Breastfeeding. We’ve done it since the dawn of time. And yet, before having a baby, we rarely stop to consider that it might be harder than it sounds! By the time we give birth we’ve heard from many well-meaning family members and health professionals that ‘breast is best’ and that ‘it is the biological norm’. So then, if we do encounter breastfeeding problems (like mastitis), it is easy to feel confused, guilty, overwhelmed or wonder ‘what is wrong with me?’
Please know that if you have/had mastitis you are not alone! In fact, mastitis affects up to 20% of breastfeeding women and occurs most commonly within the first six weeks after having a baby, but can occur at any time (Amir & Academy of Breastfeeding Medicine Protocol, 2014). Women who have had mastitis once are more likely to get it again, unless they receive the right help to correct the underlying causes. Unfortunately, women are often bombarded with conflicting information on how to best treat mastitis. And sadly, as a result women often feel that ceasing to breastfeed is the only realistic option they have.
As a physiotherapist working in the field of women’s health on both a maternity ward and in a private practice, I treat many women with mastitis. It is a miserable, horrible and overwhelming time for new mothers. And it is so important that you get the right information as soon as possible.
Here is some handy evidence-based info to get you started!
What is Mastitis?
Mastitis is inflammation of the breast (Amir & Academy of Breastfeeding Medicine Protocol, 2014). Milk ducts within the breast are designed for transporting breast milk, not for storing breast milk. Milk ducts are very easily squashed, so sometimes milk can cease to flow properly through the milk ducts due to factors like engorgement, blocked ducts etc. This results in milk products seeping from the milk ducts into the surrounding breast tissue. This causes a dramatic inflammatory response in the breast.
Inflammation is essentially your immune system’s response to a stimulus that your body has flagged as a potential threat to your health and wellbeing. Your body sends all kinds of immune cells (think of these as ‘soldier cells’) to the affected area to help fight the other cells that your body thinks are the bad guys. In the case of mastitis, the foreign milk products escaping into the breast tissue are registered as foreign and a potential threat, so your body creates an inflammatory response to fight them. This is why you may feel sick, may have a fever, pain, breast swelling and redness. Taking over-the-counter anti-inflammatory medication (such as Voltaren or Neurofen) is generally safe whilst breastfeeding and can effectively help reduce the inflammation. If you are able to catch mastitis early enough, and manage the inflammation well, usually mastitis can be effectively treated without requiring antibiotics. That’s great news!
(A note on infective mastitis: In some cases mastitis can be infective, but not in all. The only way of knowing whether it is infective or not, is if a milk culture is taken. As this is a time consuming process your doctor will normally decide whether or not to give you antibiotics based only on your clinical presentation. And whilst antibiotics will treat an underlying infection, they do not treat the inflammation associated with mastitis, nor do they correct the underlying factors that may have contributed to the development of mastitis. Therefore, it is important to address these other issues as well as taking antibiotics.)
Common symptoms of mastitis:
Common causes of mastitis:
Here are 5 important things you can do at the first sign of mastitis:
In summary, don’t suffer in silence! Pay attention to your breasts. Trust your intuition and listen to your body. If something doesn’t feel right seek help as soon as possible. There is plenty of help for mastitis and breastfeeding problems out there.
By Christel Weston.
Amir, L. H., & Academy of Breastfeeding Medicine Protocol, C. (2014). ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med, 9(5), 239-243. doi:10.1089/bfm.2014.9984
Cooper, B. B., & Kowalsky, D. (2015). Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women. Journal of Womenʼs Health Physical Therapy, 39(3), 115-126. doi:10.1097/jwh.0000000000000037
Witt, A. M., Marinelli, K. A., Gill, S. L., Bolman, M., Kredit, S., & Vanic, A. (2015). Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. Journal of Human Lactation, 32(1), 123-131. doi:10.1177/0890334415619439
She came from my being.
Started as a seed, always there. Never apart.
Her number was chosen, she won and thrived;
My bread was her bread, my lungs, her air.
She was me. There was no divide.
My rhythm was her lullaby.
We became an alien, a two headed, strong willed force of nature.
She came with a purpose, perfect from the start.
She breathed her own oxygen and her blood pumped red.
I didn’t think twice when they cut her physical bond to me. It didn’t even bleed a tear.
We smiled. Why didn’t I mourn that more?
She did not recognise herself, rather knew herself only in relation to me.
Without my body, my scent, my sounds; she was lost.
