Mastitis Care and Prevention: Back to Basics
Hi I am Carly Fleming, postpartum newborn nurse, aspiring lactation consultant, NJ mom to two boys and owner of Fourth Trimester Foundations.Postpartum, or the fourth trimester, is a wild time, and I believe all parents deserve a foundation for a safe and empowered experience.Through evidence-based education on what to expect ahead of time, one on one support when you're in it, and community connection. Breastfeeding, for those that choose to, is often a big part of the fourth trimester. Troubleshooting plugged ducts and mastitis deserves some extra TLC.
Below I highlight the extra care and considerations when dealing with clogs and mastitis, because there is a lot of new evidence out there: Whatever you think you knew about clogged ducts and mastitis, it might be time to rethink it.
The Academy of Breastfeeding Medicine has some updates to their clinical protocol for mastitis management, and you’ll be surprised with what the latest research has shown. So many techniques that we thought until recently were helping relieve clogs and mastitis, might have just been making it worse.
In a nutshell: let’s simplify the management. This means going back to the basics of ice, NSAIDs and breastfeeding on demand/pumping to match feeds, while reducing aggressive management. Increasing pumps, feeds, using lots of gadgets and interventions can create more inflammation and swelling. It’s all about going back to the core of supply and demand.
You demand more, your body makes more.
We have highlighted the latest clogged ducts and mastitis protocols here for you. Some are preventative, others are for treatment purposes. These recommendations are for a healthy mom and baby, where baby is gaining weight and having adequate wet diapers. This also includes where mom is breastfeeding in any capacity (exclusively or in combination with formula) (Exclusive pumping mamas, you don’t have to feel left out of this too, we have special EP-er considerations)
Latest plugged duct and mastitis protocols broken down for you:
Don’t feed to “empty”- your breasts will never be empty, it is unrealistic to expect. This can perpetuate the cycle of increasing lactation. Instead, feed on demand and express small amounts of milk for comfort. (EPers- pump to match babies intake)
If the area is so inflamed that baby can’t remove milk or you can’t express, don’t force it! Instead use ice, lymphatic drainage with very light touch, and a little bit of time. A dip in milk supply is expected, but can be picked up quickly.
Crazy positional feeding is not necessary- dangle feeding has no evidence to support it, and can be uncomfortable for mom and baby. Instead modify current breastfeeding positions to improve comfort.
Minimize breast pump usage- aim to only use it when mom and baby are separated or baby is not latching. Discarding milk is never ever necessary (EPers- express milk at a frequency and volume to mimic baby’s feedings)
Nipple shields use sparingly- If you are relying on a shield for many or all feeds and have frequent clogs/mastitis, please do this alongside a lactation consultant. Those who feed via nipple shield are at greater risk for clogs/mastitis.
Avoid deep massage- massaging the breasts deeply or using an electric toothbrush/vibration can increase inflammation. Breast massage may reduce pain, but it takes a lot of training/practice to massage in a way that doesn’t cause trauma to the breast. Instead, lymphatic drainage with light touch. (EPers- hands on pumping is great as long as you don’t use manual force)
Avoid saline soaks or anything topical- yes that haaka in epsom salt can irritate your skin more than it would help with the clog.
Don’t go crazy sterilizing- mastitis is not contagious and not from unhygienic cleaning practices. Clean your pumping parts as you have been (and sterilizing if your pediatrician specifically told you to). No need to clean the nipple before or after feeds. Using nipple cream does not cause a clog/mastitis.
Reduce pain and swelling- manage the mastitis symptoms
- Motrin 800mg every 8 hours
- Tylenol 1,000mg every 8 hours
- Ice- every hour or more frequently
- Heat- opens the milk ducts. It can worsen symptoms or provide relief, depends on the - Sunflower lecithin has been known to reduce inflammation and emulsify milk.
Manage oversupply- having an oversupply predisposes one to breast inflammation and milk duct narrowing. Aim for the basics of supply and demand (EPers- if your goal is to EP for the shortest amount of time possible and want an oversupply, keep it going if you aren’t getting frequent clogs/mastitis!)
Save antibiotics for bacterial mastitis- If you’ve ever taken antibiotics for clogs or possible mastitis before, don’t worry they probably did help! Antibiotics by design reduce inflammation, but they aren’t necessary unless the mastitis is confirmed from a bacterial source rather than a plugged duct. Initial mastitis is often diagnosed over the phone/through discussion rather than in person, so knowing the source is tough. Antibiotics to attempt to prevent mastitis are not a proven mastitis prevention. Rather than creating resistant strains and disputing the breast microbiome, many providers are now tending to only prescribe antibiotics when they feel the source is bacterial.
Keep an eye out for perinatal mood and anxiety disorders (PMADs)- statistically, women with a history of anxiety and depression experience higher rates of mastitis symptoms, it’s not fair. Similarly, PMADs are increased in anyone experiencing breastfeeding complications.
Some considerations:
Postpartum engorgement days 3-10 can look like early mastitis and narrowing of the milk ducts, but it is different!
If you are experiencing frequent mastitis, clogged ducts, please work with a lactation consultant and your OB/midwife at minimum. This is a clue that the feeding/transfer/pumping/breast anatomy may need to be looked into further.
If you have any history of breast surgery or breast implants, please also be in close contact with a lactation consultant since mastitis and clogged ducts can look very different for you than others.
PLEASE do not take this list as how you need to do things on your breastfeeding journey. This list highlights the most up to date research from Academy of Breastfeeding Medicine, but they are not you or your OB/midwife or your pediatrician. Some of what you see above may be tough to agree with so many who have struggled with supply, latching, etc. We are giving you all of this information with love and care. We want you to know that you are a literal rockstar for growing and birthing a human. The end