Wednesday, September 30, 2009

The Milk Blister (a.k.a. The Bleb)

We were in the midst of trying to resolve Phoebe's Sleep Issues, which meant encouraging her to nap as often and for as long as possible, and ensuring we got her to bed at her new early bedtime. We were also on our way to a party. This was a logistical challenge. How best to enjoy the party yet still get our little girl home and to bed. She hadn't slept before we left. On the way there we discussed whether to drive around and let her sleep in the car, somehow get her to sleep there or keep her going and let her catnap on the way home.

For some reason we settled on the latter. This involved pulling over and feeding her before we got there. After she fed from my left breast I thought it felt a bit sore and noticed the tiniest bit of blood on her chin which I thought could have come from my nipple. I didn't think much of it but the next feed at bedtime was also a bit painful. It felt like she was biting down but I could tell she was actually feeding. When she woke up later that night my breast was sore before I even put her on it. I found I had to hold it in position and even then it was almost unbearably painful. The pain was most acute at the top of my nipple but my whole breast hurt. This was much worse than vasospasm or cracked nipples in my experience. It was one of the most painful experiences I have ever had, with the possible exception of ear infection. I could have cried. Eventually I fed her from the other breast and when she seemed satisfied put her back in her cot without offering the left side again. I took some paracetamol and went back to bed, still in a lot of pain.

The next morning I was in so much pain I was almost dreading feeding her. I continued to take painkillers and read as much as I could about thrush, blocked ducts and mastitis. I seemed to have some symptoms from all of them but none of them quite fit. I was particularly concerned about the prospect of thrush and having to change my diet to fix it. I couldn't see any obvious signs and Phoebe didn't seem to have any symptoms either. I didn't know what to wear and felt best wearing nothing. All of the advice was to feed through it. Nice. I expressed a little bit as I could then control the suction myself which was slightly less painful. Amazingly I got quite a lot of milk.

Phoebe didn't seem to be enjoying feeding from that side either and would quite often pull off crying. This could have been because I was slightly engorged and was massaging the breast and trying her in different positions so it's likely the flow of milk was irregular and frustrating for her.

Then, on the fantastic breastfeeding website kellymom I found a reference to a milk blister, also referred to as a "bleb" (what a fantastic word that is). Earlier that day I had noticed a white spot on my nipple. It came and went and I'd wondered if it was thrush. But it definitely looked more like the milk blister on the web site. A milk blister occurs when skin grows over the top of a milk pore, perhaps due to a damaged nipple. Recall I noticed the blood the previous day. This can then lead to a back up of milk in that duct and engorgement. Engorgement can then lead to other problems including mastitis.

I treated my breast according to the advice: firstly use a warm compress before feeding, then gently rub at the blister to try to loosen the skin. After feeding I expressed as much as I could to empty the blocked duct and this relieved much of the pain in my breast. I then soaked the nipple in a saline solution before expressing a small amount of milk onto the nipple, rubbing it in and letting it air dry. Finally I applied some Lansinoh. It is recommended that you follow this rigmarole every time you feed but who has time for that? I did it once or twice and continued with the compress and rub until I was eventually able to remove the skin blocking the pore.

The majority of the pain went as soon as the engorgement was released and I felt completely better as soon as the skin was removed. A few feeds later my nipple stung a little bit but other than that I was completely fine.

I called the Australian Breastfeeding Association during this just to get reassurance that my diagnosis was probably correct and that I probably didn't need to see a medical practitioner. It can be difficult finding someone with the relevant knowledge when it comes to breastfeeding as it seems to be a highly specialised area. The counsellor I spoke to said that milk blisters are quite mysterious and no one really knows what causes them but she'd had one that kept coming back. They seem very common yet I had never heard of it. Three friends I have spoken to about it (probably the only three actually) had all had a milk blister but none of them seemed to experience quite the level of pain that I did. For some reason the blister didn't appear until the milk was already backed up and engorged, which is where most of the pain came from, whereas most other people seemed to find an obvious blister first and managed to burst it before any problems started.

Needless to say, as you may have gathered from my other posts, this didn't help Phoebe's Sleep Issues. And now she's Teething. Jeez... there's always something, isn't there?

No comments: