Ep.2/New Way to Handle Mastitis
Mastitis is a common maternal complication of lactation that contributes to the early cessation of breastfeeding
I can remember the first few weeks of my breastfeeding journey. My son was in the NICU and I was given a pump to increase my milk supply. When the milk came in, I had excessively hard breasts. At that time, everyone suggested hot showers and excessive massage to relieve the milk accumulation. The phenomenon of engorgement has been studied, and those suggestions are no longer recommended.
In the past, mastitis has been regarded as a single pathological entity of the lactating breast. The newest evidence suggests that mastitis encompasses a spectrum of conditions.
We used to believe that mastitis and “plugged ducts” were a result of a fat accumulation in the ducts within the breasts. We thought that if we did not fully empty the breasts, the infection would never leave the body. We used aggressive massage and heat to remove the accumulated milk from the breast.
The newest research shows that engorgement is actually the result of ductal inflammation and edema in the tissue surrounding the ducts. This edema presses against the ducts, making them difficult to empty. This can develop into inflammatory mastitis and acute bacterial mastitis may follow. When we aggressively massage and use heat, this increases the inflammation in the breast tissue.
The engorgement comes from mammary dysbiosis or the disruption of the milk microbiome, There are a lot of factors that contribute to this dysbiosis. These factors include maternal genetics, medical conditions, exposure to antibiotics, use of electric pumps and cesarean birth. (my son was an emergency cesarean section, I was given antibiotics in labor and I pumped due to the separation in the NICU).
Many women feel small knots in their breast. We used to call them “plugged ducts”. New research proves that ducts of the breast are innumerable and interlacing, so it is impossible for a single duct to become plugged. The internet will tell you to try to empty the “plugged duct” with massage, warmth and salt water. In reality most “plugged ducts” will resolve spontaneously. When we are aggressive, it suppresses the FIL(feedback inhibitor of lactation) and increases milk supply. This can ultimately exacerbate inflammation making the issue worse.
Bacterial mastitis is a progression from ductal narrowing and inflammatory mastitis to an entity necessitating antibiotic treatment. The most common organisms causing mastitis are staphylococcus. Bacterial mastitis is not contagious and does not pose any threat to the infant. There is no need to pump and dump that milk.
So how do we prevent mastitis or help to cure it?
1. Anticipatory Guidance
-Reasurance that many mastitis symptoms will resolve with conservative care
Feed the infant on demand and do not aim to empty the breasts unless needed
Minimize pump usage
avoid using nipple shields
wear an appropriate fitted bra
avoid deep massage of breasts
avoid topical products
avoid routine sterilization of pumps and household items
Decrease inflammation and pain. ( ice and Ibuprofen)
Treat nipple blebs
Treat hyperlactation
Reserve antibiotics only for bacterial mastitis
consider probiotics ( limosilactobaccillus fermentum or ligilactocacillussalivarius)
For postpartum engorgement
Minimize the use of IV fluids
Promote rooming in to allow on cue feeding
Instruct mothers on hand expression to relieve discomfort.
Reverse pressure softening to reduce the swelling of breasts and allow infant to latch with better ease.
consider lymphatic drainage
I can teach you some of the fundamentals to decrease your risk of developing mastitis. Feel free to reach out for a one-on-one session.
