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Massage Today
June, 2008, Vol. 08, Issue 06

The Danger of Mastitis

By Elaine Stillerman, LMT

While flying home to New York from a trip to California to introduce my 6-week-old son to his uncle, aunt and cousins, I struggled with nursing him. It wasn't until two years later, when we got his diagnosis of fragile X, that his failure to latch on and global hypotonia made any sense.

However, my breasts were bursting and I decided to bring my breast pump into the bathroom to fill a bottle and feed my son. I looked around for an electrical outlet and was stunned to find they had all been removed for fire safety reasons. I attempted manual (breast) expression, but that wasn't very effective, and I sat for the remainder of the five-and-a-half-hour flight in agony as my breasts engorged and a fever developed. Luckily, I didn't develop mastitis, but the discomfort was intense nonetheless. (Since that time, I have suggested to my clients they carry a battery-operated pump for such eventualities.)

It's not at all uncommon for women in late pregnancy and/or new mothers to feel their breasts engorge, especially when they first start nursing. When the tenderness becomes painful, a serious breast infection or mastitis might be the problem. Mastitis, or inflammation of the breast, used to be called "milk fever" or "milk leg," and there actually might be a genetic component for susceptibility to this painful condition.

This infection, which generally affects only one breast, usually occurs two to three weeks postpartum, but it might occur after only one week. It's caused by Staphylococcus aureus and Escherichia coli bacteria.1 These bacteria often are carried on the mother's or (hospital) staff's unwashed hands, or in the newborn's mouth.2 The bacteria enter the mother's body through an open, injured area of the nipple, although in some cases there might be no discernible wound.

Engorgement and milk stasis often precede mastitis, so new mothers can start paying closer attention to these warning signs. Sometimes the breasts engorge if the baby misses a feeding, when the baby starts to sleep through the night, or when mom starts to wean the baby. Other causes might be failure of the milk ducts to drain completely, underwire bras or bras that are too tight, as well as maternal stress and fatigue. Any pre-existing condition that lowers her immune system also might be a contributing factor.2

Once mastitis has developed, new mothers suffer with very sore and tender breasts. A red, inflamed spot develops and a red line can be seen that traces the clogged milk duct. Flu-like symptoms, general aches, fever (101.1 F or higher), headaches and chills accompany mastitis. If left untreated, a painful abscess can develop. This occurs 5 percent of the time.8 The milk from the affected breast might taste saltier than usual because there are higher levels of sodium within the swollen, inflamed tissue. The baby might even notice the difference and protest during the feeding.3

Some women misdiagnose plugged ducts for mastitis, although many women who have frequent bouts of plugged ducts often develop at least one case of mastitis. While plugged ducts, which are more prevalent than mastitis, can feel equally painful and require treatment, they don't hurt as much as mastitis and are not caused by bacterial infections. Milk ducts might become blocked for other reasons: an overabundance of milk, poor latch (when the baby's mouth does not form a firm seal around the nipple), a shift in nursing patterns or compressed breasts (either a bra that is too tight or from sleeping on the affected side).4

Other differences that set plugged ducts apart from mastitis are:

  • Plugged ducts come on gradually.
  • They might move around the breast.
  • They have little or no heat associated with them.
  • They might cause localized pain or discomfort.
  • They usually are not accompanied with flu-like symptoms.
  • Any fever that is present usually stays below 101 F.4
  • Plugged ducts can be easily treated by massaging or pressing directly on the affected area, or by using warm compresses.

