Why do some people get mastitis and others don’t? Why are some of us so prone to it, just from one missed feed, or pumping session, when others can go long times between feeds and not be affected by this? There may be some risk factors that are predisposing you to mastitis more than once. This blog post is going to explore some of the well-known risk factors, as well as some of the lesser-known causes behind mastitis! Knowing what can lead to mastitis, especially the things that aren’t so obvious, can help reduce the risk of the dreaded mastitis making an unwelcome appearance!
What is Mastitis?
Mastitis is an inflammation of the breast, sometimes with a bacterial infection although not always. It is caused by stasis of milk, so milk not being removed from the breast which leads to a blockage. Sometimes you can feel that ‘lump or bump’ sometimes you can’t. This blockage leads to inflammation and mastitis. Classic symptoms of mastitis include pain, swelling and redness. Often women get a wedge-shaped, red patch across one breast. Be mindful though if you have a darker skin tone as this ‘classic’ red patch may not be present or be so obvious! It can also be accompanied by a temperature, and flu-like symptoms so aching, headaches and chills. You may not get all these symptoms at the same time. Many women I have supported who have had mastitis, describe it coming on suddenly and that they felt as though they have gone down with flu. It’s definitely worth bearing this in mind if you are breastfeeding, if you feel unwell or have a temperature ALWAYS consider, could this be mastitis?
Mastitis can affect women at any time, but is common during lactation, with most
incidences of mastitis occurring in the first couple of months after your baby
arrives. During these first few weeks, you are more likely to have nipple damage
caused by ineffective attachment, you are fatigued, and your immune system
isn’t as effective due to your recent pregnancy, making you more vulnerable to
viruses, bacteria and illnesses. This milk stasis, so blockage of milk leading to inflammation, can happen when your breasts become engorged but also is more likely when you have challenges that can cause breastfeeding to be interrupted in some way. It is more likely when you are doing too much! So, returning to work, holidays, visitors, family stress or illness, can all affect this and can be why some women get mastitis
at other times outside of the early months of breastfeeding.
Causes of mastitis
- Nipple damage caused by ineffective attachment; this can lead to bacteria having a direct route in to the breast, to cause infection.
- Infrequent or ineffective drainage, so baby not feeding well, poor attachment, scheduled times of feeding, cutting feeds short or just not feeding frequently enough can lead to milk not being removed from the breast.
- Blocked ducts, milk blisters or blebs
- Missing feeds
- Stopping breastfeeding abruptly
Other risk factors;
- Tight or restrictive clothing, putting pressure, stopping flow of milk from the breast. Seat belts on long car journeys can cause this too!
- Illness in mother or baby
- Stress and fatigue.
Treatment for mastitis.
The guidance around how we treat mastitis has changed quite recently. So you may be told to feed more, to ’empty’ the breast and to rigorously massage the affected area, but this is NOT the right approach anymore!!!
This is what you need to do.
Feed your baby responsively- so this means following their cues or signs. You do not need to feed more, pump or express more than you ‘normally’ would. This is a big change to the previous information where we would say to do this more. The reasoning behind this is we don’t want to be encouraging more milk, just effectively removing the milk you have! Increased supply can make the inflammation worse.
Try using cold compress or ice packs to help reduce the swelling. Avoid warm compresses as this again can increase inflammation.
Do not use firm massage. Use gentle sweeping motions from your breast, up towards your armpit. This can help reduce the extra fluids in the breast (not the milk) that are as a result of the inflammation.
Not all mastitis is caused by a bacterial infection and if you identify and treat it early you can improve it. However, if things are not improving quickly (within 24 hours) or are getting worse, then seek medical support.
The one caveat I will mention here that ‘resting the breast’ is NEVER NEVER the right advice!!! You can’t leave mastitis untreated, you have to move the milk!!! Milk not moving, infection and inflammation not being resolved, is a recipe for developing a breast abscess!!! If it’s too painful to feed, then hand express (be aware the inflammation can make the milk flow slower), take ibuprofen (as long as you are able to). Do not just leave that breast to have a break or a rest, this isn’t going to help you!!!
Here is the link to the full American Academy of Breastfeeding Medicine protocol
The breastfeeding network has great information on mastitis. See here for guidance on correct treatment for mastitis.
and here from the NHS
But what about if you have had it more than once? What can you do to try and prevent mastitis?
- Skilled support- Get skilled support to optimise latch, check and resolve any issues such as tongue-tie or tension, that may be behind the ineffective latch. Breastfeeding shouldn’t be painful, and nipple damage puts you more at risk of other infections. Washing your nipples with mild soapy water or saline rinses may also help. Oversupply can make you more prone to mastitis. If you have concerns you may have too much milk, get skilled support to help identify if this is the issue and help you manage it correctly.
- Check your hygiene and cleanliness. Yes, these last few years we are all more aware of the importance of washing our hands, but just check are you cleaning your hands between nappy changes and breastfeeding? Sometimes when your baby is crying as you change their bum, we then quickly try and get them on the breast to help settle them, but you need clean hands first! Bacteria can find a way in if you have damage to your nipples. I used to keep an alcohol gel in the nappy bag so at least I could do a quick squirt if I couldn’t get to the sink
- Look at stresses and fatigue! So much more easily said than done, but if you are exhausted and run down, mastitis is more likely. Can you get some extra support? Meals delivered or help with other children, help with the housework or could next door’s teenager walk the dog this week? Could you do the food shopping online? Being a parent is exhausting, so do not feel you are failing if you need some extra support. Also, don’t be afraid to say NO to guests or activities that you don’t want! Not enough rest and feeling over-extended is a factor for recurrent mastitis!!! Take one of my phrases that I try and practice, as I’m not very good at saying no,
- ‘Thank you for thinking of me but I need to pass on that at the moment.’