My milk sustained and nourished her. She grew fat on it.
She was physically, completely a product of my body.
I was her world. It came with responsibilities;
some of which were terrifically, physically, emotionally challenging.
Others that were utter gluttony in their delight.
And all she wanted was me, we were so wrapped in each other,
We may as well have been one and the same. And we were.
She took food from a spoon and I mourned a little loss,
Gone was the monopoly I had on her creation.
She carried on the job of children; to grow and learn and become.
Become a personality, an individual, an identity, a person.
She found her voice, a beautiful husky utterance that I recognised as my own.
We watched her stumble out her first steps and babble out her first words.
Steps became skips and words became songs.
She was blooming. And so was our love.
And all this time, she had been observing,
Drinking in language, gestures, concepts.
Lapping up information and gathering opinions.
Lots of them mine, but then, a word I do not say, or a gesture that is foreign.
There is a dart of panic. A loss of control. An extension of the cord
Now she is at school. Now the tables have turned.
I am here for food, for clothes, for transport, for sleep.
But there are many hours and many teachers and many friends, shaping my baby.
This walking, talking, running, jumping, skipping, thinking, writing, reading; baby of my body.
Then there are the moments before dawn, a little tip toe down the hall
There is a soft little voice and hand and she is curled in my body once again.
Later, she will make her breakfast, dress herself, and run with friends
But in this moment, rarer by the day, she has come home to rest.
She is beautiful and she is mine.
But when did she become apart from me?
I will never know. And I will not hold her back.
Though she may travel far and wide,
She is my baby of my body, and always she will be.
I’m pretty much what you’d call a type ‘A’ personality. There’s a part of me that is, or used to be secretly proud of this statement. Doesn’t type ‘A’ mean you’re a perfectionist? That you work hard and achieve high? Well, maybe, but only if the conditions are perfect, and it’s likely that if you really are a type ‘A’ nothing will undo you’re perfect world faster than welcoming a little person or two into your life.
Type A’s like to have their ducks in a row, a very neat row. Generally, their brainwaves run at a pretty high velocity, often jumping on different thought trains and travelling fast in all sorts of directions. Sometimes helpful ones that solve problems quickly and get things done efficiently, especially if you can focus your full attention and can mobilise yourself to that task in that moment.
But what happens when you are forced to slow down? When you cannot get off the couch because your 2 month old has decided they’ll only settle whilst on your chest but you know you need to get to the shops to make that dinner you had planned. Or when you cannot sit in front of the computer for 30mins to type that important email because you’ve just picked up the kids and they are hungry, need afternoon tea NOW, and need to tell you about a fight they had with a friend? What happens inside that type A mind? Does it accept this new state of incapacity? Of delay? Of imperfection? Or does it run faster? Does it try to do both things at once?
The truth is being a parent sometimes (often) involves doing things well below your maximum brain power. So, it makes sense to do something else at the same time. Doesn’t it? I think about what I need at the shops while acting like I don’t know how to do a 9 piece puzzle with my 4 year old; I think about work and formulate a ‘to-do’ list while putting together a nutritionally balanced, interesting and hopefully palatable lunch box.
I thought this was multitasking and patted myself on the back for proving to the invisible Gods that women can indeed do two things at once. However, as we learnt from last weeks blog, it’s not multitasking at all but instead a horrible state of mind called ‘Continuous Partial Attention’ which forces you into a constant state of adrenal attention and eventual chronic stress and has serious health impacts. For more on this, check out last week’s blog here.
After years of doing this, I started to feel vague and disconnected. Like I wasn’t properly seeing or focusing on things. But more than that, it’s hard to describe…a sort of brain fog, a desensitisation, like an imposter was walking around in my life and they were doing a really bad acting job.
It actually felt awful. Sometimes my days were passing, but I wasn’t noticing or enjoying them. And the odd thing was, I wasn’t being that effective, even though that was the whole point of multitasking in the first place. I’d start five different tasks, but not finish one. I’d think about abizzilion thoughts, but none of them would end anywhere useful or decisive. And all this while I was missing chunks of my day that left me feeling a bit powerless and lost.
Then, I started hearing about the mindfulness movement, about being present, about immersing yourself in the sensations, the feelings and the thoughts of the present moment to achieve a calm and focused mental state.
