Suddenly feeling 'fluey'? Emotional and teary? And you have a hot sore breast?
Feeling 'fluey' any time when you are breastfeeding is a warning sign that you could be coming down with mastitis, inflammation of the breast that may or may not also be infected.
Mastitis can affect you emotionally too - it is common to feel 'just awful' and teary.
New research, new mastitis information
According to new research from the Academy of Breastfeeding Medicine, while in the past, mastitis was almost always attributed to an infection in the breast, evidence shows that mastitis encompasses a spectrum of conditions, resulting from inflammation of milk ducts, and oedema (engorgement). If congestion and blocked ducts are made worse by overstimulation of milk production, inflammatory mastitis can develop, and acute bacterial mastitis may follow. This can progress to an abscess, especially if there has been tissue trauma from aggressive breast massage.
Treating mastitis
Symptoms such as a sore, lumpy breast and blocked ducts may be caused by inflammation that can be the beginnings of mastitis. To get on top of mastitis before you become very ill, we used to be advised: 'Warmth, Rest and Empty your breast'. However, the new treatment advice is almost the opposite: as mastitis starts with inflammation, applying heat and vigilantly feeding or pumping to ‘empty’ the breast and potentially causing over-supply, can make inflammation worse. After all, we wouldn’t massage or put a heat pack on a sprained ankle, would we? However, ‘REST’ certainly still applies!
Mastitis is a medical illness so should be taken seriously – take sick leave from all duties except feeding your baby.
- Watch your baby, not the clock. Breastfeed according to your baby's cues or pump on your normal schedule, keeping your breasts comfortably soft - don’t aim to ‘drain’ your breasts. Avoid extra stimulation that may create an ‘over-supply’ that will cause pressure within your milk ducts, increasing inflammation
- Apply COLD compresses (wrapped ice packs, frozen peas or wet a disposable nappy and freeze) to relieve pain and inflammation. See the Body Ice Woman breast pads - these can be cooled to relieve breast soreness and fit comfortably around your breasts (heat can worsen inflammation).
- Gentle, sweeping lymphatic massage towards the armpit can help drain extra fluid (not milk) in the breast and... you get it... reduce inflammation.
- If you need pain relief, take over the counter medications such as Panadol or Nurofen.
- Drink plenty of fluids and increase anti-inflammatory foods in your diet.
- Some women find ultrasound treatment by a women's health physiotherapist helps relieve blocked ducts and mastitis symptoms.
- Mastitis is NOT always a bacterial infection, so antibiotics aren't always needed. However, if you are prescribed antibiotics, be sure to take the full course and continue with the other treatment measures listed.
DON'T STOP BREASTFEEDING! Weaning isn't wise while you are treating mastitis as this will increase the chances of developing an abscess that needs to be surgically drained.
Preventing Mastitis
The good news is that mastitis can often be prevented with some simple strategies and sensible self-care measures. Stress and health issues such as low iron (anaemia) can lead to a depressed immune system that makes you more prone to inflammation and infections.
Missing feeds (such as when you go on a long car trip and baby sleeps through a feed or if you express to go out but don't express while you are away from your baby) or scheduling feeds too strictly and too far apart (your newborn will need 8 to 12 feeds in 24 hours) can result in poor breast drainage and blocked ducts.
Poor attachment and latch, a sleepy baby, a baby with tongue tie who is having difficulty attaching, and using nipple shields can contribute to inadequate milk removal or engorgement. Cracked nipples can also set you up for mastitis as infection can enter the breasts through broken skin so it is important to seek help early for nipple soreness.
- Watch your baby, not the clock (I can’t stress this enough). Avoid overly full breasts that can result from implementing a strict routine and spacing out feeds (this can also signal to your breasts to slow milk production). If you feel tender or full after a feed, gently hand express a little milk for comfort (no more, you don't want to encourage 'oversupply'). If you feel very full (perhaps if baby has slept a long stretch), offer your baby a feed – he will probably nurse enough to relieve your fullness even if he is sleepy.
- Check attachment: If you are uncertain about your baby's latch, if breastfeeding hurts or your nipples look 'squashed' after a feed, get a lactation consultant to check your baby's position and attachment.
- Avoid under-wire or tight bras that may compress milk ducts ( See the Arden Bra). Also take care when you are sleeping that you don't sleep in a position that may squash your breasts – such as lying on your stomach.
- Take care of yourself. Try to get some rest each day. A nutritious, whole foods diet and relaxing activities that make you feel good will reduce the effects of stress and boost your immune system.
- Try a probiotic: You may like to try a probiotic specifically created for breastfeeding mothers such as Qiara which has been shown in clinical trials to have beneficial effects on the breast health of mothers who have recurring mastitis.
- Dietary supplements may be helpful. For instance, many mums have found vitamin C and lecithin helpful in preventing recurrent blocked ducts - for more information about lecithin, dosage and potential contra-indications check this link by Kelly Bonyata, (IBCLC),
