Mastitis: Updated Guidance
Mastitis is a common concern among breastfeeding parents and can lead to early weaning. Recently, new evidence-based guidance has been developed to help families manage conditions within the mastitis spectrum effectively, minimising its impact on their breastfeeding goals.
What's New?
The Academy of Breastfeeding Medicine (ABM) has updated its Clinical Protocol #36, focusing on the Mastitis Spectrum. This revision provides updated insights into the pathophysiology, diagnosis, and management of conditions like engorgement, plugged ducts, inflammatory mastitis, bacterial mastitis, and abscesses. Inflammation plays a crucial role across all these conditions, often linked to factors like poor attachment, long stretches between feeds, excessive milk production and imbalances in the breast microbiome.
Understanding Each Condition:
Engorgement: Typically occurring around days 3-5 postpartum (or later due to factors like cesarean birth), engorgement involves breast pain, swelling, and firmness due to increased milk volume and blood flow. Nursing on demand or maintaining a regular pumping schedule usually resolves engorgement within a few days. Techniques like Reverse Pressure Softening or gentle hand expression can aid with latch if swelling/flattening of the areola hampers breastfeeding.
Plugged Ducts: Inflammation causes narrowing of milk ducts, impeding milk flow and leading to the formation of plugs. This differs from the previous belief that thickened milk was the primary cause. Symptoms include soreness and firm lumps in the breast without fever. Like squeezing a straw, external pressure on narrowed ducts obstructs milk flow.
Mastitis: Inflammatory mastitis involves swollen, painful, and discoloured breast tissue, often accompanied by systemic symptoms like fever and chills. Bacterial mastitis, linked to dysbiosis rather than skin damage, can occur due to various factors including genetics, antibiotic use, excessive breast pump use and mode of delivery. Importantly, bacterial mastitis isn't contagious, allowing parents to continue breastfeeding with standard hygiene practices. According to Mitchell et al. (2022), antibiotics should be reserved exclusively for cases of bacterial mastitis. Using antibiotics to treat inflammatory mastitis may disturb the natural balance of bacteria in the breast microbiome, potentially leading to subsequent bacterial mastitis.
Abscess: When bacterial mastitis isn't resolved, it can lead to abscess formation—characterised by a defined area of infected fluid and pus requiring medical drainage.
Treatment and Prevention:
Dos:
- Feed on demand or maintain a normal regular pumping schedule.
- Ensure correct attachment - See a Lactation Consultant to support this if needed
- Use ice packs for pain relief and to reduce swelling.
- Express ONLY for comfort if needed between feeds. The more you express the more you may aggravate the breast tissue.
- Take your bra off while feeding and wear a supportive bra that doesn’t dig in between feeds.
- Consider a gentle massage back toward your body (lymphatic breast massage) to reduce swelling from the breast.
- Consult a healthcare provider for reducing the swelling with anti-inflammatory medications.
- Consume anti-inflammatory foods.
- Seek medical advice if symptoms worsen or persist beyond 24 hours, potentially requiring antibiotics or probiotics.
Don'ts:
- Avoid deep massage or heat on breast tissue, which can worsen inflammation.
- Minimise breast pump use
- Don’t aim to drain the breast
- Avoid using vibrating devices or topical products on the breast.
- Refrain from using nipple shields if possible.
By following these updated guidelines, families can effectively manage mastitis-related concerns, ensuring minimal disruption to their breastfeeding journey. For more detailed information, refer to resources such as the Academy of Breastfeeding Medicine's Clinical Protocol #36.
https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/36-mitchell-et-al-2022-academy-of-breastfeeding-medicine-clinical-protocol-36-the-mastitis-spectrum-revised-2022.pdf