Engorgement and mastitis

Contents
  1. Engorgement and mastitis
  2. Engorgement
  3. Engorgement symptoms
  4. Causes of engorgement
  5. Treatment for engorgement
  6. Mastitis
  7. Symptoms of mastitis
  8. Causes of mastitis
  9. Treatment for mastitis
  10. Recovery from mastitis
  11. Support for breast feeding women
  12. References
  13. Engorgement • KellyMom.com
  14. How to prevent or minimize engorgement
  15. Signs & Symptoms of Engorgement
  16. Before nursing
  17. While nursing
  18. Between feedings
  19. AVOID:
  20. Cabbage
  21. What are cabbage compresses used for?
  22. To use cabbage leaves:
  23. “Juice Jar” breast pump
  24. Fenugreek seed poultice
  25. @
  26. @ other websites
  27. References:
  28. Plugged Ducts and Mastitis • KellyMom.com
  29. Common (and not-so-common) side effects of plugged ducts or mastitis
  30. What are the usual causes of plugged ducts or mastitis?
  31. Stress, fatigue, anemia, weakened immunity
  32. It’s always best to treat a plug immediately and aggressively to avoid escalating into mastitis
  33. Does mastitis always require antibiotics?
  34. Follow-up
  35. Engorgement, Blocked Ducts and Mastitis
  36. Signs of engorgement:
  37. How to prevent engorgement:
  38. How to relieve engorgement:
  39. Plugged Ducts
  40. Signs of a plugged duct:
  41. How to prevent a blocked duct:
  42. How to relieve a blocked duct:
  43. Signs of mastitis:
  44. How to prevent mastitis:
  45. How to treat mastitis:
  46. Engorged Breasts – avoiding and treating – La Leche League GB
  47. Minimizing early engorgement
  48. Try these suggestions
  49. Treat engorgement to…
  50. When to treat
  51. Engorgement after the first weeks
  52. Common causes of engorgement are:
  53. Treating engorgement
  54. Be sure your baby is sucking effectively:
  55. Reverse pressure softening
  56. Keep comfortable:
  57. Watch out for symptoms of mastitis:
  58. Further Reading

Engorgement and mastitis

Engorgement and mastitis

Engorgement and mastitis are complications associated with breast feeding. Mastitis associated with breast feeding is also called lactational mastitis.

Breast feeding, parenting, is not always uncomplicated, especially in the first few weeks after birth. It can be easy to forget at this time that, all new skills, breast feeding can take a while to learn and become really good at.

Not all women experience true engorgement or mastitis; however, if you do it may really test your commitment to breast feeding. At times you may feel that it is not worth it, and that breast feeding is just not for you.

It is strongly advised if you are experiencing difficulties with breast feeding, such as engorgement or mastitis, that you seek the advice of a midwife, lactation consultant, community child health nurse, the Australian Breastfeeding Association or your doctor.

Engorgement

Breast engorgement happens when there is a build-up of milk and fluid in the breasts. The blood vessels in the breasts also become congested (too full).

Engorgement symptoms

When your breast(s) are engorged, they become:

  • firm or hard;
  • swollen; and
  • painful.

Engorgement can result in your nipples not protruding as much as usual, and your baby may not be able to latch on properly.

Causes of engorgement

Breast engorgement can happen if:

  • you are making more milk than your baby needs;
  • breast feeding your baby does not adequately drain your breasts; or
  • your baby misses a feed or is feeding infrequently.

Engorgement tends to happen more often in the weeks just after your baby is born, when a breastfeeding routine is still being established.

Treatment for engorgement

Engorgement can be treated with self-care measures and pain relievers if needed. A lactation consultant, midwife or your doctor can give advice on how to manage engorgement.

  • Breast feed your baby on demand until they have had enough. Let your baby finish the first breast before starting on the second.
  • Put your baby to the more painful breast first. Try using one side for each feed rather than offering both breasts. If your baby is still hungry offer the other breast.
  • Stand in a warm shower for 5 minutes before feeding. It is soothing and comfortable, and may help with milk flow during the feed. Alternatively, apply a warm compress to your breast before feeding.
  • Although is it generally not a good idea to express excess milk by hand, expressing a little in the shower before feeding can make it easier for a very new baby to ‘latch on’ correctly.
  • Take your bra off before breast feeding. Apply a cold pack after feeding to help relieve symptoms.
  • If necessary, express breast milk after feeds.
  • Avoid giving your baby any other fluids.
  • If your breasts are very painful, ask your doctor or breast feeding advisor about pain relief. You may feel reluctant to take pain-relievers, however, remember that being in pain makes establishing a healthy, satisfying breast feeding pattern much more difficult.

