus.” Is the most common complaint of the lactating parent who is experiencing symptoms of mastitis.
Mastitis, also known as a breast infection, often feels like the flu. You may have body aches and chills. You may have a fever of 100.4 or higher. One breast may be red and tender to the touch. Oftentimes, mastitis comes with or after a plugged duct, but you don’t have to feel a plug to get mastitis.
If you suspect you have mastitis, always call your on-call Midwife or OB.
Sometimes an antibiotic is necessary for the treatment of mastitis, but not always. Your midwife/OB will decide this with you.
If you have mastitis, the OB/Midwife will be asking you to follow instructions to drain the affected breast. It is safe to continue to feed your baby milk from the infected breast.
Do NOT stop breastfeeding or pumping at this point. Leaving milk in your breast when you have mastitis can cause a very severe complication called an abscess. If it is too painful to latch the baby, pump in place of breastfeeding until you have a plan in place with your health care professional.
The following protocol should be followed when you have mastitis symptoms whether or not you are taking antibiotics.
“Mastitis Flush” Protocol
- Follow instructions on how to relieve a plugged duct to keep both affected breasts well drained. Move milk, decrease swelling.
- Take 3,000-4,000 mg of Vitamin C per day.
- Push fluids- Drink 1.5-2 times your typical intake of fluids, minimum 64 ounces per 24 hours.
- REST—How can you make sure you do nothing but rest and nurse/pump for the next 24 hours? Ask for help.
If you spike a fever of 100.4 or higher, call the OB/Midwife on call.
When you can’t see or feel a troublesome spot and you feel breast pain, consider these possibilities: Let-down, random boob pain, nipple pain causing boob pain. More on these below.
Let-Down
Not everyone can feel let-down and that is perfectly normal. Others can, and they may describe it as:
- Painful, like a sharp stabbing pain in their breasts.
- Tingly or “like lightning.” Some describe it as a muscle cramp.
- Itchy.
- Pulling sensation deep in their breasts.
Some have no idea when they are letting down; others can tell the second it happens. Let-down pains happen randomly. It can happen in either breast or in both breasts at once. It may happen when your breasts are full and it is time to feed/pump or while the baby is feeding or you are pumping.
Can you feel your let-down? Whether you can or you can’t, it doesn’t matter.
Whether or not you feel your let down is entirely inconsequential to breastfeeding. Feeling your let-down does not mean you are making enough milk, or vice versa.
What is let-down?
In order to be sure lactating people don’t walk around with wet shirts all the time, the body has devised a nice holding system for breastmilk. That is, you don’t get lots of milk unless you ask for it. The technical term for this is milk ejection reflex or MER. Between feedings, your milk is synthesized and stored in alveoli. When your brain gets the message, it releases oxytocin, which makes the tiny muscles of the alveoli contract, squeezing the milk out, down the ductwork and into the baby or pump. Yes, oxytocin. The love hormone. The same hormone responsible for orgasms and labor contractions also makes your milk flow. It also tends to make you thirsty and sleepy.
How does your body know to let down?
There are two main ways your body knows to let down. The obvious trigger is nipple stimulation. The sensory neurons in your areola identify that there is either a baby or a pump sucking, so tell the brain to release milk. Sometimes it is instantaneous, sometimes it takes a minute or two. Some even have a delayed let-down of five minutes or longer.
Your body can also be triggered to let down with a simple thought. If a lactating person hears a baby cry, a let down can be triggered. This is also why some find thinking about their baby when pumping helps to release more milk than if they are thinking about something else like a busy work day.
Most lactating parents describe a sensation in their breasts between let downs which I’ve coined, “false let-down.” This sensation results from the body’s attempt to let down, but can’t because there is pressure on your nipples from your bra. I think this is comparable to when you need to pee really badly and you are right next to the toilet but you can’t get your belt undone.
What does a let-down feel like?
You tell me! I am always interested to hear how la describe their let-downs. A few say it is painful, like a sharp stabbing pain in their breasts. Others say it is tingly or “like lightning.” Some describe it as a muscle cramp. Some say it is itchy. Others say it feels like a pulling sensation deep in their breasts. Some women have no idea when they are letting down; others can literally tell me the second it happens.
So, can you feel your let-down? Whether or not you can feel it, know that your breasts are communicating with your brain through a complex and intricate system. Whether or not you can feel it, is just a subtle nuance of your personal breastfeeding experience.
Random Boob Pain
“Zingers,” as we like to call them, are random, fleeting painful sensations in your breasts. There is often no consistency or pattern to them. They change locations in your breast. You cannot find any one spot on or in your breasts that seems to be the culprit. They are not a cause for concern.
Nipple Pain Causing Breast Pain
If you are having breast pain, but you aren’t able to find a clog or an area of fullness, nor do you see a red streak, and the pain seems to be originating from your nipple, you may be having pain radiating from your nipple.
If you have had more than two plugged ducts since your baby’s birth, had mastitis even once, or aren’t sure what the heck is causing your breast pain, now is a good time to see your OB and your IBCLC.
