Three Strikes and You’re Out
November 16, 2007 by Pauline Lupercio | 4 questions or comments
credits: iStockphoto
But my three bouts with mastitis were severe enough for my doctor to send me straight to the emergency room. The first and second times resulted in a 48-hour intravenous antibiotic drip after which I was sent home, my right breast still swollen, tender, and the color of a fading sunburn. The third saw me in the hospital for five days with my breast a flaming, painful, fire-engine red. I can only remember a great sense of relief when the treating physician released me.
There are two types of mastitis that can occur in breastfeeding mothers—infectious and non-infectious. Infectious mastitis is usually caused by bacteria that enter the breast through an opening in the nipple or a break in the skin. Other causes are blocked milk ducts, not fully draining the breast while breastfeeding, stress, and lack of rest. Mastitis can also occur in non-lactating women and sometimes, men.
Mastitis usually occurs in one breast and most often in the first 12 weeks after birth, with the majority of cases occurring within the first three weeks in the 20 percent of women affected.
It is also important to note that once a woman has had mastitis, she is more likely to get it again, either breastfeeding the same child or a future baby.
Medical attention should be sought as soon as symptoms are evident as prompt treatment can help minimize the chance of a fluid-filled abscess developing, which can require surgical draining of the fluid.
Signs to watch out for include:
- Cracked or painful nipples
- Breast tenderness
- Flu-like symptoms including chills and a fever greater than 101 degrees
- A breast that is red in color and hot to the touch
If necessary, your health care provider can prescribe medicine (an antibiotic) that is safe for you and your baby. It’s most important for you to continue to breastfeed as often as possible or, at the very least, to pump your breasts. The infection will not harm your baby, and removal of milk can actually help fight the infection and get you back to your healthy self faster.
Recurrent mastitis, as previously discussed, is also common in breastfeeding mothers. Risk factors for developing mastitis include:
- Incorrect positioning of the baby on the breast
- Use of breast pads with plastic liners
- Poorly-fitting nursing bras
- Delaying or skipping breastfeeding
- Weaning
So how do you cope with a diagnosis of mastitis and a brand new baby at home? With the laundry and the cooking and the many well-meaning friends and family constantly stopping by to see the baby, how are you supposed to rest like the doctor told you to?
Simple: Enlist the help of a supportive spouse or partner, or call up those well-meaning friends and family to help with laundry and cooking. Let others know that you will be in bed with the baby, breastfeeding and resting to get healthy again. If they still stop by, make a mental note and thank them when you feel up to it.
Other tips for helping your body fight the infection are:
- Varying the baby’s position on the breast to ensure all portions of the breast are well-drained during the feeding sessions
- Sleeping without a bra, and if possible, go without one during the day, as well
Treatment for mastitis usually requires a 10-14 day course of antibiotics. Even if symptoms clear up after a few days, it is important to take the medication for the recommended amount of time to prevent re-infection. Keep in mind, however, that while non-infectious mastitis does not require antibiotic treatment, inadequate milk removal can lead to an infection.
Should hospitalization be necessary, it is paramount that your infant be allowed to room-in with you, says the Academy of Breastfeeding Medicine (ABM), in order to allow for frequent breastfeeding and the essential removal of milk from the affected breast.
If breastfeeding is too painful, the baby is refusing to breastfeed on the affected side, or your child cannot room-in for whatever reason, use a hospital-grade breast pump (one designed for multiple users) to remove milk as often as you would breastfeed your baby.
As any breastfeeding mother who has dealt with mastitis can tell you, prevention is the best medicine. I know I would not wish even one hour of body aches and chills so severe that I could not even get out of bed unassisted, let alone take care of my baby, on my worst enemy.
According to the ABM, effective milk removal is the cornerstone of prevention and management of mastitis. Hand-expressing may be necessary when breasts are too engorged to allow for the baby to latch on properly or if the baby does not breastfeed well.
Mothers also should not restrict breastfeeding—either encourage the baby to breastfeed or if necessary, pump to relieve fullness. The ABM also encourages breastfeeding mothers to check their breasts regularly for lumps, pain, and redness, and to rest, increase breastfeeding, apply heat, and massage the affected area at the first sign of a blocked duct , tenderness, or redness. If symptoms do not clear up within 24 hours, medical attention should be sought. This may also be a good time to enlist the help of an International Board Certified Lactation Consultant or a La Leche League Leader for advice on how to get your baby to latch on well and how to vary breastfeeding positions to better drain all parts of the breast.
Just remember, you’re not alone.
How can recurrent mastitis in non-breastfeeding women be treated. Symptom is recurrent pain. Yet when I tried scanning the breast, there were only signs of a normal breast. I prescribed cloxacillin and piroxica and there was a change in the pain but the dose is getting finished and my patient is still complaining about the pain. Please advise.
When breast pain does not resolve despite what you know to be adequate treatment, consideration needs to be given to other causes. Pain in the absence of fever or inflammation is likely not mastitis.
Mastitis is usually characterized by fever and/or inflammation (the breast is red, hot, and tender to touch) and the infection typically resolves with appropriate treatment e.g. dicloxacillin. The Academy of Breastfeeding Medicine has a wonderful protocol on the management of mastitis that you might want to access.
The importance of evaluating positioning, latch, and the extent to which the baby is breastfeeding effectively i.e. milk transfer is taking place, cannot be overstated. Other causes of breast pain include fungal infection, engorgement, plugged duct etc.
In addition to watching the mother and child breastfeed, you might want to contact an International Board Certified Lactation Consultant or another health care provider with expertise in breastfeeding management.
To find an IBCLC in your area visit the ILCA website.
I am 27 weeks pregnant and trying to decide if breastfeeding is for me. I want to because of the health facts and cost but I will only be able to for the first month because I plan on going back to work. I have a lot of concerns, including mastitis, weaning, switching from breast to bottle, and the affect breastfeeding will have on my breasts. If you could advise me on any or all of these please do.
There is lots of data to show that any amount of breastfeeding for any amount of time is beneficial for moms and babies. Many mothers continue to breastfeed after returning to work, you just need to plan ahead. As long as you consistently remove milk from the breasts either by breastfeeding or pumping you can maintain your milk supply. Some moms are able to breastfeed throughout the work day, while others express and save the milk for later use. It’s important to remember that there are no hard and fast rules-do what works best for you and your baby.
Many babies will readily switch from breast to bottle although some may prefer a particular artificial nipple. Some mothers avoid the use of bottles altogether and care providers offer a mother’s expressed milk using a cup, teaspoon, or eye dropper.
Mastitis seldom occurs if a mother and baby are breastfeeding well, but can occur when mothers wean too quickly or babies are positioned poorly. The secret to breastfeeding is correct positioning of the baby at and on the breast, and the secret to weaning is to wean gradually, dropping no more than one daily feeding every 5-7 days. This will give the breasts a chance to respond to the change in demand.
As for permanent breast changes, it is the weight gain and weight loss that occurs as a result of pregnancy that most affects breast size and shape, not how babies are fed.
You can always breastfeed for 2, 4, or 6 weeks and wean when you return to work. More often moms find that breastfeeding makes the return to work easier by helping them maintain that special bond with their baby, even when they’re apart.
If you have additional questions please contact an International Board Certified Lactation Consultant (IBCLC) in your area - see http://www.ilca.org.
Good luck!