Remember, there is no greater relief for engorged breasts than an enthusiastically feeding baby.

Mastitis

Mastitis is inflammation of the breast tissue, particularly the milk ducts and glands, in a breast feeding woman.

In the 6 months after giving birth, mastitis affects about 20 per cent of breast feeding women in Australia. Mastitis is most common in the first 6 to 8 weeks after giving birth to your baby. It also sometimes happens when you decide to stop breast feeding (wean your baby).

Symptoms of mastitis

Mastitis symptoms (which often come on suddenly) can include:

  • a sore breast that feels warm and tender to touch;
  • breast swelling, firmness or engorgement;
  • sharp or shooting pain in the breast that is worse with breast feeding;
  • tender, red lump(s) in the breast (from a blocked milk duct);
  • ‘shiny’ or red skin on the breast (often in a wedge shape) or red streaks on the breast;
  • feeling generally unwell with ‘flu- symptoms (aches and pains, headaches, sweating);
  • feeling tearful and tired; and
  • fever.

Causes of mastitis

Mastitis can be caused by blocked milk ducts when the breasts are too full and the milk is not draining properly. A blocked milk duct can cause the development of a tender breast lump. Mastitis can also be due to a cracked nipple.

Bacteria may get into the breast tissue, causing infection in the blocked milk ducts.

Factors that can contribute to the development of mastitis include:

  • the baby not latching on or positioning on the breast correctly;
  • the baby having tongue-tie or another problem resulting in difficulties with breast feeding;
  • wearing a tight-fitting bra or tight clothing (which can increase the risk of blocked ducts);
  • breast engorgement;
  • stress and exhaustion;
  • returning to work; and
  • having previously had mastitis.

Treatment for mastitis

Treatment for mastitis involves antibiotic treatment plus breast feeding advice to help effectively drain the breast, as well as self-care measures.

  • Antibiotics may be prescribed to cure the infection. Untreated, severe mastitis can lead to a breast abscess. Most antibiotics used to treat mastitis are safe to use while breast feeding your baby.
  • It is very important that you have time to rest and spend time feeding your baby. Seek help and support from your partner and family.
  • Breast feed on demand, starting with the sore breast. It is quite safe to feed your baby from the affected breast. Breast feeding helps treat the mastitis and relieve symptoms by draining the milk. The aim should be to empty your breast as much as possible with each feed.
  • Make sure the baby is latched on correctly (mouth covering not just the nipple but also almost the entire areola, the dark circle of skin around the nipple) and drains the breast well.
  • Wear loose fitting clothes. Make sure that your bra that is not too tight and it does not dig in anywhere (obstructing the flow of milk). It may be more comfortable to take off your bra while breast feeding.
  • You may need to gently express some breast milk if your breast is not drained after breast feeding.
  • Apply warmth to the sore area just before feeding, by taking a shower or applying a warm hot water bottle wrapped in a towel or a wheat bag.
  • If you have a breast lump that is due to a blocked duct, gently massage towards the nipple while breast feeding to help drain the duct.
  • A cold pack applied after breast feeding may help relieve breast pain.
  • Drink plenty of fluids (especially if you have a fever).
  • Paracetamol can be taken regularly (as directed) if necessary for pain and fever. Non-steroidal anti-inflammatory drugs (NSAIDs) can also be used. These pain relievers are safe to use while breast feeding.

Women with mastitis need plenty of support plus advice on breast feeding. Breast feeding tips can help resolve breast feeding problems and help recovery from mastitis.

For women who decide to stop breast feeding, it is recommended that you wean your baby gradually after the mastitis has settled. Stopping breast feeding suddenly can make the symptoms worse and may increase the risk of developing complications, such as a breast abscess.

