Mastitis

What is mastitis?

Mastitis is an infection or inflammation of the breast. Acute mastitis causes mothers significant breast pain and fever; breast redness, warmth, body aches and chills may also be present. The main difference between mastitis and plugged ducts is that plugged ducts only cause localized symptoms, whereas mastitis causes systemic symptoms Mastitis can come on suddenly without warning (characteristic of bacterial mastitis), especially if you have cracked nipples that might allow bacteria to enter. Or, it can come on gradually following unresolved plugged ducts (characteristic of inflammatory mastitis). One study found that mastitis occurs 25 times more often in women who were given antibiotics in their third trimester due to the disruption of the breast's natural flora. Keep in mind all women are given intravenous antibiotics during csection deliveries.

There are many things you can do at home to support your immune system's response and feel some relief. However, please consult your midwife or OBGYN if your symptoms are not improving after 24 hours - antibiotics may be necessary.

5 Strategies for Mastitis

  1. Follow the Plugged Duct Protocol

This protocol emphasizes the importance of reducing swelling and inflammation with anti-inflammatories; strategies for loosening any plugs and improving breast emptying. Click the drop down for the protocol - do not skip!!!

Step 1: Reduce the swelling and inflammation so that the ducts can dilate and flow freely, allowing the build up of milk to pass.

  • Ibuprofen and turmeric (curcumin) are anti-inflammatories that can be taken according to package directions. (Consult your doctor if you have other health conditions or take medications that might be contraindicated.)

  • After each feed, apply cold packs to the painful areas. Cold reduces swelling and inflammation. Try Lansinoh's Breast Therapy Packs which can fit in your bra or around your pump flange. Laying on your back with cold compresses applied can be extra helpful as it encourages lymph drainage as well.

Step 2: Liquify the milkfat so that it flows freely and is less likely to form clumps

  • Take Sunflower Lecithin according to package directions. It is an emulsifier that helps fat to mix evenly into liquids and makes it less likely to clump or separate Some women continue to take a low dose of sunflower lecithin to prevent future recurrence of plugged ducts.

  • At the beginning of the next breastfeed/pump session, apply heat for 10 minutes. Heat helps to melt/liquify the milkfat and promotes relaxation and better milk flow. Do not use heat more than 10 minutes because it can increase swelling and inflammation if overused.

Step 3: Focus on frequent and thorough breast emptying.

  • Pump or breastfeed frequently (every 1-2 hours) until the area no longer feels swollen or hard and the pain is improving. If baby has a good latch and suck, s/he may be more efficient at clearing a plugged duct than a pump. However, if baby isn't willing to nurse often or empty fully, follow breastfeeding with pumping.

  • Massage the area or use a vibrating electric toothbrush on the area to help break up the plug. Consider using a "dangling" position while pumping or nursing where you are leaning forward or on all fours so that gravity can aid in emptying.

Repeat throughout the day until you start to feel relief. Read more about plugged ducts here.

2. Bed Rest

Until you are fever-free (without the use of fever reducing meds), we recommend bed rest with your baby for two reasons. First, your body desperately needs rest to fight off this infection. Staying off your feet and cozying up in bed give you the best chance to rest even if you aren't able to get much sleep. Second, spending a day or two focused only on resting and breastfeeding will give baby lots of opportunities help move the milk and relieve your mastitis. Frequent breast emptying is incredibly important to help your body fight off mastitis. Let your baby nurse as often as s/he is willing while you are snuggling and resting in bed.

3. Boost Your Immune System

Take immune system boosting supplements, such as elderberry syrup, probiotics, vitamin c, and zinc. Avoid sugar, which lowers your immune response, and eat foods that are nutritious and plentiful in vitamins and minerals. Studies have found that two specific strains of probiotics are particularly helpful in fighting mastitis: L. salivarius and L. gasseri. Order on Amazon with one day shipping and start taking pronto! You can check local stores for these strains but we have found they can be difficult to source locally.

4. Hydrate!

Lactating mothers can quickly become dehydrated when feverish. Dehydration can temporarily lower milk supply. Help support your milk supply and flush out infection by staying well hydrated. In addition to drinking lots of water, ensure adequate electrolyte balance by eating foods high in electrolytes (bananas) or drinking electrolyte enhanced beverages.

5. Seek Medical Care

If you are not feeling significant improvement within 24 hours you need to seek medical attention. In rare situations persistent mastitis can lead to a breast abscess or bacteremia. Go to a breastfeeding medicine doctor, midwife, OBGYN, or urgent care/ER if your mastitis is not improving or is getting worse. This is true even if you are on antibiotics as sometimes mastitis is antibiotic resistant and a different prescription may be needed.

After Mastitis

After a bout of mastitis, your breast may feel bruised for several days. Milk supply is commonly lower after mastitis, but should rebuild quickly with frequent breastfeeding/pumping. We highly recommend taking a probiotic containing L. salivarius and L. gasseri following mastitis to restore healthy flora and help prevent recurrence. This is also a good time to think back to the the days leading up to when you developed mastitis to identify risk factors so you can try to avoid it in the future. Risk factors include:

  • Long spaces between feeds (feed/pump more often)

  • Oversupply*

  • Recurrent plugged ducts*

  • Cracked nipples*

  • Antibiotic use in past year (probiotics may help restore flora)

  • Run down immune system (reduce demands on your schedule to allow for more time to rest and bond with baby, take immune boosting supplements and eat a healthy diet)

  • Baby that does not drain breast efficiently*

  • Improperly fit pump flanges*

  • Tight, restrictive bra or stomach sleeping

*Meet with a lactation consultant to determine causes and solutions for these issues

Mamas in the north Charlotte and Lake Norman area, we encourage you to setup a home visit so we can help you address these issues. If you are out of our travel area, you can setup a virtual consult with us or google "lactation consultant near me" to find local help.