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The 3 Big Nasties of Nursing

Sometime in your nursing career, one of these will probably happen to you (if it hasn’t already).

What’s that, you say?

You’ll have to pay the tax. The breastfeeding tax.

Even if you have wonder-boobies, your baby latched on perfectly the first day without even trying, and your milk flows like honey from the Holy Land… I suspect even you will pay the tax at some point. It comes with the territory.

Knowing how to recognize the symptoms of these bad boys will allow you to treat them early, so you can minimize your misery; ignore them and they can get much worse.

Blocked or Clogged Ducts

A blocked duct presents as a painful, swollen hard mass in the breast, sometimes accompanied by surface redness. It is caused by insufficient drainage of your milk, either because of engorgement, a bad latch, skipped feedings, OR by wearing one of the following that is too tight: a bra (underwire is usually the culprit), a bathing suit, or even a baby carrier. If you’re like me, you can also get them sleeping in the wrong position (stomach), or by sneezing, or blinking your eyes (okay, that one’s a joke).

The guidance for treating plugged ducts was officially update in April of 2023. The current evidence reveals that the milk
ducts themselves are narrowed due to inflammation, restricting milk flow. When milk isn’t flowing freely, the fat globules can clump together to form a plug. The plug is unable to flow through the already narrowed ducts. With this update, doctors have begun advising the use of acetaminophen or ibuprofen to reduce swelling and provide pain relief; avoid applying heat.

@The Mayo Clinic

Sometimes, you can feel the blocked duct and other times, like in my case, the whole area or an entire side of the breast is sore and you can’t pin it down to a specific location (totally frustrating). Sometimes the whole damn breast feels like a clogged duct! (Confession: I threw a book against the wall one time because I was in so much pain. It takes a lot for me to throw a book against the wall…)

Not sure if that’s what you have? Do this: bend over at the waist and let the weight of your breasts fall forward. If you have a blocked duct, you’ll really feel it in this position.

So… I consider myself a blocked duct veteran. A frequent customer, if you will. I can confidently say that I have scoured every nook and cranny on the internet, talked to oodles of lactation consultants, doctors, other moms… you name it. When you get blocked ducts that can’t be resolved, you get a little desperate.

Here is how to handle it, with the caveat that deep, aggressive massage is no longer advised due to the fact that the ducts are already inflamed.


If your blockage is really painful and sensitive to the touch, you can take a painkiller about 30-45 minutes before nursing. Nowadays, your doctor will likely advise you to take Ibuprofen to help reduce the inflammation.

2. ICE

They used to prescribe heat – and now they prescribe ice or cold packs to treat the inflammation.


Begin the nursing session on the affected breast if you can stand it, as babies tend to suck harder in the beginning of the feed. Complete the nursing session as you normally would.


Right after nursing, gently massage your breast to work out the clog. You can also try to do this while you are nursing, but the logistics are difficult.


Pat yourself on the back and take a deep breath because that hurt quite a bit.

Repeat several times a day until you work it out.

Two more important things to note:

1. Ask your doctor about taking lecithin (1,200 mg) 3 or 4 times a day. Lecithin has emulsification and lubricant properties – it’s like Draino for your milk ducts. Note that taking too much can make you nauseated, dizzy, and depressed (no joke), so don’t O/D on it.

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2. Drink boat loads of water to thin everything out. Fill up the huge 32 oz water jug that you stole from the hospital and drink several refills per day.


Didn’t work? Sigh. Yeah, me neither. I have a trick for desperate souls. You will feel ridiculous, but this technique works really well.

Hover: Nurse your baby (or pump) while hovering on all fours. Like a dog.

What? That’s right, you will be on all fours and down on your elbows in the front so that your bubbies are dangling down. Nurse your baby while she’s lying underneath you. Try not to laugh.

There is something magical about this position that helps break up the blockage. Do it on a soft place like your bed and it’s not so bad. You can also do this while pumping if nursing is too painful; it just won’t be quite as effective.

