The New Mastitis… what to do and how to help
Ok so we were doing it wrong until now…. what do we know about mastitis and how do we treat it moving forward?
First things first- here are some definitions:
A ‘blocked duct’ or breast inflammation:
A blocked duct is an outdated term used to describe what we now know to be localised inflammation in the milk ducts or breast tissue. With the inflammation a mum’s breast will usually feel lumpy and tender, especially when milk is being released. It can also look red, swollen and lumpy, particularly in a certain area of the breast.
Unlike bacterial mastitis there are no associated flu-like symptoms, and so a gentle approach to help milk to flow better is advised… Here, you should be careful not to aggressively massage your breast or express milk more often to “remove the blocked duct” as this can cause further tissue damage and progress to mastitis more easily.
Breast inflammation can happen for a number of reasons, and some mothers are more sensitive toward getting inflammation on their breast. Here are a few reasons why:
You may have an oversupply of milk
You have skipped a breastfeed or your baby has slept longer than usual
Your baby didn’t drink as much as they usually do or wasn’t attached well
You are run down or using a breast pump
There was pressure on the breast from something like a wired bra
Inflammatory Mastitis
This is the next stage that happens when this ‘localised breast inflammation’ worsens. Many mums notice over a 24 hour period that there is increased redness in the area, swelling, pain and possibly the lumps have spread. With inflammatory mastitis a fever, chills or body aches and an elevated heart rate may or may NOT be present.
Bacterial Mastitis
Bacterial mastitis occurs after ductal narrowing and inflammatory mastitis and requires treatment with antibiotics or probiotics if your fever chills or body aches and an elevated heart rate persist for more than 24hrs.
Strategies and management
Breastfeed on demand
Try to feed to need and avoid offering swollen side too often- aim to breastfeed as per usual. If it’s painful to start with the infected side it can be helpful to put bub on the normal side first to stimulate a let-down and then swap side when your milk is flowing.
If you need help to get your let-down started some deep breaths, relaxation techniques, warm shower or something to make you laugh can work well!
Changing your baby’s feeding position can help if it takes pressure off a certain area of your breast or changes where the roof of bubs mouth is. Try side lying, upright, semi-reclined.
2. Ice and Non-steroidal anti-inflammatories (NSAIDs)
Aim to ice every hour (frozen wet nappies on larger areas or a bag of frozen peas)
Ibuprofen up to 800mg every 8 hrs in the acute phase.
3. Minimise Breast pump use
Mechanical breast pumps stimulate breast milk production without physiologically extracting milk as your baby would. Pumping doesn’t provide the opportunity for the same bacterial exchange between your baby’s saliva and your breast, and may, therefore, predispose you to dysbiosis. If your bub isn’t feeding from the infected side hand expressing and pumping at the times your baby feeds from this side might be necessary.
When cleaning the pump don’t sterilise every time.
4. Bras and sleep positions
Wearing a firm but comfortable and breathable bra or top is helpful. Sleep on your back or on the side that is not affected.
5. Manual Lymphatic drainage
This gentle massage can assist with fluid drainage and decrease inflammation in the area helping your milk to flow better through the ducts.
6. Correct Oversupply
If you have an oversupply or a poor attachment and your milk is sitting in your breast for an extended time proteins in your milk can push out into the breast tissue and cause inflammation. It is important to tailor your approach to correct the root cause of the mastitis.
7. Probiotics
Limosilacto- bacillus fermentum (formerly Lactoba- cillus fermentum)
Ligilactobacillus salivarius (formerly classified as Lactobacillus sal- ivarius)
Qiara is an excellent brand!
8. Lecithin
Sunflower or soy lecithin 5–10g daily to reduce viscosity of milk and help it to move more fluidly… Liposomal Vitamin C - Vital Remedies Original Pure Sunflower is great because it combines an antioxidant with the lecithin for immune support!
9. Vitamin C
An important antioxidant that is useful for treating and preventing infections. A safe dose to take is 3000-5000mg/day. Focusing on foods like citrus, berries, kale, capsicum, broccoli, cauliflower, strawberries.
10. Echinacea
To support immunity and lymphatic drainage however avoid tinctures prepared with alcohol and watch for signs in your bub like diarrhoea.
11. Therapeutic ultrasound,
TUS uses thermal energy to reduce inflammation and relieve edema. A physio can perform this on the area for 5 minutes for 3-4days.
12. In some cases, anxiety or depression can lead to higher rates of mastitis…. Vitamin D status and strategies to help stress can help a mum long term.
Some foods to focus on are herring, salmon, sardines, pasture raised eggs yolk, (and of course sun exposure- 10-15 minutes).
Recurrent Mastitis
MRSA and resistant CoNS (bacteria types) will not respond to typical antibiotics used for acute mastitis such as dicloxacillin or cephalexin (antibiotic types)
Multiple recurrences in the same location warrants radiology evaluation to rule out an underlying mass or other abnormality such as granulomatous mastitis.
Avoid
Deep massage of the breast tissue
Nipple sheilds, pumping, over-sterilisation of pumps or dummies or bottles, wire bras/
Avoid breast soaks of saline, castor oil and other topical applications.
Only use antibiotics for bacterial mastitis. Incorrect use in cases of inflammatory mastitis disrupts the milk microbiome and can contribute to the progression of bacterial mastitis.