I have had mastitis twice and each time I felt like I was dying. I was breastfeeding my third little boy (Mini The Milk) for over two years before I got my first bout of it. At that point I had breastfed for a total collective of 8 years when it happened! I was taken by such surprise that for the first 12 hours of pain I thought I had pulled my pec muscle from moving my couch. It wasn’t until the pain got worse and fever set in that I realised, “Oh no, this isn’t a pulled muscle this is MASTITIS!” I had been a breastfeeding mother FOREVER, had been in private practice as an IBCLC for a few years and still, it took me 12 hours to realise what was going on.
I spent the next 12 hours with a hot boob, in sever pain, sweating and fighting a fever. The section of my breast which had the infected glandular tissue was so large it felt like a little tea cup saucer…it was so hard I probably could have used it as one if I was up for scheduling a tea party.
While mastitis is HORRIBLE to go through, I was only really sick for about 12-24 hours and both times I had mastitis I was able to avoid antibiotics. Are antibiotics necessary sometimes for women with mastitis? Yes! However many of us can avoid them all together if we know what to look for and get on top of it immediately! Also, research shows that L. fermentum or L. salivarius (probiotics) is an effective alternative to antibiotics for the treatment of infectious mastitis during lactation (Arroyo R, et al. 2010). We know that the human gut harbours diverse microbes that play a fundamental role in the well-being of their host (Clemente et al. 2012). So simply put, avoiding antibiotics is important to our overall health along with our child’s and if we focus on getting the GOOD bacteria in, we might be able to avoid antibiotics all together. Often times women are prescribed antibiotics without even knowing if they actually have an infection or not! Having mastitis means some of your glandular tissue (where the milk is made and stored) is inflamed, but not necessarily infected.
Here is my guide with my top tips for healing and preventing mastitis. Whether you are on antibiotics or not…follow this guide!
Identify it early. Know the signs to look out for. This is the number one most important thing because the sooner you can get on top it it, the better! However as a first time mastitis sufferer, you might find yourself in the same position I was in thinking you have pulled a muscle instead of fighting an inflamed or infected boob! (Remember your boob MAY or MAY NOT be infected. It could just be inflamed). So what are the signs?…
- Red, sore area on your breast
- Plugged duct (a hard spot or lump on your breast) that is starting to feel sore.
- Flu like symptoms including fever, chills or just generally feeling “under the weather”.
*Important to note, some women will have absolutely no symptoms at all of a plugged duct or any indication that some of their milk is starting to collect in one spot. It will be like a train hit them all of a sudden with major flu like symptoms coming on quickly, without warning.
Massage, massage, massage, massage… When you think about why you are getting inflammation in your breast (milk collecting in one area) then it makes total sense to massage. This helps break up that “stuck” milk and helps it release from the inside of your ducts so it flows out freely the next time you breastfeed or express. Research has shown that massage is helpful for the reduction of acute breast pain when milk has collected in the ducts and is helpful in the management of future episodes of plugged ducts and mastitis (Witt et al, 2016).
The key to this is MASSAGE FREQUENTLY. When I say frequently I mean every 1-2 hours during the day and as much as you can half asleep when breastfeeding at night. Massage before, during (if you can) and after every breastfeed. Massage between breastfeeds if your baby goes more than 1 hour between the feeds. Don’t give your milk a chance to start sticking to the inside of those ducts! 🙂
Heat, cold, heat, cold. I have actually seen some IBCLC’s argue about whether or not heat or cold is good for mastitis. My opinion? Do what feels right for you! From a physiological perspective it does make sense to try heat before a feed and cold after. Why? Because heat helps stimulate a let down (important for clearing as much milk out as possible with each feed or expression session) and it feels good. When I had mastitis heat was my saviour! It felt good so I did it. You can apply heat with a hot rice pack or heating pad. Cold is often recommended after the feeds as it is soothing and helps reduce the swelling and inflammation. HOWEVER cold did not feel right for me, I felt as though I really wanted to heat up and open up as much of my breast as I could and it helped a lot over the time spent healing. You can take ibuprofen too as it helps reduce the inflammation (yes it’s safe while breastfeeding!)
Frequent breastfeeding and/or pumping. Breastfeed your baby FREQUENTLY. What does this mean? At least every 1 1/2-2 hours during the day and 2-3 hours overnight. The longer you let your breast “fill up” the more at risk you are of continued inflammation. Get your milk moving out of the ducts! A baby who is breastfeeding efficiently is the best way to do this. Are you not able to get your baby or toddler breastfeeding frequently or efficiently? Then you can use a pump or hand expression. Just get the milk out!
