Breast advice

The key to beating a bout of mastitis is to recognise the symptoms. Jessie Reid of My Child Magazine reports on why this infection occurs, what to look out for and how to treat it

It started out as a bit of a pinkish-red blotch on my breast. I didn't think much of it, as I had breastfed my other children with no problems,' says mother-of-three Teresa. ‘But the redness got worse and my breast was hard and sore. I woke up the next morning and my whole body was shaking. I had flu-like symptoms and felt very sick.'

This is a common story with mothers who have experienced mastitis but, like Teresa, who breastfed her daughter until she was two, many mothers deal with it quickly and go on to have a successful breastfeeding relationship with their little one.

The key to beating a bout of mastitis swiftly is to ensure that you can recognise the common symptoms so you can treat it early.

Types of mastitis

There are two types of mastitis:

Non-infective Caused by blocked milk ducts, this type can lead to an infection, but can also be lowered in severity if recognised early and treated vigilantly. If your ducts are blocked, milk can leak into the surrounding tissue, where foreign bodies can cause an inflammatory reaction.

Infective This type is caused by a bacterial infection and there are two forms. The most common form of infective mastitis is cellulitis of the interlobular connective tissue. Pus is not found in the milk in this case. The other type is adenitis. This is where infection occurs within the ductile system. Pus may appear in the milk but systemic symptoms are less severe.

Why it happens

There are a number of causes of mastitis and some women are more prone to it than others, regardless of the precautions they take. Here are some reasons why you may develop it:

• Insufficient drainage, which can be because of poor attachment by your baby or from limiting the time your baby spends breastfeeding
• Missing feeds and delaying feeding, which can lead to engorgement of the breasts
• Trauma to the nipple caused by incorrect attachment of your baby
• Holding the breast too tightly during feeding
• Trauma to the breast, such as a kick from a toddler or pressure from a seatbelt
• Wearing a tight or ill-fitting bra
• Consistently lying in one position to sleep
• Poor health, exhaustion or anaemia
• The use of nipple creams, which can harbour bacteria
• Rapid weaning
• Infections from your baby's nose, mouth or eyes.

Symptoms

Knowing the symptoms of mastitis is the key to treating it early and preventing it from becoming severe:

Redness The skin on your breasts may appear tight and shiny, and be streaked with red blotches.

Pain Breasts can become tender or painful, hot to touch, red, hard and swollen. ‘ Mastitis felt like a bowling ball covered in spikes sitting in my boob,' says Jane, a mother of three. ‘I remember crying out to my husband, “Everything hurts!” It happens really quickly – overnight, or in an afternoon.'

Fever If your temperature is over 38 ° C and is accompanied by chills, aches and pains, see your doctor as soon as possible. ‘ It felt like I had the flu,' says mum-of-two Julianne. ‘I felt fine at Ruby's 3am feed but was so sick by 6am that I could barely speak or move.' Rozie , a mum to two little ones, says similarly, ‘ I was suffering from bouts of cold chills and shaking uncontrollably.'

Barbara Brinsdon, a lactation consultant for Breastmates, a shop and resources website for breastfeeding mothers, says, ‘To differentiate between a blocked duct and breast infection, you need to understand that a blocked duct will come on slowly with milder symptoms, whereas an infection will come on suddenly with flu-like symptoms and a temperature.'

However, blocked ducts are a major cause of mastitis and need to be treated immediately so they don't develop into an infection.

Prevention

‘Women need to avoid the situations that lead to mastitis,' says naturopath, fertility consultant and breastfeeding counsellor Julie Cottle. Here are some things you can do to help prevent this painful situation:

Sufficient feeding ‘The most common reason is blocked ducts and insufficient emptying of the breast,' notes Cottle. ‘ Relieve engorgement as quickly as possible. Milk that doesn't flow gets thicker and can cause blocked ducts.' After a feed the breasts should feel softer and more comfortable. There should be no hard, tender lumps remaining.

Frequency of feeds ‘ Breastfeed frequently, don't restrict the length of breastfeeds and if you feel your breasts getting full, encourage your baby to feed. You don't have to wait for your baby to be hungry,' says Cottle.

Positioning Make sure your baby is positioned and attached properly on your breast. ‘If the baby is damaging your nipples or breastfeeding is painful, have a breastfeeding professional observe a feed and check how your little one is latching on,' says Cottle.

Clothing Wear loose, comfortable clothing. If you wear a bra, it should be properly fitted.

Sleeping Avoid sleeping on your stomach or so far over on your side that your breasts are squashed.

Hygiene Thoroughly wash your hands before you breastfeed after a nappy change. ‘ Take extra care with handwashing when nipples are damaged to prevent the entry of bacteria,' adds Brinsdon.

Creams Avoid prolonged use of nipple creams, ointments and nipple pads, which can all harbour germs.

Health & vitality ‘If mastitis becomes recurrent, a naturopath will be able to supply nutritional and homoeopathic remedies that can help to address any health issues that may predispose a woman to recurrent mastitis,' says Cottle.

Sleep Rest as much as possible, and try to avoid being stressed and fatigued.

Treatment

If you recognise that you have a blocked milk duct, it is important to treat it as soon as possible. If it's not cleared within 24 hours, and remains untreated, it can lead to mastitis.

‘The first time I had mastitis I was on antibiotics,' says mother-of-one Lauren. ‘But the subsequent times, as soon as it appeared, I focused on feeding on demand, massaging the lumps and resting as much as possible, and it went away within 24 hours.'

