The mastitis updates you need to knowMay 22, 2023
First of all - what even is mastitis?
The usual definition of mastitis is a tender, hot, swollen, wedge shaped area of breast associated with a temperature and flu-like symptoms.
But did you know that mastitis literally means inflammation of the breast. This inflammation may or may not involve a bacterial infection.
It's likely that it goes like this:
Engorgement -> Non-infective Mastitis -> Infective Mastitis -> Breast Abscess
What can cause it?
Well, it’s a long list. Including:
Infrequent or scheduled breastfeeds
Poor attachment or weak suck
Illness in mum or baby
Oversupply of milk
Pressure on the breast (e.g., tight bra)
Blocked nipple pore or duct (milk blister/bleb)
Stress and fatigue
Keep breasts as close to empty as possible
Feed baby on demand, and do not aim to empty breasts
Repeated feeding will suppress feedback inhibitor of lactation (FIL), which will result in increased milk production. This will worsen the inflammation and ductal narrowing.
Use a breast pump to keep breasts as close to empty as possible
Minimise breast pump usage
Pumping does not provide the opportunity for bacterial exchange between baby's mouth and your breast. This can change the milk microbiome (aka. microorganisms in the milk). Breast pumps can also cause trauma.
Use massage to relieve symptoms
Avoid deep massage of the breast. Instead use manual lymphatic drainage with light sweeping of the skin.
Deep massage causes increased inflammation, tissue oedema (swelling), and microvascular injury.
- Avoid the use of nipple shields as they can result in inadequate breast milk extraction
- Wear an appropriately fitting supportive bra (without underwire)
- Avoid saline soaks, castor oil, and silicone breast pumps filled with Epsom salts as these can macerate the skin
What to focus on?
- Holistic support from an IBCLC and GP
- Feed on demand, not to 'empty' breasts
- Decrease inflammation and pain with ice and non steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen
- Consider therapeutic ultrasound and manual lymphatic drainage
- Discuss with your doctor the use of antibiotics for bacterial mastitis only
- Consider probiotics
Mastitis is a literal pain, so please get support early.
As always, you’ve got this mama, and I’ve got you.
Source: Academy of Breastfeeding Medicine.