bleb?

[Guest guest]

Have a mom with a unresolved bleb on both nipples. They feel coarse almost

scaly, not the typical bleb. But after nursing it looks more typical. Had for 4

weeks now.

Warm moist heat, olive oil and ???? what else? Any new miraculous tips for me?

thank you all for your replies, I LOVE this group.

Liz Pevytoe, RN, IBCLC

[Guest guest]

" Scaly " makes me think eczema..?  

  , MS, IBCLC, LLLL wellspringlactation.com |

[Guest guest]

Hi, Liz.

I've described what I tell mothers below. But I've gotten to the point where I tell them when they call with the first bleb, so that they might be able to *avoid* the "recurring" part!

Here's what I suggest for a "recurring" nipple bleb. Personally, I think that it really isn't "recurring", but more likely "never quite cleared up in the first place." I think that when that milk sits at the front of the nipple pore, thickened, so it can't get out, then the milk behind it in that particular duct also thickens as it sits there unable to move out. Then, eventually, the mother finds a way to get the white spot at the nipple pore to go away, and she temporarily feels better. I think she took the pressure off the tissue at the nipple pore. But that other milk that thickened as it couldn't get out, is still there, just back farther in the breast where it can't be seen. Then as baby nurses a few more times, or another day or two, he gradually pulls that

toothpaste-thick milk down to the front of the duct, and that thick milk puts pressure on the tissue around the nipple pore again, and mom is in pain again. But it's not a "new" bleb (at least, this is my conjecture), but just more stuck milk finally making its way down the duct.

So I suggest that moms take a pain reliever (like Motrin) right before they nurse the baby, preferably when there is another adult in the house to take care of the baby after they've finished nursing. Otherwise, if she is alone, she can try to do this when she expects baby to take a long nap after nursing. She takes the pain reliever, so that it has time to get into her system, and I warn her that what I'm suggesting will not feel good. (So she isn't cussing at me while she's in the tub, thinking I'm a complete moron.) She breastfeeds, so there's the least amount of milk/pressure in the breast as possible. Then she gets in the tub, with the water high enough that she can comfortably lean over and submerge her breasts.

She soaks them for 3-4 minutes, to let the heat help to widen the ductwork. Then she starts at the nipple and massages and expresses the nipple to move out any thickened milk she can. Then she moves back to the areola and massages and expresses a strip about an inch wide, all the way around the breast. Then she moves back about an inch toward the chest wall, and again massages and expresses any milk she can out the front of the breast. She continues to move back on the breast, inch by inch, constantly moving the milk towards the nipple. (If she starts back at the chest wall, she's just running milk into the blockage and increasing the pressure.) I warn her that if she manages to express any thickened milk, it is likely to feel unpleasant or even painful, but that if she manages to get it out, she will feel much better

afterwards.

I also warn her of two more things: 1. If she gets out a plug of thickened milk, it is likely to look kind of stringy and clumpy and cottage-cheesy in the water. If you don't warn her and she sees this, she will absolutely freak out. 2. Then you must immediately reassure her that if she doesn't see this in the water, but

the pain/plug/bleb goes away/does not return, then it won't hurt her baby to have swallowed it down. It's just breastmilk that lost some of its water and got thick, but it still has all the antibodies and nutrients it ever had. Otherwise, the mother's mind immediately goes from "don't worry if you see this in the water" to "what if the baby swallows that awful-looking stuff?".

I suggest that they do this three nights in a row. It very frequently solves the problem.

Dee Kassing

To: Sent: Wed, August 8, 2012 9:27:26 PMSubject: Re: bleb?

I do not have your protocol but would love to see it.I did see baby and did correct a VERY shallow latch, so the abrading part is entirely likely.Liz Pevytoe, RN, IBCLC>> Hello, Liz.>  Sometimes blebs are caused because baby keeps abrading the nipple. Have you > observed this baby at breast? If this has just been a phone consultation, you > may want to suggest she do an in-person consultation. Do you have my protocol > for clearing out blebs from the inside?>     Dee Kassing> > > > > ________________________________> > To: > Sent: Wed, August 8, 2012 6:20:04 PM> Subject: bleb?> >  > Have a mom with a unresolved bleb on both nipples. They feel coarse almost > scaly, not the typical bleb. But after nursing it looks more typical. Had for 4 > weeks now.> Warm moist heat, olive oil and ???? what else? Any new miraculous tips for me? > > thank you all for your replies, I LOVE this group.> > Liz Pevytoe, RN, IBCLC>