Follow these tips to treat a blocked duct and lessen the severity of mastitis:

Don't stop! The most important point that Cottle stresses is, ‘ Do not stop feeding! It is really important to continue feeding while you have a blocked duct or mastitis. Breastfeeding is the most effective way of removing milk from the breast. Your baby has a much more efficient suck than any breast pump.'

Feed effectively Make sure your baby is feeding well on the affected breast. If it isn't possible to frequently drain the affected breast through feeding then try expressing. ‘ If there is a blocked duct present, point the baby's chin towards the blockage,' says Cottle. ‘I find the easiest way to get the chin to the right position is to lay the baby down and to then lower the breast into the baby's mouth.'

Get heated Apply a heat pack or warm face washer for a few minutes before feeding.

Massage Gently massage the breast during feeding.

Be cool Use a cold compress between feeds to reduce pain and inflammation. ‘Cabbage leaves can be helpful if engorgement is the problem that caused mastitis in the first place,' says Cottle. ‘Keep the leaves in the fridge, pound them to break the veins in the leaves a little and wear the leaf inside a bra until it becomes limp. This provides a convenient way to apply a cool compress, which will be relieving in itself and will also supply compounds that help blood flow in and out of the breast, and assist the excess fluid in the breast in being reabsorbed into the bloodstream.' But she adds a word of caution: ‘Don't use cabbage leaves for too long or if you are having a problem with milk supply. There is some concern though little evidence that cabbage leaves can cause a drop in supply.'

Find relief Ibuprofen is the most effective pain-relieving medication because it is an anti-inflammatory as well as a pain reliever. Paracetamol provides safe and effective pain relief for those who may not be able to take ibuprofen.

Drink water Maintain a good fluid intake: up to eight glasses of water per day.

Rest ‘Go to bed, rest and feed,' says Cottle. ‘Have someone help you with child care and anything else that may be considered essential.'

See a GP If symptoms persist or you have a temperature over 38 ° C then see your doctor as soon as possible.

Use antibiotics Infective mastitis will require antibiotic therapy. It is important to be treated with the correct type of antibiotic. Most infective mastitis is caused by staphylococcus aureus bacteria and is usually resistant to penicillin. A course of between 10 and 14 days of the appropriate antibiotic treatment is key in preventing reinfection.

‘ The most important message I'd like to give other mums is to get to the doctor early and get antibiotics,' says Jane. ‘When ringing for an appointment, say, “I'm a breastfeeding mother, and I think I have mastitis.” Suddenly a space for an appointment will miraculously appear!'

Mums who have experienced mastitis seem to agree with Jane that seeing a doctor and treating it as soon as possible after experiencing symptoms is the best way to beat it. Symptoms can quickly become severe if left untreated, such as in Julianne's case: ‘I was admitted to hospital for a week with an IV drip.'

Breastfeeding during & after mastitis

Breastfeeding is not only the best way to give your baby a healthy start to life, it is also an amazing bonding experience for mum and bub. But as Cottle notes, many women struggle to get back on their feet after a bout of mastitis. ‘It is often a big interruption in the establishment of breastfeeding and does sometimes cause a mother to stop breastfeeding, especially if she does not have the support and encouragement of those around her,' explains Cottle.

However, in many instances, mothers will continue to breastfeed and have no further problems. And, as Brinsdon says, ‘ This is not the time to stop breastfeeding… it is an important part of mastitis treatment.'

In the end we all want to make the decision that is right for our little ones and ourselves. Share in these mums' experiences of breastfeeding with mastitis and see how different it is for everyone:

Jane I breastfed my three babies for 12, 11 and almost six months respectively. I had recurring mastitis with each round. I weaned my third baby earlier than I wanted to because I had mastitis five times in five months. I loved breastfeeding, and I am very sad that it's all over. But in the end I decided that breastfeeding my baby couldn't be my main priority in life. I have three other people who I love and need to care for, and me being wiped out for days at a time was bad for them, as well as for me.

Julianne When I was admitted to hospital with mastitis, I was in no condition to consider my breastfeeding options or make decisions, but the midwives in the hospital just kept bringing Ruby to me to feed. I was too weak to hold her so one midwife would hold her to my breast and the other would massage my breast while she fed. My job was to not scream and scare the baby.

Ruby and I went on to have a 15-month breastfeeding relationship and I was glad I pushed through the mastitis even though I didn't consciously make the decision to do so.

Lauren I continued to breastfeed both during and afterwards. After developing mastitis for the seventh time in four months, I began to think that perhaps I should give the breastfeeding up, but I soldiered on and ended up breastfeeding very successfully until Lachlan was 14 months old, when he self-weaned.

Rozie I had people telling me left, right and centre that it was OK to give up breastfeeding, but I just willed myself to get through one feed at a time. Zara was thriving; she never even lost any of her birth weight and this made me push through even harder, as I knew I was giving her what she needed. Very slowly but surely, in the following weeks, things started to look up. I can't describe the closeness I feel with my babies when I feed them, but I really had to fight to get there, physically and emotionally. For me, breastfeeding took a lot of practise. For such a natural thing it did not come naturally at all! Know yourself and what you are capable of… you need to be able to come out the other side in one piece. •

RESOURCES

USEFUL CONTACTS

• bellybelly.com.au Find more articles about breastfeeding and related issues.
• breastfeeding.asn.au The Australian Breastfeeding Association website has a host of information on breastfeeding. You can also call their helpline on 1800 686 2 686.
• breastmates.com.au An online store with helpful breastfeeding products and a resources section for mums.
• essentialbaby.com.au Chat with other breastfeeding mums on the forum.
• naturaltransition.com Contact breastfeeding counsellor Julie Cottle for further advice on breastfeeding and mastitis.

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