One of the most common breastfeeding problems is an illness called mastitis. It seems to come out of nowhere and can leave you feeling simply awful. The good news is it’s very treatable. We chatted with Registered Nurse and International Board Certified Lactation Consultant Kate Barry to find out what causes mastitis, its symptoms and how to treat and prevent it.
Breastfeeding can be an emotional and physical rollercoaster ride, full of ups and downs. One of the downs that many breastfeeding mamas experience is an illness called mastitis.
Mastitis often seems to strike out of the blue, and it can make you feel downright awful. But the good news is that there are ways to treat it and proactive steps you can take to try and avoid it altogether.
We chatted with Registered Nurse and International Board Certified Lactation Consultant Kate Barry to find out more about this common breastfeeding problem. Kate is an experienced neonatal intensive care nurse and the founder of Little Bird Lactation, a lactation support service and online breastfeeding store.
We asked Kate what causes mastitis, its symptoms, and how to treat and prevent it.
What is mastitis?
Let’s start at the beginning.
Mastitis is inflammation of the breast tissue. It is a common breastfeeding problem, with around 1 in 5 breastfeeding women in Australia and New Zealand developing it in the first six months after giving birth.
What are the symptoms and signs of mastitis?
Mastitis symptoms include redness on the breast, possibly in a small wedge shape. This can be harder to see on darker skin. Mamas may notice what feels like a hardened lump, and the breast may be sore and tender. Mastitis can cause you to feel quite unwell with flu-like symptoms, including fever, chills, headaches and joint aches.
How fast does mastitis develop?
Kate says mastitis can come on very suddenly. If you suspect you have mastitis, it’s important to address it straight away because it can get worse quickly. But it’s not all bad news - Kate says it can resolve quickly with treatment too.
What causes mastitis?
Kate explains there are two types of mastitis – infective mastitis and inflammatory mastitis.
Until recently, it was believed that all mastitis was the infective kind caused by bacteria. Infective mastitis can occur when bacteria enter the breast tissue via a cracked nipple. It needs to be treated with antibiotics.
But we now know inflammation can cause mastitis too. Inflammatory mastitis is caused by a narrowing of the milk ducts. Kate says this can happen when the breast produces a lot of milk and becomes engorged. That engorgement can trigger inflammation, narrowing the milk ducts, possibly causing blockages and making it difficult for the milk to get through.
Inflammatory mastitis can also be caused by a mama’s microbiome. Our microbiome is the community of microorganisms, including helpful bacteria, that live in our bodies, aiding digestion and helping control our immune systems, among other things. For reasons that aren’t yet fully understood, if a mama’s microbiome is out of balance, it can cause her milk ducts to narrow, resulting in inflammatory mastitis.
Registered Nurse and International Board Certified Lactation Consultant Kate Barry with her family
How to treat mastitis
Kate explains that the usual advice given to mamas with mastitis is to consistently drain the breast with extra feeds or pumping to ensure it is as empty as possible and vigorously massage out any hardened lumps. But she says the Academy of Breastfeeding Medicine has recently released a new and updated protocol for mastitis treatment, and it is all about reducing inflammation.
“We want to get rid of the inflammation to allow that milk to flow,” Kate says. “Gently mobilising our breasts, moving them around in a gentle fashion to help elongate the ducts, stretch things out and get things moving.” Gentle breast massage to aid lymphatic drainage can help reduce inflammation too. Kate recommends rolling a Lactamo ball very gently across the breast, starting from the base of the breast and moving up towards the armpit to encourage lymphatic fluid to drain back up into the armpit. Your breast is likely to be sore and tender, so gentleness is key. Roll the Lactamo over your breast as softly as you would stroke your baby’s face. Using a warm Lactamo ball during a feed to gently massage towards the nipple can aid milk drainage, which can make the breast feel more comfortable. After a feed, a gentle breast massage with a cooled Lactamo ball can help relieve inflammation and also soothe the hot, burning feeling that comes with mastitis. Anti-inflammatory medication, like paracetamol or ibuprofen, can help ease mastitis symptoms too.
Kate says contrary to advice mamas are often given, there’s no need to pump or feed more than usual when you have mastitis. Instead, she says it’s important to continue feeding as you usually would. Excessive feeding or pumping will encourage more milk production, which can exacerbate mastitis. Restricting or reducing feeds can make mastitis worse too.
If your symptoms don’t start to improve within 12 - 24 hours, or you start to feel more unwell, contact your GP. They may need to prescribe you antibiotics.
If you’ve had mastitis once, are you more likely to get it again?
Possibly, Kate says, but not necessarily. It all depends on why you got it in the first place.
Mamas with an unbalanced microbiome and mamas who pump are slightly more at risk of contracting mastitis. Taking a probiotic to support healthy gut bacteria can help. If you’ve previously had mastitis that developed into an abscess (a rare complication), you’re more at risk of getting it again too. Mamas with babies with latching issues might also find themselves getting mastitis more than once.
Kate says if you’re suffering from recurring bouts of mastitis, it’s important to have an assessment with a lactation consultant. “They can look and see if there's something in the latch causing the milk not to come out or if you're predisposed for other health reasons to mastitis. Then they can prepare a personalised plan for you.”
How to prevent mastitis
Kate’s top advice for preventing mastitis? Get to know your breasts. “The biggest tip I give all the women I work with is to understand your breasts. Know your normal. Have a daily check-in. When you jump in the shower, have a feel around.” It’s important to remember that it is normal for some areas of the breast to be fuller than others, and not all lumps are mastitis. If in doubt, please always consult your healthcare professional.
At the first sign of engorgement, Kate advises carrying out a gentle breast massage with a Lactamo ball to aid lymphatic drainage. Roll the Lactamo up from the base and across the breast towards the armpit. This can keep the fluids within the breast moving and prevent unnecessary pressure on the milk ducts before it develops into mastitis. Gentle warm massage towards the nipple with the Lactamo ball before or during feeds can support milk removal from the breast. By gently mobilising breasts, keeping the fluid within them moving and not restricting any feeds so milk isn’t left sitting in the breast for a long time, mamas can reduce their chances of getting mastitis. Kate also recommends avoiding tight-fitting clothes and making sure you wear well-fitting breastfeeding bras.
“Learning the right techniques, following the pre-emptive measures and making sure you’re regularly removing good amounts of milk can help you avoid mastitis,” says Kate.
If in doubt, please always consult your healthcare professional.
Looking for more breastfeeding support? Try these articles from Lactamo’s The Circle: