When a breastfeeding mother gets mastitis: How to treat infected milk ducts and build up supply after
Mastitis is the big M word that breastfeeding mums fear. What should you do if get blocked milk ducts and an infection? Will it permanently affect your milk supply? And how do you reduce the risk of mastitis? Experts tell us in this instalment of CNA Women’s series on breastfeeding.
Just nine days after first-time mum Jolene Neo gave birth to her daughter, she was hit by a painful bout of mastitis, a breast infection caused by blocked milk ducts.
Being inexperienced at breastfeeding, Jolene had bought a compact breast pump for the convenience. However, the weak motor, coupled with her naturally “very, very fatty milk quality”, meant she was unable to clear her breasts effectively. It resulted in blocked milk ducts that caused her first round of mastitis.
Trying to cope with the pain of the inflammation, on top of the lack of sleep while finding her footing as a new mum, took a heavy toll on the 36-year-old. Her breast milk supply was affected – her yield plummeted by “a good 50 per cent”, she said.
Aside from taking antibiotics, Neo engaged a breast masseuse to clear the blockages in her milk ducts. To ease the pain, she placed chilled or frozen cabbage leaves on her breasts – a popular home remedy – but that also lowered her yield. To rebuild her milk supply, she invested in a hospital-grade breast pump.
Neo isn’t the only mum who has experienced mastitis. One of her friends had multiple bouts of mastitis within months, which caused an abscess; she realised that something was wrong when she found herself expressing fresh blood. The abscess needed to be drained and the poor mum came close to weaning her baby because of what she went through.
Like Neo and her friend, other mums too, may face traumatising experiences with mastitis. How can mothers better understand and manage this breast infection – or better yet, avoid it? CNA Women asked the experts.
WHAT IS MASTITIS AND WHAT CAUSES IT?
Mastitis refers to the inflammation of the milk ducts and surrounding breast tissue with swelling, causing a narrowing of the ducts.
“When the narrowing of the ducts persists or worsens, this may lead to symptoms such as fever, chills and body aches,” said Cynthia Pang, a senior lactation consultant and Assistant Director of Nursing, Lactation Service, at KK Women’s and Children’s Hospital (KKH). “It can progress to bacterial mastitis requiring antibiotics to resolve the condition.”
Symptoms of bacterial mastitis include worsening redness, pain and swelling in the affected area, which may spread to other parts of the breast.
HOW COMMON IS MASTITIS AMONG BREASTFEEDING MUMS?
Pang said that according to medical literature, mastitis has been reported to occur in about 2 to 10 per cent of breastfeeding women.
WHAT CAN A BREASTFEEDING MUM DO WHEN MASTITIS FIRST SETS IN?
You can try taking sunflower or soya lecithin supplements – 5g to 10g a day – to reduce milk duct inflammation, said Pang.
To relieve any pain and inflammation, try pain relief or anti-inflammatory medications such as ibuprofen. If you have a fever, increase your fluid intake and take fever medication (antipyretics), she advised.
Also consider taking probiotics such as lactobacillus fermentum and lactobacillus salivarius. “These may be effective against mastitis and have been recommended in medical literature,” she added.
Applying cold compresses in between feeds or pumping sessions can also provide comfort.
AT WHAT POINT SHOULD BREASTFEEDING MUMS SEEK HELP?
Seek help from a lactation consultant if you cannot resolve the breast issue by yourself, for example, by feeding your baby on demand or expressing your breast milk regularly, and applying cold compresses, Pang advised.
If the fever, pain, swelling and redness persist for more than 24 hours, you should see a doctor.
WHAT ARE SOME SEVERE CASES OF MASTITIS YOU’VE ENCOUNTERED?
“We have had cases of repeated occurrences of mastitis or abscesses (build-up of pus). In those severe cases of mastitis, regular on-demand feeding and cold compresses can help to regulate the mother’s supply,” said Pang.
A follow-up consultation with a lactation consultant may be needed to address issues such as improper latching, incorrect pumping techniques or using a breast pump shield that’s the wrong size.
