Mastitis Management in Breastfeeding Women

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July 31, 2023
6 min read

Updated on 3 July 2024.

Mastitis is an awful condition associated with breastfeeding.  This painful complication  can (rightly) contribute to early cessation of breastfeeding.  In this blog we’ll discuss the significant changes to mastitis care and management that were announced in 2023, which can hopefully help with early intervention and management.

Did you know mastitis care and management has changed recently?

The Academy of Breastfeeding Medicine, an international organisation of medical doctors who support breastfeeding have released NEW mastitis guidelines acknowledging that previous standard treatment strategies may have been exacerbating mastitis.

The NEW changes debunk the theory of ‘clogged ducts’ or a ‘blocked milk duct’ that led to women trying to ‘empty’ their sore breasts by feeding their babies more regularly or pumping. 

It’s now considered inflammation not blocked ducts driving breast lumps and pain 

It’s now believed that mastitis is caused by a narrowing of the milk ducts or the milk duct opening that can occur when milk flow is restricted by inflammation.  This occurs when too much milk is being produced. 

The lumps that women with mastitis might feel in their breasts are a build-up of fluid linked to this inflammation.

What is mastitis?

Mastitis is an inflammation of one or both breasts that can lead to infection and is suspected to affect up to 20% of breastfeeding mothers.  It is most common in the first 6 weeks of breastfeeding,  with the highest incidence occurring during weeks 2 and 3. 

Symptoms of Mastitis:

  • It can feel like you have the flu; 
  • Fever with body aches and pains 
  • As well as a red, tender or sore breast that can be hot to touch     
  • Localised breast inflammation  
  • Acute breast pain
  • Burning sensation and/or discomfort while nursing/pumping

Bacterial Mastitis and Abscess’:

In severe cases inflammatory mastitis can lead to bacterial mastitis – in rare cases this breast infection can lead to an abscess. An abscess is a collection of fluid that requires draining. As you will see from the new guidelines below if you suspect bacterial mastitis you need to see your doctor to talk about next steps.

What can cause mastitis?

It’s not always clear what causes mastitis but some reasons could be:

  • The most common – hyperlactation or an oversupply of milk
  • Narrowed, inflamed milk ducts 
  • Long gaps between feeds, causing very full and inflamed breasts
  • Suddenly stopping breastfeeding
  • Tight or underwire bras that put pressure on your breasts
  • Breast Nipple damage

How long does mastitis last?

Inflammatory mastitis usually resolves within 10 to 14 days, when managed correctly.  With swift intervention and following the new guidelines and treatment plans (like ice and lymphatic drainage) symptoms should improve dramatically within 24 to 72 hours. Recognising the signs of engorgement and inflammation early is key.

The Updated Treatment & Management Guidelines:

Thanks to evolving research and understanding, we now have some updated recommendations to help prevent the condition and encourage it to pass quicker. 

(NOTE: On day 3 or 4 when your milk starts coming in and your breast hardens or becomes firm, this is a natural occurrence led by hormones – follow the ABA guidelines for initial breastfeeding).

Let’s talk about the new mastitis advice in detail…

CHANGE 1. The first recommendation promotes breastfeeding on demand equally on both sides.

OLD NEW 
In the past, a common approach to dealing with blocked milk ducts was repeated feeding on the affected side. 

However, recent findings suggest that this can perpetuate the cycle of hyperlactation and actually worsen inflammation. 

The advice is to feed normally on both breasts

CHANGE 2: The second recommendation is to limit the use of breast pumps and expressing

The frequency and volume of milk expression have undergone a significant shift in recommendations. 

OLD NEW 
Previously, pumping was often encouraged to “empty” the affected breast after a feed.  The new advice is to limit pumping where possible – only pump if you miss a feed and only pump what your baby would consume. It is recommended to hand express a small amount for comfort only.

If you opt for baby formula feeds at any point this would mean you’d have to  pump as this would count as a missed feed. 

REMEMBER: This recommendation on pumping is  for mastitis management only, if you are undersupplied or have attachment issues and your midwife, lactation consultant or health care professional advises you to pump regularly to meet the supply needs of your baby  please continue to listen to them (you still need to ensure your supply is matching your babies needs and the milk is being removed effectively). 

CHANGE 3: The third recommendation is to opt for lymphatic drainage over deep tissue massage. 

OLD NEW 
Squeezing and deep tissue massaging of the breast has been recommended in the past to alleviate blockages. 

Unfortunately, this can lead to increased inflammation and potential injury. Avoid deep massage or electric toothbrushes and other commercial vibrating or massaging devices.

The new advice is instead, a gentler approach called manual lymphatic drainage or the breast tissue is now preferred. This technique involves lightly sweeping the skin from the nipple to the armpit, or lightly sweeping in a circular motion aiming to unblock the duct without causing harm.

CHANGE 4: The fourth recommendation is cold over heat

OLD NEW 
Previously heat pack and hot showers were encouraged  It’s now recommended to use ice and cool to soothe inflammation (If we reduce the swelling milk will flow!) 

Interestingly…There may have been something in the age-old treatment of cold cabbage leaves for mastitis, with the new protocol acknowledging that while cabbage is no more effective than ice, its cooling effect might deliver some therapeutic benefits!

CHANGE 5: The fifth recommendation is around antibiotic use

OLD NEW 
If you developed a fever or redness on their chest, women were told to see a doctor immediately where antibiotics might be prescribed. Women are now urged to seek medical help if they don’t start to feel better, or get worse, within 12 to 24 hours of following the new strategies. 

The fever and chills that often accompany mastitis are now thought to be symptoms of an inflammatory response and not necessarily an infection. 

Over-the-counter medication such as ibuprofen and paracetamol can help with pain relief and inflammation. 

Sunflower or soy lecithin 5–10 g daily by mouth may be taken to reduce inflammation in ducts and emulsify milk. 

Antibiotic use is only recommended if mastitis transitions to bacterial mastitis:

If bacterial mastitis is suspected, a culture of your breast milk might help your doctor determine the best antibiotic for you, especially if you have a severe infection.

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Things to keep doing when it comes to mastitis management: 

  1. Start each feed on alternate breasts
  2. Avoid underwire bras and ensure feeding bras are supportive are the correct size
  3. Ensure correct attachment of your baby’s mouth to the breast when you’re feeding – effective removal of milk will prevent inflammation
  4. If you’re experiencing mastitis REST, only focus on feeding and your recovery, eat nutritious anti-inflammatory food, stay hydrated and sleep –  if there’s ever a time to ask for help this is it.
  5. Utilise therapeutic ultrasound by a professional as needed

Other complications to be aware of:

Other less common breast problems may present in a similar way to inflammatory mastitis or general mastitis symptoms – inflammatory breast cancer is a rare presentation that can also cause redness and swelling and can be  initially confused with mastitis.  Again, it is very rare but should be considered if mastitis is not responding to treatment. Your doctor may recommend a mammogram or ultrasound or both.

Seeking up to date medical advice from doctors of lactation consultants:

Research is evolving quickly in the space of lactation and mastitis, these changes to mastitis guidelines are based on the latest research and understanding.  It is important to always talk to your healthcare provider to make sure you’re getting current treatment information. If you’re experiencing any difficulties or have concerns, please always consult with a lactation specialist or healthcare professional who can provide personalised guidance and support. 

The Dr Golly Sleep Program has guidelines on all breastfeeding issues, including engorgement, undersupply, damaged nipples etc. – the updates listed in this blog are in relation to the changes to mastitis management only.

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