However, one of the best ways to treat mastitis is to continue nursing. Breastfeeding with mastitis is safe for the baby and most antibiotics used to treat this inflammation are not going to harm the newborn. La Leche League urges women not to give up on nursing because it actually shortens the duration of the infection and reduces a woman's chance of developing an abscess.3 Some women might be concerned about taking antibiotics when the child is so young. At least half of new mothers who develop mastitis don't need antibiotics.1 There also is reason to be cautious about multiple rounds of antibiotics. One study suggested repeated dosing of antibiotics might increase the risk of breast cancer.5

So, what can a new mother do to treat this painful infection? Obviously, strategies to prevent the condition need to be in place. Gentle breast massage will keep the milk ducts from becoming plugged. While in the shower or when moisturizing, the new mother can lightly effleurage around her breasts six times, lightly knead the base of the breasts and press on any areas that might feel tender. There also are some effective acupuncture points that might help reduce the discomfort. She can draw an imaginary line from the nipples vertically upward, just beneath both clavicles. These tender spots are Stomach 13. Press both points for a count of 6-10, repeating 6-10 times. From there, she can make an imaginary line about 3 inches down to the beginning of each breast. These are the Stomach 16 acupuncture points. Treat them as you would Stomach 13.

In the middle of the sternum, your client can find Conception Vessel 17. This point is going to feel tender to the touch. She should start the treatment by pressing gently and gradually increasing her pressure.6

Other natural treatments to treat plugged ducts or mastitis can be used once symptoms appear, as a way to prevent the condition from worsening. For those women who chose to avoid antibiotics, these techniques might be their best form of defense and care.

When the breast starts to feel tender, apply moist heat to the area. This will help dilate the milk ducts and prevent them from clogging. She can stand in the shower, facing away from the shower head, and let the water cascade over her shoulder(s). Anyone who has ever taken my workshop knows what to do with potatoes (I am going to keep the rest of you guessing). For breast tenderness, grate a raw potato and apply a cold poultice a few times each day to the sore spot.6 Place cold, raw cabbage leaves in the bra to reduce swelling. Rupture the veins by rolling over the leaves with a rolling pin and wear them until they become room temperature, and then change them. Some women report a decrease in milk supply from using the leaves, so the new mom needs to be attentive to that change.4

Start nursing with the sensitive breast first until it's empty and direct the baby's chin toward the tender area to create more sucking power on the clogged duct.1 Dietary changes also can have a positive impact. Reducing the amount of saturated fats and sodium in the daily diet has been shown to help some women. Certain nutritional supplements also might aid mastitis prevention: lecithin, bromelain, the vitamin B complex, vitamin C, echinacea and iron. Be sure your client discusses any and all supplements, herbs or homeopathic remedies with her care provider before taking them if she is nursing.1,3,7

Another simple remedy is to remember to drink adequate amounts of water daily. Eight to 12 glasses will help maintain the milk supply and keep the new mother's body running (internally) smoothly. Once the baby stars to crawl, bacteria can be picked up from the floor and any surfaces they touch, so moms should wash their hands and the baby's face before nursing. If mastitis persists, she should consult with her care provider. She might want to get another opinion to rule out tumors.

By paying attention to her body and heeding the warning signs, a new mother can enjoy the intimacy, nurturing and pleasure of breast-feeding her baby.

References

  1. Newman J, Pitman T. The Ultimate Breastfeeding Book of Answers, Rocklin, Calif.: Prima Publishing, 2000.
  2. McKinney ES, James SR, Murray SS, Ashwill JW. Maternal-Child Nursing, St. Louis: Saunders, 2005.
  3. Mohrbacher N, Stock J. The Breastfeeding Answer Book,3rd Review Ed. Schaumberg, Ill: La Leche League, 2003.
  4. Villamagna D. "Triumph Over Mastitis." Mothering, March/April 2007;141.
  5. Velicer CM, Heckbert SR, Lampe JW, et al. Antibiotic use in relation to the risk of breast cancer. JAMA 18 Feb, 2004;291(7)827-35.
  6. Stillerman E. Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork, St. Louis: Mosby, 2008.
  7. Lim R. After the Baby's Birth: A Complete Guide for Postpartum Women, Berkeley, Calif.: Celestial Arts Press, 2001.
  8. Gibbs RS, Sweet RL, Duff WP. Maternal and Fetal Infectious Disorders. In: Maternal-Fetal Medicine: Principles and Practice; Creasy RK, Resnik R, Iams JD, eds. Philadelphia: Saunders, 2004.

Click here for previous articles by Elaine Stillerman, LMT.

 

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