Mastitis - what you really need to know
Suddenly feeling 'fluey'? Emotional and teary? And you have a hot sore breast?
Feeling 'fluey' any time when you are breastfeeding is a warning sign that you could be coming down with mastitis, an inflammation of the breast that may or may not also be infected. Symptoms of mastitis can hit suddenly and hard: one minute you feel just fine and the next you feel shattered and aching all over with chills and a fever. Sometimes flu-like symptoms come on even before you get a fever or notice breast tenderness.
Mastitis can affect you emotionally too - it is common to feel 'just awful' and teary.
Another sign that mastitis may be rearing its ugly head is an intensely painful breast. Your whole breast may feel tender and 'tight' and be swollen, red and hot or you may present with a red, sore, lumpy patch on one area of your breast only. A sore, lumpy breast may also be caused by a blocked duct or, in the early days of breastfeeding can be due to engorgement (full breasts).
A blocked duct or mastitis without infection will start to feel better with simple measures such as rest and emptying the breast but if you feel increasingly unwell, you will need to seek medical treatment – the sooner the better!
Often the causes behind mastitis can be attributed to lifestyle stresses such as overdoing things and becoming exhausted or stressed. Stress and health issues such as low iron (anaemia) can lead to a depressed immune system that makes you more prone to infections. Missing feeds (such as when you go on a long car trip and baby sleeps through a feed or if you express to go out but don't express while you are away from your baby) or scheduling feeds too strictly and too far apart (your newborn will need 8 to 12 feeds in 24 hours) can result in poor breast drainage and blocked ducts. Poor attachment and latch, a sleepy baby, a baby with tongue tie who is having difficulty attaching, and using nipple shields can contribute to inadequate milk removal or engorgement. Cracked nipples can also set you up for mastitis as infection can enter the breasts through broken skin so it is important to seek help early for nipple soreness.
- Empty the breast: Watch your baby, not the clock. Avoid overly full breasts and empty both breasts at each feed – if you feel tender or full after a feed, express a little milk for comfort (no more, you don't want to encourage 'oversupply'). If you feel very full (perhaps if baby has slept a long stretch), offer your baby a feed – he will probably nurse enough to relieve your fullness even if he is sleepy.
- Check attachment: If you are uncertain about your baby's latch, if breastfeeding hurts or your nipples look 'squashed' after a feed, get a lactation consultant to check your baby's position and attachment.
- Massage: If you feel any lumpiness that signals a potentially blocked duct, massage your breast GENTLY towards the nipple under a warm shower (not hot) and express for comfort - see this video showing gentle breast massage and hand expression. One tip if you have a hard lumpy patch is to massage ‘in front’ of the lump (the side closest to the nipple) to try and clear the blockage, then as baby feeds, GENTLY massage the rest of the lump towards the nipple.
- Avoid under-wire or tight bras that may compress milk ducts ( See the Arden Bra). Also take care when you are sleeping that you don't sleep in a position that may squash your breasts – such as lying on your stomach.
- Take care of yourself. Try to get some rest each day. A nutritious diet and relaxing activities that make you feel good will reduce the effects of stress and boost your immune system.
- Try a probiotic: You may like to try a probiotic specifically created for breastfeeding mothers such as Qiara which has been shown in clinical trials to have beneficial effects on the breast health of mothers who have recurring mastitis.
- Dietary supplements may be helpful. For instance, many mums have found vitamin C and lecithin helpful in preventing recurrent blocked ducts - for more information about lecithin, dosage and potential contra-indications check this link by Kelly Bonyata, (IBCLC),
The good news is that if you start treatment early, you can get on top of mastitis before you become very ill. 'Warmth, Massage, Rest and Empty your breast' is a good adage to remember and if you suspect mastitis, consult your doctor early. If you call a medical centre tell them you think you have mastitis so they prioritise an appointment for you.
Mastitis is a medical illness so should be taken seriously – take sick leave from all duties except feeding your baby.
- Breastfeed frequently (aim for every two hours) to empty the affected breast. Vary feeding positions to drain all ducts. You may find it helpful to ‘dangle feed’ –try breastfeeding while kneeling over baby on all fours so gravity can help breast drainage.
- Before feeding, apply heat to stimulate circulation and mobilise infection fighters in the breast. Heat will also help your milk flow: have a warm shower or apply a heat pack, a warm wet face washer or comfortably hot water in a disposable nappy against your sore breast (this will stay warm longer than a face washer but test carefully that it isn't too hot) and GENTLY massage the affected area (after and between feeds, apply cool compresses). See the Body Ice Woman breast pads - these can be heated or cooled to relieve breast soreness and fit comfortably around your breasts ( heat before feeds and cool after feeding).
- If you need pain relief, take Panadol or Nurofen half an hour before a feed.
- Loosen your bra so there is no pressure on your breast that may inhibit milk drainage.
- Feed on the sore side first but if your affected breast feels too sore to nurse on, start feeding on the least sore side, then switch sides when your milk lets down.
- Drink plenty of fluids – fever and infection will increase your need for fluids.
- After breastfeeds, make sure your breast is drained and feels soft. If you need to, hand express or pump.
- Apply cold compresses (wrapped ice packs or frozen peas or wet a disposable nappy and freeze) between feeds to relieve pain and reduce inflammation.
- Many women find ultrasound treatment by a women's health physiotherapist helps relieve blocked ducts and mastitis symptoms very quickly.
DON'T STOP BREASTFEEDING! Weaning isn't wise while you are treating mastitis as this will increase the chances of developing an abscess that needs to be surgically drained.
If you are prescribed antibiotics, be sure to take the full course.