Mastitis – Advice for the Breastfeeding Woman

​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:

• Pain
• Swelling/a lump in the breast
• Redness
• Fever
• Fatigue and generally feeling unwell

Common causes of mastitis:

• Interrupted or erratic feeding patterns
• Sudden changes in the infant’s feeds e.g. infant sleeps longer overnight
• Skipping feeds
• Breastfeeds replaced by bottles or dummies
• Suboptimal positioning and attachment to the breast
• Overly abundant breast milk supply
• Nipple damage
• Pressure on the breast from e.g. tight garments, bras

Here are 5 important things you can do at the first sign of mastitis:

1. REST! REST! REST!
   Clear your diary. Cancel appointments. Mastitis is not something to push through and soldier on with. Your body needs as much rest as possible to fight the inflammation and/or infection. Aim to do only two things: sleep and feed.
2. Take anti-inflammatories.
   These medications are safe to take whilst breastfeeding and don't just treat the pain and fever associated with mastitis but they treat the underlying cause - inflammation!
3. Prioritise feeding from the affected breast.
   This may include comfortable expressing if required. It is important to keep the milk flowing in that breast, even if it is uncomfortable.
4. Manual lymphatic drainage techniques.
   A trained physiotherapist can teach you how to manually assist your lymphatic system to better drain swelling, lymph fluid and the nasty by-products of inflammation from the breast more effectively (Cooper & Kowalsky, 2015). These techniques can also be very effective in preventing future occurrences of mastitis as well.
5. Get help!
   Make sure you speak to someone who is knowledgeable and up-to-date with the latest research about mastitis. Treatments such as correcting any latching problems, therapeutic breast ultrasound and other supportive measures can make a huge difference (Witt et al., 2015). Health professionals who can help are:

• A women’s health physiotherapist who is trained in managing breast conditions
• A lactation consultant
• Your doctor

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.
​Womankind Physiotherapy. 

References

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