21: Help! I Have Recurrent Mastitis!
Today, we're going to answer a question that came directly from a mom, “Barbara, I've had mastitis with each of my babies. I really want to avoid it this time. What should I do?”
Mastitis can be caused by multiple contributing factors, sometimes more than one at a time. So when a mom asks me about issues related to recurrent mastitis, I need to know a lot more about the situation in order to help suss it out. Melissa emailed me about this because she has four babies. They've all been exclusively breastfed.
And she's really gone out of her way to educate herself on breastfeeding and mastitis and treatment of mastitis with a lot of reading and extensive internet searches. So, when she's continued to get mastitis with each baby, she's left wondering: Why? When I've done everything I can, And I've tried everything I've found.
Well, unfortunately, a lot of advice on the internet is outdated. So I wanted to start from scratch with her, go through her whole history, and figure out, based on the updated information, what clues might be contributing to this issue.
Firstly, Melissa has a history of oversupply of breast milk. This started with her very first baby. Melissa started breastfeeding exclusively and pumping. She had an ample supply, no, she had an oversupply. In some ways this is a matter of pride for new mothers to be able to not only feed your baby, but have excess if needed. Especially in our culture. So while there was no concern of not being able to feed her baby, she was trying to keep up with the engorgement, the leakage, and the oversupply.
When she experienced her first bout of mastitis, it was pretty miserable. She had the flu-like symptoms, the whole kit and caboodle. She tried her best to avoid antibiotics by keeping the milk moving. Unfortunately, when you continue to pump and have oversupply, you can accidentally keep sending the message to your body that we need more, more, more therefore snowballing the oversupply issue.
She has since experienced oversupply with each of her babies. So that's clue number one. There wasn't a lot of other clues. I mean, she's had four babies, and that's a lot to keep up with. So, keeping detailed notes on all of these things in hindsight years later is a lot to expect. But another clue came up when we were talking about her current bout of mastitis.
It happened after her baby had a longer sleep stretch at night. Now, naturally- baby sleep means you sleep, and I highly recommend this strategy. However, if you have a history of engorgement and oversupply, then going from expressing milk or breastfeeding your baby every three to four hours at night, jumping all the way to a seven hour stretch… not quite as easy on your breasts. So that was clue number two. Her breasts probably needed a little bit more of a gradual approach to spacing this timing out.
We spoke a little bit about diet and if anything had changed. And consistently, Melissa is a pretty whole food eater. There wasn't really a lot that stuck out and certainly no big changes that happened around that time. The only thing she could think of was after a few months maybe she would be more willing to have a small glass of wine, but we couldn't really consistently pinpoint if that was part of what put her over the edge.
We talked about how inflammation and dehydration can certainly play a part in the recipe for mastitis, but after talking about this contributing factor, it didn't really seem like this was one for Melissa like it can be for other mothers who experience mastitis.
The next thing we pinpointed was, what is she doing to manage it. What is her behavioral response when she starts feeling the onset of mastitis? Well, first she told me that she keeps the milk moving. Now, this is an important thing to consider because, again, if we keep the milk moving, we are ordering more from the restaurant, or rather the “breastaurant” (hehe), in this case.
We used to think that plug ducts, mastitis, and other breast issues were caused by stagnant milk, a clog in the tubing, for example, but we know that this is not true. So when she continued to over pump to try to ‘suck out any potential duct clogs’, she accidentally potentially exacerbated the problem by promoting more and more oversupply.
The other thing she stated was that heat often made things feel a bit better. And while I never try to discourage a mom from doing something that brings her comfort, heat is considered now an outdated recommendation for mastitis because heat is not necessarily anti inflammatory. So the current recommendation is to use cool or ice for 10 to 15 minutes/for comfort.
When Melissa and I put together all of the information we gathered, we realized that oversupply and jumping to longer sleep stretches quickly seem to be a recipe for mastitis for her. On top of that, using heat may have felt comfortable in the moment, but accidentally worked against her goals. And lastly, Melissa would have to be very careful finding the balance to express milk to comfort, but not accidentally exacerbate oversupply.
This is a tricky balance unique to each woman's breasts. A great option for her would be to set a backup alarm (uh, I know, I hate even saying that) so that she can slowly expand her sleep stretches and accommodate the transition to slowing down milk production during those times.
After talking about it, and sorting out some of the factors that might be contributing to her mastitis, I'm happy to say that Melissa has created her own new protocol if she starts feeling some symptoms, but that she has not had another bout of mastitis since. I guess the real test will come if she has another baby.
But even if she doesn't, maybe this will help another mom to more quickly resolve an issue or to understand what's going on and what contributing factors might be impacting her breasts to get recurring mastitis.
If you'd like to know more about the updated definition and recommendations regarding mastitis, please check out episode 14.
If you'd like to learn more about oversupply, causes, and symptoms, please check out episode 20.
You may also want to check out my free downloadable guide to mastitis. It's got the updated definition, contributing factors, as well as a quick plan of action if you need help. You can find it at FeedingByJanuary.com, I'll put the link in the show notes for you.
As always, I hope this episode brought you great value, and I'll be here next week!