18/02/2023
IF YOU ARE A BREASTFEEDING MOTHER OR A HEALTH PROFESSIONAL GIVING BREASTFEEDING ADVISE, READ THIS, NOW!
Academy of Breastfeeding Medicine (ABM) has released their new Mastitis protocol based on rigorous, peer-reviewed clinical research which all health professionals should be aware of and follow to improve breastfeeding success. Their new findings on mastitis suggest that we had it (at least partially) wrong.
Every parent I have seen this month has been given advise by well-intentioned health-professionals that inflict with CURRENT mastitis treatment guidelines: to “nurse, nurse, nurse!” and “pump, pump, pump!” to keep breasts emptied or “massage, massage, massage!” to clear out clogs.
This is why I have decided to sit down and break down the very long peer-reviewed protocol in a fast and simple way for other time poor fellow health professionals and for breastfeeding parents to read.
It was believed that mastitis is due to milk stasis, which means that breast was not emptied properly and “plugged ducts” occurred. This is now more appropriately described by ABM as ductal narrowing.
ABM now asserts that mastitis should be considered as a spectrum of conditions, ranging from oversupply (hyperlactation), which could lead to inflammation, causing narrowing of the milk ducts and possibly progress into inflammatory mastitis.
Just like any other inflammation in our body, we should use ice and anti-inflammatories instead of heat, massage and add extra pumping sessions, these measures will only hurt NOT help! “Overfeeding from the affected breast or ‘pumping to empty’ perpetuates a cycle of hyperlactation and is a major risk factor for worsening tissue edema and inflammation,” states ABM.
Ask yourself this: Would I massage and put a heat pack on for my inflamed sprained ankle?
NO, we use RICE ( Rest, Ice, Compression and Elevation). But mastitis, which by the way, has the latin word inflammation in its name(-itis) , is treated exactly the opposite. We are told to apply heat, massage, and dangle the breast and not wear a bra.
SO THAT MEANS, WE DO NO LONGER RECOMMEND:
• Trying to unplug a duct or break up a clog through vigorous massage.
• Extra nursing or pumping to get milk flowing (though you should still nurse on demand).
• Starting a nursing session on the inflamed or plugged side.( You should actually try feeding first from the unaffected breast and then switching to the affected breast to avoid overstimulation).
• Using massage tools/vibrating massagers/electric toothbrushes.
• Using positions such as “dangle nursing” to work out a plug.
“No evidence exists to support ‘dangle feeding’ (i.e., feeding an infant on the floor with the mother hovering above) or other unsafe infant positions. Patients may consider safe variations on standard feeding positions, with the understanding that this may improve comfort. However, this does not address underlying inflammation.” Also, a comfortable bra should be worn to provide support for the area.
I KNOW RIGHT!! - it’s so different from what we all used to do, huh? But this is the world of science, we always find new evidence and better way to practice.
INSTEAD, THIS IS WHAT THEY RECOMMEND:
• Nurse your baby on demand, following their cues.
• Use ice or cooling packs between feeds to decrease inflammation.
• Consider taking regular ibuprofen to soothe pain and reduce inflammation ( consult with your pharmacist).
• If you are engorged and your baby can’t latch on, you can hand express a little to soften the area around your ar**la.
• Consider supplementing with soy or sunflower lecithin to decrease inflammation (ABM recommends 5-10 gram a day)
• Consider taking probiotics to balance the microbial flora in your body.
• Work on decreasing hyperlactation (overproduction of milk) by nursing your baby on cue, and not pumping more than your baby needs
• If comfortable, wear a supportive bra that fits well
• If massage provides relief, you can use lymphatic drainage technique instead, massage very light, like patting a cat—no deep pressure massage.
Antibiotics may not always be necessary and unfortunetly we are using it as a first line treatment too often in Australia.
Antibiotics should be reserved for bacterial mastitis, but not inflammatory mastitis, the authors note. “Use of antibiotics for inflammatory mastitis disrupts the breast microbiome and increases the risk of progression to bacterial mastitis.” Antibiotics also shouldn’t be used for mastitis prevention. Many antibiotics also boast anti-inflammatory properties, “and this may explain why women experience relief when taking these,” state the protocol authors.
Instead, consider taking probiotics for mastitis prevention. “A systematic review suggested that probiotics may be effective for both treatment and prevention of mastitis, but a strong recommendation could not be made due to limitations of the studied trials.” Specific strains that have clinical research supporting their use with mastitis include: Limosilactobacillus fermentum (formerly classified as Lactobacillus fermentum) or, preferably, Ligilactobacillus salivarius (formerly classified as Lactobacillus salivarius) strains.
So, if you’ve tried all the techniques in the “yes” column and you still aren’t feeling better, make sure to contact a lactation consultant ( IBCLC). Here are a couple of key points to keep in mind:
• As stated above, if you have a fever for over 24 hours, you may have bacterial mastitis—this requires a doctor consultation and you may end up needing antibiotics.
• Another complication of mastitis is an abscess, where a particular area of the breast becomes infected. Symptoms can include pain to the touch, warmth in the affected area, a breast lump, ni**le discharge, and fever and flu-like symptoms. Abscesses also require medical assistance but can usually be avoided with prompt mastitis care.
• Some breastfeeding parents get something called a ni**le bleb along with mastitis. This is when a small white bump appears on the ni**le and can block the milk from flowing. ABM recommends using a prescribed steroid cream and lecithin to resolve it, and they recommend you avoid trying to open up the bleb yourself.
Feel free to share.
Love
Somayyeh
Pharmacist and Lactation Consultant at Pharmacy 777 Nollamara.
