June 2014, Issue 3

BREASTFEEDING IN THE
21
ST
CENTURY
San Franciscos Breastfeeding Promotion Coalition Monthly Newsletter


apply a warm pack for no longer
than 5 minutes before a feeding
to help soften breast. Too much
heat can cause further swelling.
If the areola is taut, consider
reverse pressure softening.
(http://kellymom.com/bf/concern
s/mother/rev_pressure_soft_cotter
mna/) Encourage mothers to
massage and compress breast
while baby is feeding. A cold
compress after feeding can help
relieve swelling and pain. Some
moms have used crushed cold
cabbage leaves between feeds
with some success. Pumping for
comfort is also acceptable and is
another treatment option. Some
mothers have also used an anti-
inflammatory to help relieve
swelling and pain

Plugged Ducts

Unresolved engorgement can
lead to plugged ducts.
According to *LLL, plugged
ducts can come on gradually,
shift position, may or may not
be warm to the touch. Although
moms generally feel well, it may
be somewhat painful. Plugged
ducts feel like a slight marble in
the breast.
(Continue on next page)
Predicting a individual mothers
risk for and course of
engorgement may not be possible,
but application of some general
principles may be of help in
anticipating situations that
predispose to a higher risk. The
following factors may place a
mother at a higher risk of
engorgement:
Failure to prevent or
resolve milk stasis -- as a
result of infrequent or
inadequate drainage of the
breasts.
Small breast size while
small breast size does not
limit milk production, it
does influence storage
capacity and feeding
patterns.
Previous breastfeeding
experience Second-time
breastfeeding mothers
experience greater levels of
engorgement sooner with
faster resolution than first
time breastfeeding
mothers.
Limited mother/infant
contact less engorgement
is seen in mothers that
experience more skin-to-
skin care versus standard
nursery care.
http://www.llli.org/ba/nov00.html
Predicting a
Mothers Risk for
Engorgement
By: Zylmira Ivonne Garcia RN, MSN, IBCLC
Engorgement
While many mothers
experience a significant
amount of breast fullness, it
should not be confused with
engorgement. With breast
fullness, the areola and breast
are still soft enough for baby
to easily latch-on. Usually,
after the baby feeds, the
breasts feels softer. After the
first 2-3 weeks the fullness
should subside and the breast
should feel consistently soft;
this is normal and does not
imply loss of breast milk.
Engorgement on the other
hand is considered overfilling
of the breast tissue, the breasts
are taut and areolas are
difficult to compress, making
it hard for babies to latch-on
and/or drain breast.
Prevention
Allow baby to feed
unrestricted at breast.
Assess latch to make
sure baby is latched
deeply and able to
drain breast
effectively.
Treatment
Goal is to relieve pressure and
drain breast. Moms should

Engorgement, Plugged
Ducts, Blebs Oh My!
July 2014, Issue 4
June 2014, Issue 3



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Homeless mother fights to breastfeed in
public

Plugged Ducts Prevention:
Allow baby to feed unrestricted at the
breast.
Assess latch to make sure that baby is
latched deeply so that he/she can drain
breast effectively.
Avoid underwire bra.
Restrict fat and sodium intake in diet.
Treatment:
The goal is to relieve the plug that is not
allowing milk to flow freely. Apply heat before
the feed (as in engorgement). Massage breast in
affected area while baby feeds, although it
might be tender to the touch. Most importantly:
breastfeed frequently.
Blebs
A clogged-milk pore or bleb is caused by milk
that has dried on the tip of the nipple,
preventing milk to flow through and thus cause
further blockage.
Prevention:
Same prevention procedures as plugged ducts
and engorgement; refer to previous treatment
sections.
Treatment:
Do not pick at it! Instead, use wet heat to help
loosen the dried milk. Another suggestion is for
mothers to wear a cotton ball soaked in olive oil
between feedings to soften the skin. Feed the
baby as usual. As the bleb releases itself, it can
be seen as a strand of cheese! It is safe to
continue breastfeeding!
*LLL: La Leche League
July 2014, Issue 4
The battle over breastfeeding in public continues
as we learn of a Hawaiian mother faced with
conflicts after she refused to cover herself
breastfeeding her baby in a local shelter.
Hawaii law states: It is discriminatory practice
to deny, or attempt to deny, the full and
enjoyment of the goods, services, facilities,
privileges, advantages, and accommodations of a
place of public accommodations to a woman
because she is breastfeeding a child.
Due to Hawaiis heat and the shelters space
limitations, comfortable accommodations were
not possible so Penley, the mother, chose to feed
her child in common space within the shelter.
Penley was asked to cover herself but felt she was
being discriminated against and even [being]
controlled. She reports feeling torn between
wanting to feed her child the way she wants and
giving up her rights because that may mean
living on the streets.
Ultimately, the shelter replied saying they never
asked Penley to leave the shelter: If she leaves it
is going to be her own choice, a shelter
representative says. Despite the option to stay in
the shelter, Penley may continue to be
discriminated against for choosing to breastfeed
in a shelter that does not possess the adequate
accommodations.
Penleys story reminds us of why it is important
to advocate for breastfeeding as a social norm. If
vulnerable mothers, like Penley, are discouraged
to breastfeed, health disparities will continue to
widen. To advocate for social normalcy of
breastfeeding is to advocate for mothers, of all
socioeconomic backgrounds, the comfort of
breastfeeding their children in any environment
they choose.
To read more on this story, please visit:
http://www.hawaiinewsnow.com/
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