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The first few months of motherhood are challenging. You’re a sleep-deprived, mumbling, stumbling zombie with huge, leaking breasts. Huge, leaking breasts that, all of a sudden, neither look nor feel the same as each other. Your left breast is unbearably red, hot and swollen, and nursing feels like torture. You’re exhausted and you feel like you’re coming down with the flu. Get yourself checked out and chances are you’ll find you’ve got mastitis – a painful breast infection that affects about ten per cent of breastfeeding women.
Do I have it?
Mastitis typically affects only one breast so it’s usually quite easy to realise that there’s a problem. Part of your breast may become inflamed, hot and swollen, and there may be a hard, sore lump. It may be incredibly painful to breastfeed, made worse by the fact that mastitis can temporarily distort the shape of your breast. Milk may look lumpy or stringy, and there may be signs of blood and pus. Your milk will also taste saltier, which may result in your baby grunting, “Thanks, but no thanks, Mama,” when you offer him your infected breast.
Bacteria from a baby’s mouth, nose and throat can wriggle their way into cracks in the nipple. Mothers are most likely to fall prey to mastitis during the first three months post-delivery. This is especially true for first-time mothers who are mastering the art of breastfeeding and may either have cracked nipples caused by a poor latch-on, or engorgement because breasts are not being emptied properly.
According to Jenny Buck, La Leche League leader, “It is also common with older babies if there is a sudden increase in the length of time between feeds, such as if a baby starts sleeping longer through the night or their mother goes back to work and can’t pump frequently enough.”
What can I do?
If your breasts are engorged but not infected (i.e. you have swollen, painful and lumpy breasts but no fever, flu-like symptoms or pus and blood in your milk), then the below home remedies are very effective. If you do have signs of an infection – “especially if your symptoms have not improved after 24 hours and/or you have a fever over 38.4C/101F,” according to Jenny – call a doctor immediately because you might need antibiotics. Mastitis left untreated can lead to a breast abscess that requires antibiotics and surgery.
Some mothers are well and truly ready to throw the towel in now. After all, big, swollen, lumpy dairy pillows are not quite what we signed up for when we decided to give our babies the good stuff. But now’s not the time to give up breastfeeding. Empty the infected breast out as much as possible to clear the infection, be it through nursing, expressing or both.
Jenny explains, “Continuing to breastfeed during mastitis is not only safe and good for your baby, but the best cure for you. Weaning when you have mastitis will make the condition worse and risk an abscess developing, which would require surgery, so it’s important that your affected breast is well drained. Take your baby to bed with you if you are feeling feverish and/or exhausted.”
She continues, “If your baby is having trouble latching on to the affected side due to engorgement, it may help to express a little milk on that side before feeding in order to soften it slightly. If that doesn’t work, you can try latching your baby on to the unaffected side first, and then transferring him/her over to the affected breast as soon as possible. Express milk or pump if your baby is not draining the affected side.”
Cold packs, cold towels, cold cabbage leaves or even rolling a cold can of soda down your breast can help to keep your infected breast cool, whilst paracetamol can help to reduce the pain. Your doctor may also prescribe ibuprofen to help reduce the swelling.
Jenny advises, “As with all types of engorgement, it’s advisable to apply cold (such as an ice pack) after feeds, and mild warmth before feeds. Ice will help reduce swelling but will inhibit your milk letting down, so don’t apply ice if you are expecting to feed your baby or express within the next hour. If nothing helps to drain your breast, lactation consultants can perform specialist massage, but this needs to be done by a board-certified lactation consultant, not your regular massage therapist.”
Can I prevent it?
Mastitis can strike again, for as long as you breastfeed.
To protect your breasts, empty them fully at each feed through a combination of nursing and expressing. Feed more frequently when your breasts feel lumpy and get your hands on a can of Coke and start rolling. It feels bizarre, but it really does help. Ask a lactation consultant for advice if you find that your baby is not latching on properly. Finally, get some rest. Tiredness leads to a weaker immune system, and a weaker immune system leads to greater risk of infection.
Jenny advises, “Be alert to the early warning stages, which are severe engorgement and plugged ducts, and try to prevent them. The easiest way to prevent engorgement in the early days is by feeding your baby frequently. We recommend newborns to be breastfed eight to 12 times per 24 hours. If your baby is having trouble latching on well and/or is not draining your breasts effectively, seek immediate help from a lactation consultant.
“If you notice a sore lump or tough part of your breast that doesn’t go away after feeding, this is known as a plugged duct,” Jenny continues. “Take immediate action and apply mild warmth and gentle massage before feeds, then cold after feeds, and try different breastfeeding positions so that your baby’s chin or nose is pointing at the sore spot. I got rid of plugged ducts by taking a warm shower, gently massaging my breast behind the lump and expressing a little milk in the shower, then feeding my baby immediately afterwards. If the situation does not improve within 12 hours, seek immediate help from a lactation consultant.”
If you experience recurrent mastitis, discuss your situation with your lactation consultant, or your doctor, or contact La Leche League (www.lllhk.org).