When you breastfeed also try to get into positions that will help drain the breast. You can “dangle feed” where you are on all fours and your baby is underneath you breastfeeding like a baby cow! Yes it feels weird but works really well as gravity helps to drain the breast. You can also point baby’s chin towards the plugged or infected area in your breast. The chin is where the strongest part of the suck is. You’ll feel the difference!
Rest. I know, I know, you want to punch me for saying that. You don’t even have time to pee and eat a cracker much less lie down and rest. BUT this is extremely important when fighting mastitis. Whether we like it or not we have to STOP what we are doing and get into bed. If you have other children and are struggling to find a way to do this, have a read of my article “How to rest when you don’t even have time to pee”. Can’t get into bed? Lie on the floor and let your toddler crawl all over you. At least you are not moving!
GUT HEALTH. So this topic is something I am extremely passionate about and unfortunately this is often never mentioned to women when they are seeking help with mastitis. They are just given a script for ANTIbiotics without ever mentioning how the good bacteria in our gut is absolutely CRUCIAL to healing and preventing mastitis. Among other infections. Because here’s the thing…infection is about bacteria. We are more likely to get an infection when we are run down (motherhood!) and if our microbiome is out of wack. Our microbiota includes bacteria, archaea, protists, fungi and viruses. Also, the gut microbiota interacts with the immune system, providing signals to promote the maturation of immune cells and the normal development of immune functions (Chow et. al., 2010). We need a healthy microbiome (much of this found within our gut) to fight off infection…including infections in our breasts! Seek guidance from a gut health knowledgable health care provider and IBCLC to work through diet changes to help with this.
Lethicin. Lethicin is naturally occurring in some foods and you can get this in supplement form (tablets are easiest). I recommend getting Lethicin sourced from sunflower seeds, NOT soy. Dr. Jack Newman (MD and IBCLC in Canada) states that although we don’t know exactly why it works, we think it decreases the viscosity (stickiness) of the milk, by increasing the percentage of polyunsaturated fatty acids in the milk. It is safe, inexpensive, and seems to work in some cases. The dose is 1200 mg four times a day. (Jack Newman, MD). I have spoken to many breastfeeding mothers of multiples (twins and triplets) over the years and they SWEAR by this stuff!
Work with an IBCLC to help establish WHY you are getting mastitis and form a plan for you on how to best prevent it for your individual situation. Mastitis can start for a number of different reasons, however if your gut health and microbiome is in tip, top shape then you are less likely to develop mastitis, regardless if the following things are going on or not. Some women will have all of this going on and still not get mastitis. So it’s not as simple as knowing the risk factors. My main point still stands though, finding out if some or a few of these things is going on is helpful in preventing future episodes. The following possible causes include:
- Poor attachment to the breast (Have you tried “the flipple” or “laid back breastfeeding”?)
- Nipple damage (Find out WHY you are experiencing damage – Have a consultation with an IBCLC!)
- A long break between breastfeeds (Frequent draining of the breast is crucial)
- Breasts that are too full (If you are feeling full offer the breast to your baby or express)
- Blocked milk ducts (Massage, massage, massage)
- Stopping breastfeeding too quickly (Try to wean slowly if possible)
- Overly tight bra (Let them be freeeeeee!) If your bra is digging in, it can cause damage to the glandular tissue.
- A baby with a tongue tie who is having problems attaching to the breast (Have you read my articles on ties?)
(Bullet point list from: https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-problems/mastitis)
Do what is working best FOR YOU. Do you feel as though your IBCLC is not finding a solution for you? Then get a second opinion from a different breastfeeding specialist. Trust your instincts and make sure you find help from someone that is listening to you and your concerns and perception. It is possible for women to heal mastitis without using antibiotics and to prevent future episodes. Seek help as soon as you suspect mastitis is showing it’s ugly head!
Arroyo R, et al. (2010). Treatment of infectious mastitis during lactation: antibiotics versus oral administration of lactobacilli isolated from breast milk. Clin Infect Dis. 50(12):1551–1558.
Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic breast massage in lactation for the management of engorgement, plugged ducts, and mastitis. Journal of Human Lactation, 32(1), 123-131.