Another thing to note is when you finally do break up the blockage, you may not be able to tell until the next morning. If you still feel the blockage after an extensive workout session, don’t be too discouraged. You may not know that you succeeded until a little later.


Ooooh, now we’re getting into the FUN stuff. As if the pain of blocked ducts wasn’t bad enough, many women will go on to develop mastitis as a result. I wrote this section after just recovering from a terrible blocked duct situation, which then caused mastitis. It was so awesome. I got to spend the whole weekend in bed with a killer headache and fever while my husband was off at a video game tournament (is that grounds for divorce?).

I put Blue’s Clues on the TV and slept on the floor next to my daughter while she played on her activity mat and prayed that the house didn’t catch on fire. Good times.

Puerperal mastitis is inflammation of the breast associated with breastfeeding or weaning. It is caused by blocked milk ducts, excessive supply, and engorgement. It is relatively common among nursing moms: about 1 in 5 will get it.

Symptoms usually appear suddenly and include:

  • Breast tenderness, warmth to the touch, or swelling
  • A fever of 101 F or greater
  • Headache
  • General malaise or feeling ill
  • Pain or a burning sensation continuously or while breastfeeding
  • Skin redness, often in a wedge-shaped pattern (seriously, it looks like a slice of pizza)

Generally, feeling like total shit. There you go.

A fever is the hallmark of mastitis. If you have (or have had recently) plugged ducts and you have a fever? You probably have mastitis.

The perpetrator is usually the bacteria staphylococcus aureus (i.e. staph), which enters your system through the nipple or a skin lesion. Your doctor will prescribe an antibiotic, although it can go away on its own (mine did). Delayed or inadequate treatment may lead to the formation of an abscess within the breast. An abscess is… something really gross. Google it. Don’t delay in calling your OB. This is a dime a dozen for them and they’ll know exactly how to treat you.



Thrush is a yeast infection of the nipple and/or breast. It’s the result of a fungus that thrives on milk on the nipples and/or in the milk ducts. Your baby can get it too. In fact, you can pass it back and forth to each other (sweet).

The hallmark symptom of thrush is red, shiny, itchy, and burning nipples. You may also experience shooting pains during or after a feeding (I could put a picture of it here, but I will spare you…).

In your baby, look for a shiny or “mother of pearl” look inside the cheeks. There may be creamy, white patches that cannot be wiped off on the inside of the mouth, along the inside of the gums, inside of the cheeks, roof of the mouth, or tongue. It may also spread to the diaper area (what? Sometimes, yes). If your baby has “diaper rash” that’s not responding to regular rash cream? It could very well be a yeast infection.

Orrrrrr, your baby may also be completely asymptomatic. Just to confuse you.

Preventing Thrush

The best way to prevent thrush is by always keeping your nipples dry. Change your nursing pads promptly when they become soaked. Also, be extra vigilant if you are taking antibiotics, as these make you more susceptible to thrush. (Do you see where I’m going with this? A blocked duct can lead to mastitis, whose treatment can then lead to thrush. AWESOME, the triumvirate!!)

How to Treat Thrush

I always like to treat things without drugs first, if possible. If you have a mild case, first try the following:

  • Like vampires, yeast organisms hate sunlight, so give your breasts a sun bath. Expose your nipples to sunlight for several minutes, several times a day (if it’s wintertime in Minnesota, sorry!). The old man across the street will enjoy this too.
  • Wash your bras in very hot water and let them dry in the sun.
  • Air-dry your nipples after each feeding.
  • Change breast pads after each feeding. Remember: moisture is your enemy.
  • Eat lots of yogurt. This will encourage the “good bacteria” and discourage the growth of yeast.

If that doesn’t work, call your doctor. She can prescribe you an anti-fungal cream (mycostatin, clotrimazole, or miconazole). Some docs will say that your baby should also be treated, even if he is asymptomatic.

So there you have it. It’s the price we pay, ladies, to provide our babies with the best food in the world (although feel free to curse me while you are suffering).

That is everything I’ve learned the hard way. Hopefully, you won’t follow in my footsteps!!



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