04/09/2023
Things are always changing in breastfeeding medicine & here’s the biggest news lately! It’s a big one but honestly- so important too as this is seen so often in the breastfeeding world. I know it’s going to rock some of my friends’ worlds (as it did for me too while I read the new protocol) but this is worth knowing. Hope I outlined the important stuff well enough!
Check the comments… I will post the ABM’s protocol – if you’re interested in a cool 17 pages of reading 😉
Clogged duct and mastitis management recommendations from the Academy of Breastfeeding Medicine are suggesting lactation educators and healthcare providers let-go of some previous regularly encouraged treatment modalities. Meanwhile - calling to action the implementation of others, in order to decrease acute and long-term complications that can develop as a result of things we’ve been utilizing for some time now.
}} A recent study shows that clogged ducts are not likely connected simply to milk stasis within a duct but rather is frequently caused by narrowing of milk ducts consequently causing edema formation as a direct result of alveolar congestion- primarily due to hyperstimulation and excessive milk production.
}} This is a big one!!
It is no longer recommended to aggressively massage the affected breast and in specific the clogged area with deep tissue hand massage and/or to perform massage with a vibrating toothbrush or other vibrating mechanical device of any kind. Rather, emphasis now lies within gentle lymphatic massage. This should be the primary focus in education delivered to the breastfeeding mom as deep massage has shown to cause extensive tissue damage and increase edema in the acute phase which potentially causes other complications to arise necessitating intervention.
}} Another big one…
Due to the suggested evidence regarding increased edema formation within the alveolar pathways - HEAT is no longer emphasized as this only increases the blood flow to the affected area – therefore, worsening the inflammation. If a mother finds comfort and relief in heat, it *can* be used sparingly but is no longer recommended as a primary treatment modality for resolution of symptoms.
}} Likewise, “dangle feeding” or other suggested nursing positions to rid the breast of the clogged area are also no longer recommended. Rather, focusing on maternal and nursling comfort as this was found to have no positive affect on symptom resolution.
}} So what do we do now??
Education and treatment should now focus on: ice/cold compresses, alternating between Tylenol and Ibuprofen, lymphatic tissue massage and monitoring for symptom progression. Yes- that’s it!It is also encouraged that **no** usage of a breast pump or silicone breast pump is utilized to “completely drain the breast”. Meanwhile, on-demand breastfeeding should still stay with its typical alternating schedule as to which breast each feeding is initiated on – and perhaps starting on the unaffected breast more frequently to decrease hyper-stimulation on the affected side could be of benefit.
}} Suggested shift in medical management focus - so as to not treat all potential cases of mastitis with immediate antibiotic initiation. Rather, moving towards treating only the cases that become bacterial in nature and do not resolve based on the previously listed set of interventions. Resolution during the study was shown to have positive improvement and/or complete resolution within 48 hours when properly utilizing all techniques to relieve inflammation and irritation.
}} Education regarding use of probiotics can be helpful – however, ensuring pertinent strains are included in the probiotic supplement purchased is important. Lactobacillus fermentum and ligilactobacillus salivarius are the two most beneficial strains to be present for breast microbiome health.
