title: Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis.
abstract: BACKGROUND
  Many women in developed countries do not meet their breastfeeding goals and wean early because of breast pain.
  
  
  OBJECTIVE
  This study aimed to describe clinical response to therapeutic breast massage in lactation (TBML) in the management of engorgement, plugged ducts, and mastitis.
  
  
  METHODS
  Breastfeeding women presenting with engorgement, plugged ducts, or mastitis who received TBML as part of their treatment were enrolled (n = 42). Data collected at the initial visit included demographic, history, and exam data pre-TBML and post-TBML. Email surveys sent 2 days, 2 weeks, and 12 weeks following the initial visit assessed pain and breastfeeding complications. A nested case control of engorged mothers (n = 73) was separately enrolled to compare engorgement severity.
  
  
  RESULTS
  Reasons for the visit included engorgement (36%), plugged ducts (67%), and mastitis (29%). Cases, compared to controls, were significantly more likely to have severe engorgement (47% vs 7%, P < .001). Initial mean breast pain level among those receiving TBML was 6.4 out of 10. Following TBML, there was significant improvement in both breast (6.4 vs 2.8, P < .001) and nipple pain (4.6 vs 2.8, P = .013). All women reported immediate improvement in their pain level. At the 12-week survey, 65% found the massage treatment very helpful. The majority of the women with a new episode of mastitis or plugged duct during the study follow-up found the techniques learned during the office visit very helpful for home management of these episodes.
  
  
  CONCLUSIONS
  In office, TBML is helpful for the reduction of acute breast pain associated with milk stasis. Mothers find TBML helpful both immediately in-office and for home management of future episodes.
authors.affiliation: Breastfeeding Medicine of Northeast Ohio, Cleveland, OH, USA Senders Pediatrics, Cleveland, OH, USA Case Western Reserve University, Cleveland, OH, USA awitt@bfmedneo.com.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Witt
authors.affiliation: Breastfeeding Medicine of Northeast Ohio, Cleveland, OH, USA Senders Pediatrics, Cleveland, OH, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Bolman
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Kredit
authors.affiliation: Breastfeeding Medicine of Northeast Ohio, Cleveland, OH, USA Senders Pediatrics, Cleveland, OH, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Vanic
mesh_terms: D000328:Adult; D001942:Breast Feeding; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007774:Lactation; D007775:Lactation Disorders / Q000628:therapy*; D008405:Massage; D008413:Mastitis / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: blocked ducts; breast engorgement; breast pain; breastfeeding; breastfeeding experience; breastfeeding practices; breastfeeding support; expression; mastitis