- Rest where you can. A ‘rescue’ sleep for you, where someone you trust has the baby and you get a block of uninterrupted sleep. Express well prior to trying to have around four hours of sleep undisturbed. You may need to feed or express as soon as you wake if you normally feed more frequently than this, as remember long periods
between feeding can cause milk blockage. Even just maybe a few days of someone
coming to take the baby out for a walk between feeds so you can try and nap or
rest (if you feel able to when someone else has the baby) can help lessen the
- Anaemia?- Check you aren’t anaemic. Some health deficiencies can predispose you to mastitis. Also, if you aren’t responding to a certain antibiotic or you aren’t completing the whole course, could be a factor in recurrent mastitis. This may mean the infection isn’t fully cleared. Some bacteria can be resistant to some antibiotics so a different one may be needed (Lawers and Swisher 2021).
- Get a bra fitting- Check your maternity bras fit. You will need more than the size you started with as there are changes to your breast size since pregnancy, in the early days of feeding, to when your milk supply has stabilised a bit. Check your clothes are not too tight or restricting the breast when you are feeding. We have all tried to do that discrete feed by not really pulling our top down fully so you don’t flash everyone in the restaurant, but if it’s stopping the flow of milk, it could lead to a blockage.
Change up the positions- Try and use different feeding positions from time to time. It’s common that we find a position we like, and we tend to stick to it. But the strongest part of the baby’s suck is nearest their chin. Alternating where the chin placement is, can help better drainage from the breast- although this still needs to be an effective latch, whichever position you are using. A ‘Dangle feed’ can really help to drain the breasts well from time to time, especially if you detect a blockage. Expressing after some feeds too can help. You don’t need to be doing this all the time as the body should regulate milk production to your baby’s needs over the first few weeks (oversupply issues aside) but especially if you feel the baby hasn’t fed well, or you are feeling very full, a dangle feed uses gravity to really drain all quadrants of the breast and expressing or pumping until you feel the breast is well-drained can help prevent blockages.
These are never instead of getting the right support and treatment for mastitis, but some of these things are reported to help alongside the recommended treatment.
- Garlic- Sometimes a baby may not feed as well during a bout of mastitis. It is safe to feed them whilst you have mastitis, but it can cause the milk to taste more salty, due to the increased sodium and chloride in the milk caused by the infection. Apparently eating more garlic can help this!! Garlic also has anti-inflammatory and anti-bacterial properties, so upping the amount of garlic you eat could help!!! Another point that’s worth knowing is that sometimes, for some women, having mastitis can drop your supply slightly. Your baby may be fussier at the breast. This may be due to the taste of breastmilk during mastitis inflammation, or less supply. Having lots of skin to skin, and feeding frequently, which is needed to treat the mastitis, should help return it to its normal levels with a bit of time. Caution to steadily increase supply is needed as you don’t want to create excess milk, especially if you haven’t resolved problems such as effective latch and feeding to remove the milk that’s being made. Garlic apparently can make the breastmilk taste sweeter and encourage your baby to feed more!
- Probiotics- There is more research needed into the use of probiotics. These are good bacteria that some people choose to take, especially after they have had an infection or needed antibiotics due to how this can alter the flora or microbiome in your body. However, for this to truly be effective the actual bacteria that are depleted, so finding out the specific strain that is deficient would be needed, and these shouldn’t be used instead of other treatments that we know are more effective. (Amir et al 2016).
- Lecithin- is something I have wondered about for many years. Evidence surrounding its effectiveness, like with many things relating to breastfeeding, is lacking, but many mothers have reported using it to help prevent recurrent blocked ducts. Lecithin is a food additive and can be found naturally in many foods. Dr Jack Newman has stated that it may work by reducing the viscosity of breastmilk and increasing the level of polyunsaturated fatty acids in the milk (Bonyata 2018). I have certainly supported mothers where it seems to have helped reduce bouts of blocked ducts, which could have led to mastitis, but if you want to know more about this here’s a link to some further information. Some women I have supported anecdotally report that reducing the fat in their diet has helped reduce the occurrence of blocked ducts.
- Cabbage leaves- Great for helping the pain of inflammation and there is some evidence that savoy or green cabbage does contain anti-inflammatory properties, but identifying the cause for mastitis and moving the milk are the main priority here. Never just assume popping a cabbage leaf in your bra will sort everything out.
You are a priority!!!
There are many factors that could be leading you to be more prone to mastitis. Stop and re-assess things to see if you can identify what is putting you more at risk. Get the right support to help you reduce the likelihood of mastitis and remember that your health and well-being are a huge factor here too. You need to put yourself up there in terms of priority to ensure you are able to care for and feed your little one. Prevention is always better than cure, so try and find time to regularly check your breasts for any signs of redness and get to know what your breasts feel like, this will help you identify any lumps or bumps early on! Treating it early can turn it around and stop the pain that accompanies the dreaded mastitis!