Lactational Mastitis – Causes, Symptoms And Ways To Treat & Prevent It.

You may be noticing that an area of your breast is red, hard, swollen, warm and painful and it doesn’t seem to go after feeding.  You may even be experiencing flu-like symptoms such as a fever, aches, or chills and really don’t know if this is normal.

Now these can be the early symptoms of mastitis and so firstly we want to start by reassuring you it’s a fairly common condition for breastfeeding mums, with up to a third of breastfeeding women developing it. Secondly, if it’s noticed early and treatment is started, you can hopefully avoid it progressing to an infection. lastly, no lasting damage can be caused to the breasts, and it doesn’t harm milk production.

So let’s delve into the symptoms, causes and effective treatments for mastitis, what to look out for, and how to deal with it should you experience it during your breastfeeding journey. 

How Will I Know If I’m Experiencing Engorgement Or Mastitis?  

Engorgement and mastitis are both complications associated with breastfeeding which can make your breasts feel uncomfortable and they often have similar symptoms. Engorgement affects most mothers and is usually noticed at around days 3-5 when milk production increases.  Both breasts are usually affected appearing swollen, feeling heavy and hard, warm and sensitive and on occasion can appear red. Whilst it may feel uncomfortable, it can be reassuring to new breastfeeding mums as it shows that the breasts are responding well to your newborn’s demands. It comes from not only an increase in milk production, but an increase in blood flow and other fluids that are directed to the breast, to help with the process.

Usually, these symptoms decrease as the body adjusts, but engorgement can lead to mastitis, so here’s a few things you can do to help reduce the swelling and help the milk to keep flowing:

• Feed baby on demand but no longer than 2-3 hours between feeds, letting baby finish on one breast before moving to the other.
• Ensure your positioning and attachment is good and baby is feeding effectively.
• Avoid using dummies as these can mask baby's feeding cues.
• Just before feeding, use a warm compress to help the milk to flow.
• Hand express a small amount of milk to soften the breast slightly, this can also help baby with latching.
• In between feeds use ice or a cold compress to help reduce any swelling.
• Light sweeping of the breast can help stimulate lymphatic drainage, helping to remove fluid and toxins by gently stroking from the nipple towards the arm pit.

If you are coming up to weaning your baby from breastfeeding, then it’s best to do this slowly and gradually to avoid engorgement at this stage.  

What Is Mastitis And What Can Cause It?

Mastitis isn’t just one thing…it’s actually described as a spectrum!

Generally starting with an over-supply of breast milk, which simply put is when the breast is producing milk faster than its being released. Having full milk sacs leads to swelling and inflammation of the breast tissue, causing the milk ducts to narrow. Mastitis usually only affects a small area of one breast, but it can affect the whole breast, with symptoms that often come on very quickly.

Some reasons why Mastitis can occur are:

• Your baby is not latching on well.
• You’re feeding as well as expressing milk.
• Baby is not feeding often enough, or missing feeds.
• An injury has occurred that has damaged a milk duct or gland.
• You’ve stopping breast feeding too quickly.
• There’s an Imbalance of the microbiome following a caesarean section or antibiotics.
• A bacterial infection (often stemming from sore or cracked nipples).

Even if you’re not breastfeeding, you can still experience mastitis. Principally caused by an infection, it can occur if your nipples are sore or cracked, or even through a nipple piercing. 

What Are The Early Signs Of Mastitis? 

The signs and symptoms of mastitis can develop rapidly and can be very uncomfortable, and can include:

• Burning pain or tenderness of the breast which can be continuous or worse during breastfeeding.
• The affected breast may feel swollen, warm, or hot to the touch.
• Redness on a specific area of the breast. Unfortunately, it can sometimes be more difficult to see on darker skin, so it pays to be aware of the other symptoms to look out for.
• A lump or thickening of breast tissue that is sore and hard.
• Flu-like symptoms such as fatigue, chills, body aches and a mild fever.

How Can I Treat Mastitis? 

With care and attention mastitis can be treated naturally and can be resolved without medical treatment, so if you think you have mastitis you should: 

• The first and most important thing is to continue breastfeeding baby on demand from the affected breast. If your breasts are uncomfortably full you can hand express a little milk to help make it easier for baby to latch.
• Try not to completely empty the breast or offer the breast more as this can result in an over-supply, remember your breasts work on a supply and demand process.
• Reduce the use of breast pumps if you can, as taking more from the breast than baby needs can result in over production, worsening swelling and inflammation. If you solely use the breast pump, then don’t pump any more than baby drinks at each feed. Oh, and make sure you have the right size pump flange!
• Even the smallest of adjustments can help ease any tenderness when feeding, so ensure that you are comfortably positioned, and that baby’s positioning and attachment is good.
• Ensure you have a well fitted and supportive nursing bra.
• Try using a cold compress in between feeds which is great for reducing swelling, as well as blood flow.
• Avoid any firm pressure or strenuous massaging of the breasts.
• Carry out lymphatic drainage by gentle sweeping across the breasts.
• Take Ibuprofen to help reduce inflammation with paracetamol to help with the pain and to help reduce your temperature. Both are suitable for breastfeeding mums but be aware that Aspirin is NOT
• Drink plenty of fluids to keep your body hydrated and eat a well-balanced diet, both of which will help with the healing process.
• Finally, it’s important to look after yourself and that includes your mental health, so try to rest as much as you can. It’s difficult we know with a little one to care for so don’t be shy when asking for help and as always talking things through is good.

Many breastfeeding mothers actually stop breastfeeding sooner than planned when suffering with this condition, so we strongly advise getting support to help you through and particularly if you find you have recurring mastitis.

Having mastitis can be really challenging for nursing mums, but having an awareness of the symptoms and how to treat it will help you prevent the condition altogether or stop it escalating.

Will I Need Antibiotics To Treat My Mastitis?

 Antibiotics aren’t recommended for inflammatory mastitis but if symptoms persist or worsen after 12-24 hours, or you’re very unwell then contact your health care provider.  This may be a sign of bacterial mastitis and a course of antibiotics for 10-14 days may be suggested.

And please don’t forget to reach out for support if your symptoms become unmanageable, or you need advice and reassurance.

How Can I Prevent Mastitis From Occurring? 

Firstly, check your baby’s latch and positioning as a starting point. A midwife, health visitor, lactation consultant or breastfeeding counsellor will be able to help you with this.

To prevent recurring mastitis:

• Continue to feed your baby  responsively (for as long, and as often as they need).
• Encourage your baby to feed if your breasts feel very full. 
• Wait for your baby to finish feeding – they usually release themselves when they’re done!
• If you are expressing milk as well as feeding your baby yourself, it’s important not to express too much milk as this could cause an over-supply. 
• Consider probiotics to help balance the microbiome.
• When you decide you want to stop breastfeeding, ensure you reduce your feeds gradually and over a number of weeks.

IT CAN BE TEMPTING TO STOP BREASTFEEDING WHEN YOU HAVE MASTITIS, BUT WE CAN’T STRESS ENOUGH THAT EFFECTIVE MILK REMOVAL REALLY IS KEY TO TREATING THIS CONDITION. SO WE HOPE OUR TIPS WILL HELP GIVE YOU THE CONFIDENCE TO CONTINUE, EVEN THOUGH IT MAY FEEL LIKE THE LAST THING YOU WANT TO DO WHEN YOUR BREASTS ARE SO SORE, AND YOU FEEL UNWELL.