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 and about 25% of women are given antibiotics for Group B Strep.
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
- 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 or turmeric (curcumin) are anti-inflammatories that can be taken regularly according to package directions until symptoms resolve. (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.
Heat can optionally be applied to the breasts before nursing/pumping for 5 minutes, but should be used with caution as it tends to increase swelling and inflammation. Overuse of heat often makes plugged ducts worse!
Step 2: Improve breast microbiome to ward off harmful bacteria and reduce white blood cell clumps
Take a women's probiotic containing L. salivarius and L. gasseri to reduce plugs that are sometimes caused by white blood cells in response to breast dysbiosis. Lots of good bacteria (probiotics) help to keep harmful bacteria at bay.
Step 3: Focus on frequent and thorough breast emptying.
If you are experiencing breast engorgement, pump or breastfeeding frequently (every 1-3 hours) until the area softens. 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 soften the breast, follow breastfeeding with pumping. Discontinue this practice once plug is resolved to avoid triggering oversupply.
Use appropriate fit pump flanges (approximate nipple diameter)
Gently massage the area moving from outer quadrants towards areola. 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. Do not use aggressive massage that causes bruising or might increase inflammation.
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. Garden of Life Women's probiotic contains these strains and is easy to find locally in almost any store (Target, CVS, etc) or order on Amazon with one day shipping and start taking pronto!
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.
