Mastitis - a Common Breastfeeding Fear

Non-infective mastitis can result from a blocked milk duct. The mother notices that an area of the breast becomes tender, reddish and hardened. Sometimes there appears to be a red cord leading from the areola (brown area) up the breast. The inflammation (at this stage it is not infected) is caused by the blocked duct not allowing milk to flow. The milk banks up causing localized distension.

If the blockage is not cleared rapidly, milk is forced into the surrounding breast tissue, and, it is thought, into the blood stream. Quite suddenly (eg. in a matter of hours) the mother experiences systemic symptoms such as high fever, aches and pains, and feels like she has the flu.

What causes mastitis?

Usually poor drainage of the breast, which may result from poor positioning and baby not attaching well or not properly draining the breast due to frequent short feeds (under 3 1/2 hrs) or swapping breasts before one side is properly drained. Quite a few other factors may be implicated. Baby may prefer to only suck in one position at the breast. Even a couple of missed feeds from one breast can predispose towards mastitis. In the early days baby should not go longer than 6hrs between feeds. Other reasons could be an ill-fitting bra or lying persistently on one side when sleeping.

How can the mother clear the blocked ducts?

The primary aim must be to clear the blocked ducts. This is certainly not the time to wean, as doing so may well result in a breast abscess developing.

Feed frequently from the breast and try, if possible, to have baby place his lower jaw over or towards the red and tender area. Sometimes it helps to feed from the infected breast first for a couple of feeds in a row. Gently massaging the area of mastitis towards the areola as the baby is sucking, or later under the shower, helps to get the milk flowing. Cold cabbage leaves or a cold pack applied after a feed can help inflammation. Usually, when treated promptly, the blockage clears in 12 to 24 hours.

Warm cloths can be applied to the breast before a feed to assist with the let-down reflex. If the mother is confident, she may try expressing her milk - either by hand or with a pump.

If, after trying these measures for a full 12 hours, symptoms persist, then the local doctor will prescribe antibiotics. On completion of the course (no less than 10 days otherwise the infection will return) the mother must be careful to ensure her milk continues to flow well, with baby sucking vigorously over the previously tender area.

Some form of pain relief and anti-inflammation medication can be taken as soon as symptoms become apparent. They do not harm the breast-feeding baby.

Blockage of ducts can reoccur and mothers become adept at recognizing this and can encourage adequate drainage.

Article by Wendy Back. Lactation Consultant.

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