Mastitis during breastfeeding

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What is it about ?

Women who are breastfeeding may get inflammation of the mammary gland (mastitis). This inflammatory reaction is caused by one or more blocked milk ducts, often due to a poorly emptying breast (for example, because the baby is not positioned correctly). It can also be accompanied by an infection (a germ that causes the inflammatory reaction). Infection is more likely if the mother has cracked nipples and symptoms appear suddenly. In these cases, staphylococci are often the pathogenic germ (= responsible for the infection); streptococci and E. coli are other possible pathogens.

What is its frequency?

Obstruction of a milk duct is very common. Breastfeeding mothers with repeated milk ducts are more likely to develop mastitis.

How to recognize it?

The inflammatory reaction causes pain in the breast. A hot, red, tender area develops at the site of the inflammation. Other possible symptoms are fatigue, headache, muscle pain, increased heart rate, and fever. A painful, hard, fluctuating lump in the breast may indicate a breast abscess.

How is the diagnosis made?

The doctor will immediately think of mastitis in a nursing mother who has a high fever (38.5 ° C and above) and whose breast is painful, hot and red.

What can you do ?

Often, women with mastitis have already had (several times) an obstruction of one or more milk ducts. Breastfeeding mothers should pay attention to (small) painful, swollen, hard, and slightly reddish patches on the breast. Often, they indicate the obstruction of a milk duct. If they spread, you can try to stimulate the flow by breastfeeding the baby more often at the breast with the duct blocked. Try to empty the affected breast well. To help, massage the breast during and after breastfeeding, express more milk after breastfeeding, and make sure the baby is drinking well.

At the onset of mastitis, it is also essential to ensure good circulation. Breastfeeding should therefore be encouraged. The child risks absolutely nothing. It is advisable to first position the baby on the side of the affected breast, so as to empty the breast as much as possible. It may also be helpful to apply warm compresses before feeding the baby or to shower the affected breast with hot water.

Be careful if you have a fever (persistent). Despite possible antibiotics and regular breast pumping, fever may indicate an abscess in the breast. In this case, it is necessary to remove the abscess. If this happens, contact the doctor promptly.

What can your doctor do?

In addition to giving advice to improve circulation to the breasts, the doctor will prescribe paracetamol and / or ibuprofen (an anti-inflammatory medicine) for pain.

At the same time, he will prescribe antibiotics (amoxicillin or erythromycin in case of penicillin allergy) in certain situations, to prevent the possible development of a breast abscess. In the case of an abscess, symptoms do not improve after 24 hours, despite regular emptying of the affected breast.

If antibiotics do not cure mastitis, then a fungal infection (= a fungus) may be causing the problem. The sudden onset of complaints, especially with cracked nipples and fever, may also indicate the presence of an abscess.
A lactation specialist (often a midwife with special expertise in breastfeeding) can give you advice on preventing and treating mastitis.

If the complaints return or if you continue to feel a lump after treatment for mastitis and its recovery, the doctor will think about underlying causes, including breast cancer. In this case, he will suggest that you consult a specialist.

Sources

Foreign clinical practice guide ‘Puerperal mastitis’ (2007), updated on 18.08.2017 and adapted to the Belgian context on 03.01.2018 – ebpracticenet

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