The New Way to Treat Mastitis

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 my milk came in, I had excessively hard breasts. At that time, the instructions on how to treat mastitis all 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.

What we thought we knew about Mastitis…

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. It was thought that if we did not fully empty the breasts, the infection would never leave the body. Aggressive massage and heat were used to remove the accumulated milk from the breast.

It was also believed that mastitis and “plugged ducts” were a result of a fat accumulation in the ducts within the breasts. We were taught 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.

What we have more recently learned about Mastitis…

The engorgement actually comes from mammary dysbiosis or the disruption of the milk microbiome, and 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 (for example, 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, which we used to call “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. Additionally, internet may 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 make 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.

Above photo by Jessica Gillan, Bellies, Boobs, Babies & Bliss

So how do we prevent mastitis or help to cure it?

Anticipatory Guidance

Reassurance that many mastitis symptoms will resolve with conservative care:

• Feed the baby on demand and do not aim to empty the breasts unless needed
• Minimize pump usage
• Avoid using nipple shields
• Wear an appropriate fitting 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” or “room sharing” to allow baby to feed on demand
• 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

For more personalized support and information on how to prevent and treat mastitis, connect with me for a one-on-one session. I offer in-office, in-home and virtual appointments as well as a free weekly Breastfeeding Support Group at The St. Augustine Birth Collective (5A Sanchez Ave. Saint Augustine, FL 32080) on Thursdays from 10am-12pm.