Yes! I thought. This is me…This is what I’ve been missing. I’ve been mentally somewhere else because I was trying so hard to be everywhere and be everything. I want to feel present all the time, I want to really see my kids when I look at them and hear their little voices. Not be caught up in some other task my brain is wanting to focus on.
But it’s hard to do. The shopping list still needs to be thought about and doing the same 9 piece puzzle every day is mind numbingly easy. So how do we do it?! How do we genuinely engage in our present and not be temped into the easy trap of mentally drifting away?
Well the first is to convince your brain that it’s not worth it. That doing several things at once does not in fact make you any more efficient. This may take some time because you’re brain is pretty stubborn, so you need to be patient, kind to yourself and persevere.
Then, there are some pretty nifty Mindfulness tools you can use to bring your mind back to the moment. Here are some of my favourites:
“One thing at a time.”
When I feel my mind racing off in front of me, I rein it in by repeating “One thing at a time” to myself. It’s a great mantra and immediately forces me to be calm, methodical and see what is in front of me.
Notice the small things.
When my 4 year old is concentrating on a puzzle, she gets an adorable focused look on her face. I can see her brain ticking and her entire body is involved in locating the pieces, fitting them into place with her pudgy little fingers and then she gives herself an adorable clap when she’s done. When I focus on these details my mind is sharper, and alive. I feel happy that I’ve genuinely enjoyed watching this little piece of magic.
Feel sensations on your skin
If you are outside, become aware of the sun on your skin, or a cool breeze. If you are feeling warm and cosy or wearing something soft, take a few seconds to acknowledge the material sitting on your skin. Even better, if you are lucky enough to be holding a little persons hand, notice how soft it is, yet how much power they have to cling tight to you.
Take a belly breath
Breathing a full breath and travelling with the air into your nose, down your throat, into your lungs and through your blood and to your muscles is a great way of becoming aware of your body in the present. It also, floods your system with oxygen which rejuvenates your cells and gives your more energy.
This is a good start. But it’s not an immediate fix. One thing I’ve learnt is that you need to forgive yourself. It’s helpful to treat your mind like you would a 2 year old. Steer it in the right direction, but when it starts playing up, gently, and with good humour, direct it back on task and don’t expect too much of it.
Mindfulness, it’s a journey worth taking. Not one I profess to be much good at yet, but I really have no interest in continuing down the unfulfilling journey of poorly attempting to multitask, and I encourage you to do the same.
I can’t do two things at once.
Well, I can, sort of…but I’m trying to stop. You know why? It’s killing me. And I don’t just mean emotionally killing me, I mean it’s actually increasing my risk of cardiovascular disease, weight gain, osteoporosis and Alzheimer’s Disease….and that’s just the start of the list.
I like being on top of things as much as the next person. I like being effective and feeling in control. So….I’ve been multitasking, or so I thought. Turns out what I thought was multitasking is actually something else coined Continuous Partial Attention (CPA) and it’s really bad for me. What’s the difference?
Multitasking is literally doing two things at once, such as stirring pasta whilst having a conversation. But in order to really multitask, at least one of the tasks has to be so simple it is essentially automatic, in the above example it would be stirring the pasta.
Continuous partial attention refers to doing two tasks that require cognitive attention at the same time. However, in actual fact, we are not performing the two tasks simultaneously, rather rapidly switching between the two, or three, or four, and this is where things begin to go drastically wrong…
An example of CPA would be; following a recipe to make a new gluten-free, dairy-free, fructose-free dinner, whilst having two independent and unrelated conversations with a 7 year old and 4 year old, and receiving a text message… at the same time. The brain does not process these cognitive demands simultaneously, rather it’s doing a crazy aerobics workout reminiscent of a Les Mills Body Attack class and leaving you equally exhausted.
This kind of shifting of concentration is driven by our desire to achieve across all levels, not to miss anything (I think the kids are calling it FOMO), and due to being chronically time-poor. Setting all the problems with these motivations aside for another blog on another day… let’s deal with the issue at hand, which is what impact is this constant CPA state having on our health?
Continuous Partial Attention forces us to maintain our attention in a state of hyper-vigilance which in turn keeps our bodies’ flight-or-fight response activated. The flight-or-fight response is a natural, necessary reaction to a threatening or stressful situation that requires immediate action. It turbo charges our bodies for action and for repair, it mobilises stress hormones such as adrenalin and cortisol and increases platelet concentration and immune cells in preparation for tissue damage. It is designed to be used occasionally and for brief periods of time, such as running away from a lion. When it is chronically engaged, as in constant CPA, all these chemicals and physiological changes are being turned on, with nowhere to go. We experience this as anxiety.