Recovery from mastitis

Most women with mastitis feel better after 2 to 3 days of treatment. If you continue to have symptoms after 48 hours of treatment, you should see your doctor. You should also seek medical help if you develop a tender breast lump that is not relieved by breast feeding.

Support for breast feeding women

Many women who develop engorgement and mastitis are already feeling tired and run-down after the birth of their baby. Developing mastitis can trigger strong emotions, and depression and anxiety have also been associated with episodes of mastitis.

Support is available from your doctor, midwife, lactation consultant or community nurse. The Australian Breastfeeding Association can also provide support. They have a National Breastfeeding Helpline (1800 686 268) that is available 7 days a week and also provide an email counselling service.

References

1. Australian Breastfeeding Association. Engorgement (updated Oct 2014). https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/engorgement (accessed Jun 2016).
2. Mastitis (published November 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2016 MAr.

http://online.tg.org.au/complete/ (accessed Jun 2016).
3. Cusack L, Brennan M. Lactational mastitis and breast abscess. Australian Family Physician 2011; 40 (12): 976-99. http://www.racgp.org.au/afp/2011/december/lactational-mastitis-and-breast-abscess/ (accessed Jun 2016).
4. MayoClinic.

Mastitis (updated 12 Jun 2015). http://www.mayoclinic.org/diseases-conditions/mastitis/basics/definition/con-20026633 (accessed Jun 2016).
5.BMJ Best Practice. Mastitis and breast abscess (updated 3 Sep 2015). http://bestpractice.bmj.com/best-practice/monograph/1084.html (accessed Jun 2016).

Source: https://www.mydr.com.au/babies-pregnancy/engorgement-and-mastitis

Engorgement • KellyMom.com

Engorgement and mastitis

It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (“comes in”) 2-5 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

How to prevent or minimize engorgement

  • Nurse early and often – at least 10 times per 24 hours. Don’t skip feedings (even at night).
  • Nurse on baby’s cues (“on demand”). If baby is very sleepy: wake baby to nurse every 2-3 hours, allowing one longer stretch of 4-5 hours at night.
  • Allow baby to finish the first breast before offering the other side. Switch sides when baby pulls off or falls asleep. Don’t limit baby’s time at the breast.
  • Ensure correct latch and positioning so that baby is nursing well and sufficiently softening the breasts.
  • If baby is not nursing well, express your milk regularly and frequently to maintain milk supply and minimize engorgement.

Signs & Symptoms of Engorgement

When?   Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment).

How does the breast feel?    The breast will typically feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth, tenderness, and/or throbbing. Engorgement may extend up into the armpit.

How does the areola feel?    The areola will typically feel hard ( the tip of your nose or your forehead) rather than soft ( your earlobe), with tight skin that may appear shiny. The nipple may increase in diameter and become flat and taut, making latch-on challenging.

You may also have a low-grade fever.

Moms’ experiences of engorgement differ. Engorgement:

  • May occur in the areola and/or body of the breast;
  • May occur in one or both breasts;
  • May build to a peak and then decrease, stay at the same level for a period of time (anywhere from minimal to intense), or peak several times.

Before nursing

  • Gentle breast massage from the chest wall toward the nipple area before nursing.
  • Cool compresses for up to 20 minutes before nursing.
  • Moist warmth for a few minutes before nursing may help the milk begin to flow (but will not help with the edema/swelling of engorgement). Some suggest standing in a warm shower right before nursing (with shower hitting back rather than breasts) and hand expressing some milk, or immersing the breasts in a bowl or sink filled with warm water. Avoid using warmth for more than a few minutes as the warmth can increase swelling and inflammation.
  • If baby is having difficulty latching due to engorgement, the following things can soften the areola to aid latching:

While nursing

  • Gentle breast compressions and massage during the nursing session can reduce engorgement.
  • After nursing for a few minutes to soften the breast, it may be possible to obtain a better latch by removing baby from the breast and re-latching.