CHOOSING THE RIGHT BREAST PUMP FOR YOU
Here are two things to consider when shopping for a breast pump.
MANUAL OR ELECTRIC BREAST PUMP?
It really depends on one’s comfort level and needs. A colleague who breastfed both her kids swore by her trusty manual single pump. She found the electric pump painful to use. Pumping by hand allowed her to control the pressure more intuitively, even though it gave her quite a workout.
On the rare occasion that she had blocked ducts, she managed by latching her baby and using the manual pump regularly until the blockage cleared.
An electric pump will do all the hard work for you but tends to be more expensive than a manual pump. Mums who prefer an electric pump feel it does a more thorough and faster job, which may help to prevent plugged milk ducts.
For some who have fattier milk and are more susceptible to mastitis, a hospital-grade pump – though more expensive – is the best way to unblock those painful milk ducts.
Of course, using an electric pump means you need an electric plug or batteries. A manual pump eliminates all that and is lighter to pack. Some mums thus use an electric breast pump on a daily basis but switch to a manual one when they have to be on the run or on business trips.
SINGLE OR DOUBLE PUMP?
Using a single pump on one breast, then the other, will naturally take more time compared to using a double pump. If a mum is rushed for time, she may sometimes cut short or even skip expressing milk from the second breast. If that happens frequently enough, it may lead to blocked milk ducts and mastitis.
There are ways to work around this. Breast pump maker Medela recommends that “if you’re single pumping, alternate and switch breasts every five minutes until your milk flow stops”. Think of it as how you’d alternate breasts when you latch your baby.
Whatever your preference for breast pumps, the key thing is to clear both breasts adequately – although not completely – when you express milk. Emptying both breasts may lead to an oversupply of milk. While having plenty of milk may sound like a good problem, it may backfire on you and increase your risk of mastitis.
DOES MASTITIS IMPACT THE MILK DUCTS PERMANENTLY?
Associate Professor Lim Geok Hoon, head of the KK Breast Department at KKH, said mastitis usually does not have any permanent consequences. However, it is more likely for a woman who has had mastitis to develop another episode of mastitis later, which could affect her breastfeeding.
WILL IT REDUCE THE MUM’S BREAST MILK SUPPLY FOR GOOD? IS THERE ANY WAY TO REVERSE THIS?
“Depending on the damage, the mother may not be able to build up her supply or may take a longer duration to build up a good supply of milk,” said Pang. “Some mothers may have to rely solely on the unaffected breast to meet the needs of her baby.”
DO MUMS WHO BREASTFEED SUBSEQUENT CHILDREN HAVE A LOWER CHANCE OF GETTING MASTITIS?
It makes no difference if you breastfeed just one child or subsequent babies, said Pang.
HOW CAN BREASTFEEDING WOMEN BUILD UP THEIR MILK SUPPLY AGAIN AFTER A BOUT OF MASTITIS?
Regular on-demand feeding or expressing can gradually help to build up the milk supply, said lactation consultant Pang.
IS THERE ANYTHING MUMS CAN DO TO AVOID GETTING MASTITIS?
Pang says wearing an appropriate fitting and supportive bra will help. Before and during a feed, massage your breast gently to stimulate milk flow. However, avoid deep tissue massage as this may cause trauma to the breast tissue.
When latching your baby, Pang urged mums to ensure that their baby has properly attached on the areola to prevent sore nipples, as this may increase the risk of mastitis. Vary the feeding positions while breastfeeding to drain the milk effectively.
If you’re pumping, get the correct breast shield for your breast pump, said Pang. The breast shield should fit snugly over your breast to create a “seal” when you pump. “This facilitates the effective removal of breast milk,” she added.
And, a surprising tip: Feed on demand and do not aim to empty the breasts.
“Overfeeding or ‘pumping to empty’ may lead to hyperlactation (oversupply) and can increase the risks of mastitis, hence increasing the risk of tissue swelling and inflammation,” said Pang.
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