Image: Start running; an appropriate activation of the flight-or-fight response.
This long term, over-activation of the stress response causes wear and tear on the body. Some of the symptoms are
Sooo…..who still thinks they’re being efficient when they’re multitasking? But it makes sense doesn’t it. Doesn’t it feel awful when you’ve been jittering around all day from unfinished task to unfinished task, never fully seeing or hearing the world (let alone your kids) around you?
It did for me. And therefore, enter Mindfulness.
But sorry, you’ll have to wait. This blog is long enough and I can’t possibly do justice to the force that is Mindfulness in less than 200 words. But I hope I’ve given you some food for thought. So don’t hold your breath for the next instalment, rather take a big belly breath and actively stop doing too many things at once, it’s really not good for you.
Until next time.
So, confession time, I occasionally can be seen loitering in the ‘self help’ section of a book store. I actually find it fascinating, I am always sucked in to the opportunities for bettering my life and filled with an exciting sense that can only be described as “turning over a new leaf”. Here is the ‘self help’ section of my personal bookcase:
(Oh, I feel a bit naked now!)
So, you may have spotted in my collection, Gary Chapman’s classic book ‘The 5 Love Languages’. For those of you who are not familiar with the 5 Love Languages, here they are listed below:
-Words of Affirmation
-Acts of Service
The premise of the book is that most people identify with a particular love language and that is how they like to receive, and generally the default way that they give, love! So for example, If your love language is gifts, you like to buy people you love gifts, that is how you communicate your love. And generally, you expect gifts in return to feel loved. If your partner is speaking a different language, for example, is missing a night out with friends to be home with you watching a movie because his language is ‘Quality Time’, but you never get a look in, in his weekly shopping list, then we have a mismatch and fireworks can begin (the bad kind, not the good ones).
Now I think I bought this book about 2 years into my relationship with my now husband, so no kids on the scene, not even a ring on the finger and still living separately. I distinctly remember identifying myself as a ‘Physical Touch’ linguist, I loved to feel the comfort of strong arms embracing me or the feel of his rough hands interlocked with mine as we walked down a street. My husband was a ‘Words of Affirmation’ kind of guy. This was interesting to us and fuelled a few good D&M’s (probably late at night over the cordless phones!) but I can’t recall there being much else to note. However, I do remember being very critical of the ‘Acts of Service’ language. Let me explain…
Acts of Service refers to physically doing things for your partner as a way of showing you love them. For example, cleaning the house, mowing the lawn, taking out the rubbish, folding a load of washing. As a young independent woman in my early 20’s (who still lived at home and had very few responsibilities), I thought this was extremely mundane and old fashioned. How could anyone possible interpret that as passion? As an act of love? And what sort of person would you be if you expected that of someone you loved? I thought that meant you basically wanted a slave. I vowed never to speak that love language and proudly ticked the box ‘Physical Touch’ (so much more romantic!)
Then, I moved out of home…
And had kids….
Now; I would strip naked for a man who folds a load of my washing. Now; there is nothing sexier than my husband voluntarily cleaning up the kitchen and placing a fully cooked breakfast in front of me. Now, I get ‘Acts of Service’ as a love language. Oh boy, do I get it.
And Physical Touch? Well, as a mum, I have been smothered, physically, for 7 and a half years. I have revelled in the softness of their skin, their pudgy arms clinging to my neck, their soft kisses all over my face, their little hands wrapped around my fingers. I regularly bury my face in their soft tummies to blow raspberries and they nudge their hard little heads under my chin and into my chest. I receive love through physical touch by the truckload, so I don’t actually need it from my husband.
This paradigm shift in our relationship took a lot of figuring out (I’m making it sound easy here) and quite a while to get our heads around. The very rhythm of how we loved each other had to change as our needs changed. And between work, study, breastmilk, nappies, houses, kids and sleep deprivation it was hard to see things so clearly.
But we got there, and lucky for me, now on a weekend morning…I get both my favourite love languages, hugs in bed with the kids while my husband cleans the kitchen and cooks breakfast!
Now, you’re speaking my language!
For resources and help with shifting your relationship after you have kids, check out this website:
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Please be aware, Womankind Physiotherapy's blog is not intended to replace information and advice from your health care provider. For specific concerns regarding your health you must seek individualised care by your preferred provider.