Managing Mastitis

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What is Mastitis? 

Mastitis is a condition where the breast is inflamed. Commonly, an area of the breast is red and tender. There may also be a blocked duct which feels like a lump in the breast. Mastitis generally occurs in the first 3 months after your baby's birth. There is a peak of occurrence at the second week postpartum and another peak at 5-6 weeks.

Signs of Mastitis 

Part or all of the breast is markedly painful, hot and tender to touch, and may look red and swollen

You may feel tired, nausea, run down, have chills, a headache or think you have the flu. You may feel achy all over especially in the low back and neck. Flu-like symptoms can occur before breast tenderness.

You may have flu-like symptoms plus a temperature greater than 38 degrees. The breast may become increasingly hot, tender and appear tight and shiny. These symptoms suggest you have an infection, which is more likely if you have cracked nipples.  You should see your GP as you may require anti-biotics.

Recent events may have set you up for mastitis – eg. change in baby's feeding pattern, increased stress and tiredness.

The Causes of Mastitis 
1. Breast Engorgement (swelling)  

When the breasts are producing a lot of milk and are not fully emptied by your baby, the milk can overflow from the ducts into the breast tissue.

Breast engorgement happens with:

Changes in feeding patterns: delayed feeding, missed feeding, giving bottles in place of breast feeding, skipping expressing sessions when separated from the baby.

The breasts not being fully emptied during a feed, e.g. poor attachment, hurried breastfeeds or rapid weaning

2. Cracked or damaged skin or tissue on and around the nipple 

Many women experience exceptionally sore nipples when they begin to breast-feed, this can lead to cracked nipples and bacteria entering the breast through this opening or a break in the skin; leading to the breast tissue  becoming infected. When bacteria enter the breast ducts, it grows and attracts inflammatory cells to fight the infection. It is usual bacteria from the baby's mouth that cause breast infections.

Damaged nipples may be caused by:

  • Poor attachment of the baby onto the breast
  • Poor hygiene: infrequent removal of wet breast pads and constant use of nipple creams that may harbor bacteria
  • Candida/Fungal infections. This can be a primary infection, mixed with a bacterial infection, or a complication of antibiotic treatment
  • Poor physical health: maternal stress and fatigue, malnutrition or anaemia.

Blocked milk duct 

Milk duct blockages cause the milk to pool in the breast. This forms an ideal environment for bacteria growth and can lead to infection - may be caused

by:

  • Pressure from an ill fitting bra
  • Trauma such as a kick from a toddler, pressure from a seat belt or an ill fitting front carrying pouch
  • Compression of the breast during sleeping on your stomach or far over on your side, consistently lying in one position.

How to prevent a blocked milk duct 

  • Relieve engorgement promptly; you may even need to pump between breast feeds, especially at night if the baby goes for extended periods of time without feeding
  • Breast feed regularly and don't restrict the length of feeds
  • Take care of yourself and get plenty of rest. Boost your immune system with good nutrition and decrease your stress
  • Well fitting bras or none at all. Often a singlet will do especially at night. Avoid tight clothing.
  • Ensure a good sleeping position on your back or side
  • Vary the baby's position at the breast
  • Thoroughly wash your hands before feeding and after a nappy change
  • Change wet breast pads frequently, avoid overuse of nipple creams,   instead of creams rub breast milk into nipples to prevent cracking
  • Ensure prompt attention to any signs of engorgement and blocked ducts: regularly check breast for any lumps, tenderness or redness
  • Ensure your baby has good attachment when feeding
  • If you have had Mastitis in a previous pregnancy you have a three – four fold increased risk with the current pregnancy. Be vigilant

Management of Mastitis 
Promote Effective & Regular Milk Removal. Seek advice from a maternal and child health nurse, lactation consultant or the Australian Breast feeding Association: Ph - 1800 686 268

  • Do not stop feeding the baby.
  • Promote milk flow and 'let down' with relaxation and a warm compress on the breast.
  • Start the feed on the affected breast, but if pain inhibits let down, feeding may begin on unaffected breast, the switch to the affected side once let down is achieved; breast feeding is often more comfortable once milk is flowing
  • If pain prevents breast-feeding, remove milk by hand or pump
  • Position the baby on the breast so the chin is over the blockage
  • Vary the baby's position on the breast so that all ducts are emptied

Decrease Pain & Swelling 

  • Cold Packs (specifically after feeding) and/or Cold Cabbage leaves
  • If there are no contraindications to Panadol and Neurofen (Ibuprofen) these can safely be taken while breast feeding to decrease pain and fever
  • Build the Immune System: rest, rest, rest, drink lots of water, eat well, decrease salt intake

Physiotherapy

  • Ultrasound opens the ducts and promotes circulation. You may need 3-5 days of ultrasound treatment
  • Promote lymphatic drainage of the breast tissue to decrease inflammation

You may need to see your GP and have antibiotics if: 

  • You have a history of frequent mastitis
  • A fever is rising and you are feeling progressively sicker
  • You have a Candidal infection of the nipples. Often the baby will also have oral candidiasis (thrush) and both of you will need treatment.

Remember

  • Seek treatment at an early stage
  • Ensure you physiotherapist provides you with methods of self treatment.