14: The New Mastitis Guidelines
Hey there, Mama. If you are listening to this episode, I really hope you don't have mastitis. If you do, I really hope this episode helps you out. I'm going to review the updated definition of mastitis, what it is, some things to know, some outdated recommendations. As well as some possible contributors to mastitis on this episode.
Hopefully, by the end of this episode, you will understand a lot more about mastitis, and you'll also be able to recognize outdated recommendations when someone provides them to you. All of that being said, mastitis is a really good reason to call in a professional lactation consultant. This is not really the best DIY issue, but The more you know, the more of an informed consumer you'll be.
So, without further ado, let's jump right in. What is mastitis? Well, the Academy of Breastfeeding Medicine updated their mastitis protocols and definitions in 2022 and it hasn't really reached the mainstream everywhere yet. So you're going to be updated possibly even more so than professionals that you run into, but just know that this actually was updated in 2022.
All right. Mastitis is literally just inflammation of the breast. It has multiple causes. It might be caused by engorgement. It might be caused by plugged ducts. There's also non specified mastitis. It may or may not be infected. Signs of mastitis are pretty general. They include localized redness of the breast, tenderness, and warmth.
Of course, that makes sense. If you have inflammation somewhere in your breast gland, then you might have tenderness, redness, and warmth in that area. But did you know that not all mastitis requires antibiotics? Only specific cases. with specific signs of infection. Now, of course, if you fall into that category, you would want specific antibiotics, not the wrong kind, not too much, not a bunch. Just the right kind specifically for you. And of course you would never want something to turn into an abscess or a really severe issue. So while it is important to be aware that antibiotics may be a part of your treatment plan, it's also important to know that many cases do not require antibiotics. And we need to know, what are the possible contributors to mastitis in order to avoid severe and or reoccurring situations.
So we're going to talk about a few common ones here. And again, this is great food for thought. It can certainly help you take the best care of your breast glands while you are Lactating, but again, I just want to reiterate (and I will remind you again later because it's that important) that working with a professional lactation consultant- someone who works regularly in the community with lactating mothers- is really important in helping you to sort of suss this out, unless you are absolutely sure what the cause is.
Okay, let's jump in to the possible contributors to mastitis. One contributor is tight bras and tops. It's really tricky to properly fit lactating breasts because they fluctuate in size. And oftentimes we get our nursing bras before we even have the baby and then our breasts continue to fluctuate in size.
Tight fitting clothing or bag straps, backpack straps, under wires, et cetera. Anything that puts pressure on your breast glands, even on the side, can contribute to mastitis. Another causative factor to consider is incorrect pumping technique. Well, this is a big one as well because oftentimes mothers phalanges that don't fit correctly.
They may be using the wrong suction level over or under pumping. This can also cause nipple damage. Pumping should not hurt, by the way. Many times we're using too high of suction or we are over pumping and creating oversupply, which is another contributing factor to mastitis. (Oversupply is when you are lactating and producing more milk than your baby needs.)
Oversupply it's really common in our pumping and stashing culture because we are a busy culture. Moms are expected to provide milk for their baby, also work full time, also get up through the night and feed their baby…. and there's just a lot of demands when we still have very young infants at home. This can create a lot of anxiety, and one of the ways that we ease (temporarily) the anxiety is to have a huge stash of milk. I understand this -I was definitely “a freezer milk mom”.
So, I totally hear this (haha). I'm not laughing at you. I am laughing at myself. What happens is we're feeding the pump, and the baby, and then the pump some more. So we end up kind of creating oversupply. This is actually more common issue than you think and another really good reason to talk to a lactation consultant.
Another possible contributor to mastitis is poor latch. So when your baby doesn't latch optimally, it can impact milk transfer through the breast. Not only does this contribute to breast inflammation, but poor latch can also make nursing painful and breastfeeding should also not hurt. This kind of ties in with poor milk removal which of course could be through breastfeeding/nursing or pumping. And again, if you have poor milk removal or something isn't working quite right (which is not expected, but can happen), that can be a contributor to mastitis.
Maternal diet is also listed on the protocol as a possible contributor. So, for example, alcohol may contribute to breast inflammation and inflammation in the body. It also can create a situation where mom might have less frequent pumping or a dramatic adjustment in her feeding/pumping schedule, and that may create some inflammation and some engorgement.
Breast trauma is another one. So, if a mom has had previous or recent trauma to her breast glands, that can contribute to inflammation in lactating women. Let me give you an example. Um, a car accident that resulted in some scar tissue that has really gone unnoticed. But now that the breast glands are fully developed and lactating and the ductal system is mature, scar tissue may be impacting the ducts in a non-optimal way.
Sometimes this might be the case with breast surgery, whether it was a reduction, augmentation, or really any kind of breast surgery. Again, there's always a potential risk or change in tissue when any of those things occur. That does not mean that if you have had any kind of breast surgery or trauma that you will get mastitis. It's just one of the things that we need to think about when we're collecting all of the possible causes in order to create an action plan.
So let's talk about your action plan for mastitis. Well, as you can imagine, it is a multifaceted issue, which is optimally managed with a professional on your team. So I really suggest first and foremost that you contact a lactation specialist immediately in order to assist you in identifying the cause (or causes) and help create a personalized plan to support your resolution and also avoid reoccurrence. While you're awaiting their arrival, you can continue cue based feeding, if breastfeeding. You can continue pumping, but don't over pump. And you may start anti-inflammatory measures, such as ice for 20 minutes, or maybe an approved oral anti-inflammatory, based on what you and your doctor have discussed. Then just rest as you are able. Do call the doctor if you have flu like symptoms.
Depending on the cause (or causes) of mastitis, your plan of action may lead you down different paths. So if poor latch is an issue, you may be working with a lactation consultant or a speech language pathologist depending on where the issue lies. If it is a pumping issue, a lactation consultant is your new best friend. Bras and tops causing issues? Then perhaps a store that sells new brassieres and can properly fit you is your new best friend.
There’s a lot of different avenues as far as the support system, which is why I kind of lean towards saying this is not really a DIY issue. Another support that is underutilized, I think, is a physical therapist who specializes in lymphatic drainage.
Now, this is not the same as a lymph drainage massage. Please do not go to a massage therapist and get a massage for this. It could create a lot of lymph back up, undesired edema, further engorgement, and further issues. I personally have worked with a physical therapist who specializes in lymph drainage and is very skilled at helping to remove some of the breast congestion and get things to a manageable state, but she has specialized training in lactation and breast glands. Because the breast is the gland, not a muscle.
Which brings me to my list of please don't do this things. Please do not aggressively massage your breasts. They are a gland, not a muscle. Please do not use a Theragun or any other aggressive machinery on your breasts. Please try to avoid using heat. Sometimes a hot shower can be really relaxing for a mother and can help with letdown, I do understand that, but heat is generally counterproductive for inflammatory issues and is no longer part of the recommendations on the ABM protocol. If you would like to see this information visually laid out on a handout, it’s under the Mastitis Handout resource. I made this handout specifically for an infant feeding course that is set to be released in April, but this is a really important and helpful handout for moms to have. So I'm going to go ahead and throw it up on the website for anyone that wants it.
I'd also like to send a special thank you out there to Mary Ellen Kramp (a Doctor of Physical Therapy) and Cat Halek (an International Board Certified Lactation Consultant) for all of their contributions, because when it comes to issues like mastitis, quite often there are multiple factors involved.
And thank you for tuning in and sharing this episode for anyone who might benefit from knowing the updated mastitis information.
Resources:
Free downloadable mastitis resource