What is mastitis?
Mastitis is usually the result of a blocked milk duct that hasn't cleared. Some of the milk banked up behind the blocked duct can be forced into nearby breast tissue, causing the tissue to become inflamed. The inflammation is called mastitis (also sometimes called 'milk fever'). Infection may or may not be present.
If you think you have mastitis, start treatment straight away and see your medical adviser if it does not resolve itself in a few hours.
What are the symptoms?
Early symptoms of mastitis can make you feel as if you are getting the flu. You may begin to get shivers and aches.
Some mothers who do not have any early signs of a blocked duct get mastitis 'out of the blue'.
The breast will be sore like it is with a blocked duct, only worse. It is usually red and swollen, hot and painful. The skin may be shiny and there may be red streaks. You will feel ill. It is common for the ill feeling to come on very quickly.
What can I do?
Start treatment as soon as you feel a lump or sore spot in your breast.
Drain the breast often, but gently.
This is not the time to wean. More than anything else, your breasts need to be kept as empty as possible. Your baby's sucking is the best way to do this. The milk is quite safe for your baby to drink.
Feed more often than usual, starting each feed on the sore breast. Let your baby suck long enough on this side to make sure that it is being drained well. However, take care not to let the other breast become too full, as it may cause a similar problem in that breast.
Check that your baby is getting the milk - that is, the let-down reflex is working soon after s/he begins to suck. When your let-down happens, you may notice tingling feelings in your breasts, a sudden feeling of fullness or milk leaking from your other breast. Your baby's sucking pattern will change and s/he will start to gulp or swallow more often. Make sure your baby is attached well and that you are relaxed and comfortable to help the let-down reflex work.
There are ways of helping the breast to 'empty' or drain more easily:
- Make sure your bra is very loose or take it off.
- Relax while you feed to help your milk flow.
- Make a special effort to relax your arms, legs, back, shoulders and neck.
- Breathe deeply and evenly.
- Listen to soothing music and think about your baby to help start the let-down reflex.
- Change feeding positions - try to choose positions that allow the milk to flow downhill to your baby. For instance, feeding while lying on your left side might help a blockage on the right side of either breast. If the blockage is under the nipple, raise the breast with your hand while you feed. If this doesn't work, another option is to feed 'on all fours' kneeling over your baby.
- Gently massage the breast by stroking toward the nipple while your baby feeds. Gentle pressure behind the lumpy area may help move the blockage.
- Hand express to 'empty' the breast if your baby won't suck. If you have mastitis, your milk may taste salty. This won't harm your baby, but may cause him to refuse the breast. A good place to hand express is under a warm shower.
Apply warmth and cold
Using COLD packs on the affected breast can help reduce swelling and relieve pain.
Use WARMTH only sparingly and just before a feed (for up to 10 minute) can help trigger your let-down to help clear the blockage and may relieve pain.
Some sources of warmth:
- Have a warm shower.
- Immerse your breasts in warm water in the bath or a basin.
- Use a heat pack (wheat packs that you heat in the microwave oven work well), well-covered hot water bottle, warm hand towel or a face washer wrung out in hot water.
Getting rest when you have mastitis is vital. Stay in bed if you can, or at least put your feet up for most of the day. If you do go to bed, take your baby, supplies for changing nappies and your own food and drinks with you, so you don't have to keep getting up. If you have other children, it may be better to lie down in your living area.
Seek medical help
Consult your medical adviser straight away if you have a fever, feel unwell or if you cannot clear a blocked duct after 12 hours.
If you are prescribed antibiotics, make sure you finish the course. If you get mastitis again, or you, or your baby, react to the antibiotics, contact your medical adviser straight away. Some mothers and babies get a thrush infection after a course of antibiotics, so if you have had thrush in the past, discuss this with your medical adviser. When mastitis is not treated promptly, a breast abscess may form, although this is rare.
A summary of things to do to help relieve mastitis
START TREATMENT STRAIGHT AWAY
- Rest as much as you can
- Keep the sore breast as empty as possible by feeding your baby often
- Apply warmth to the sore area before a feed
- Feed from the sore breast first, when your baby's sucking is stronger
- Massage the breast gently while your baby feeds
- Change feeding positions to help shift the blockage
- Talk to an Australian Breastfeeding Association counsellor for ideas on other feeding positions
- Hand express if needed, before, after and between feeds
- Cold packs after a feed may help relieve pain and reduce swelling
- Gently massage the affected area towards the nipple while in the bath or shower
- See your medical adviser if these measures do not clear the lump within 12 hours, or if you develop a fever or feel unwell
- Breastfeed often. Hand express if your breast feels full and your baby won't feed often
Early treatment will mean you get better faster, you will feel less ill and you will be at less risk of a breast abscess.
- Ensure your baby is attaching well to your breasts and feeding well
- Breastfeed your baby as often as your baby wants to feed
- Avoid missing or putting off feeds
- If a breast becomes uncomfortably full, wake your baby for a feed. If your baby is not interested in feeding, you may like to express a small amount for comfort
- Avoid putting pressure on your breasts eg with clothing or with your fingers while feeding
- Rest as much as you can
- Alternate from which breast you begin each feed. This can help ensure at least one breast gets drained well at every second feed
- Avoid giving your baby any other fluids except your breastmilk, unless medically advised to
See the Royal Women's Hospital mastitis clinical guideline https://thewomens.r.worldssl.net/images/uploads/downloadable-records/clinical-guidelines/mastitis-and-breast-abscess.pdf
The information in this website article has been taken from the ABA booklet Breastfeeding: breast and nipple care and does not replace advice from your health care providers.
© Australian Breastfeeding Association Reviewed March 2015