Between feedings

  • If your breast is uncomfortably full at the end of a feeding or between feedings, then express milk to comfort so that the breasts do not become overfull.
  • Hand expression may be most helpful (though obviously second to breastfeeding) as this drains the milk ducts better.
  • Mom might also use a hand pump or a quality electric pump on a low setting for no more than 10 minutes (engorged breast tissue is more susceptible to damage). A “juice-jar” pump may also be used.
  • Massaging the breast (from the chest wall toward the nipple area) is helpful prior to and during milk expression.
  • It’s not good to let the breasts get too full, but you also don’t want to overdo the pumping, as too much pumping will encourage overproduction. If you do need to express milk for comfort, your need to express will ly decrease gradually over time; if it does not, then try gradually decreasing the amount you express.
  • Use cold compresses (ice packs over a layer of cloth) between feedings; 20 minutes on, 20 minutes off; repeat as needed.
  • Cabbage leaf compresses can also be helpful.
  • Many moms are most comfortable wearing a well fitting, supportive bra. Avoid tight/ill-fitting bras, as they can lead to plugged ducts and mastitis.
  • Talk to your health care provider about using a non-steroidal anti-inflammatory such as ibuprofen (approved by the American Academy of Pediatrics for use in breastfeeding mothers) to relieve pain and inflammation.

AVOID:

  • Excess stimulation (for example, don’t direct a shower spray directly on the breasts).
  • Application of heat to the breasts between feedings. This can increase swelling and inflammation. If you must use heat to help with milk flow, limit to a few minutes only.
  • Restricting fluids. This does not reduce engorgement. Drink to thirst.
  • Engorgement is not relieved by these measures.
  • Baby is unable to latch or is not having enough wet/dirty diapers.
  • You have mastitis symptoms: red/painful breast, temperature greaterthan 100.6 degrees F, chills, body aches, flu- symptoms.
  • You have any questions.

Cabbage

Applying cabbage leaf compresses to the breast can be helpful for moderate to severe engorgement. There is little research on this treatment thus far, but there is some evidence that cabbage may work more quickly than ice packs or other treatments, and moms tend to prefer cabbage to ice packs.

What are cabbage compresses used for?

  • Engorgement.
  • Extreme cases of oversupply, when the usual measures for decreasing supply (adjusting nursing pattern, nursing “uphill,” etc.) are not working
  • During weaning, to reduce mom’s discomfort and decrease milk supply.
  • Sprains or broken bones, to reduce swelling.

To use cabbage leaves:

  • Green cabbage leaves may be used chilled or at room temperature.
  • Wash cabbage leaves and apply to breasts between feedings.
  • For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for 20 minutes, no more than 3 times per day; discontinue use as soon as engorgement/oversupply begins to subside.
  • During the weaning process: Leave the leaves on the breast until they wilt, then apply new leaves as often as needed for comfort.

“Juice Jar” breast pump

This simple pump can be useful to help with engorgement, and to draw the nipple out when baby is having a difficult time latching on.

  • Find an empty glass jar or bottle at least 1 liter in size with a 5 cm or larger opening. The type of bottle that cranberry juice comes in is often a good size.
  • Fill the jar nearly full with very hot water. The glass will get very hot and you will need to hold it with a towel.
  • Pour all the water the jar.
  • Use a cool washcloth to cool down the rim and upper part of the jar so you can touch it without burning yourself (test it with your inner arm).
  • Place your breast gently into the mouth of the jar so that it makes an airtight seal. Some moms lean over a table to do this, others put the jar in their lap on a pillow and lean forward. Expect this to take a few minutes, so make yourself comfortable.
  • As the air slowly cools inside the jar, it creates a vacuum inside the jar and this gentle suction expresses milk from the breast. Break the suction immediately if you feel discomfort – if the jar cools too quickly it may create excessive suction which can damage breast tissue.
  • Repeat for the other breast.
  • Some moms need to repeat this, others find it works sufficiently with only one try.

Fenugreek seed poultice

This is a traditional treatment for engorgement or mastitis. Steep several ounces of fenugreek seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots. For more information, see Fenugreek.

@

Reverse Pressure Softening… aids latching when mom is engorged

@ other websites

Prevention and Treatment of Engorgement by Becky Flora, BS, IBCLC

Animation of baby nursing when mom is engorged showing how engorgement can lead to nipple trauma, from the Breastfeeding Management Series software by Sallie Page-Goertz, MN, CPNP, IBCLC and Sarah McCamman, MS, RD, LD

References:

Veldhuizen-Staas C. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007; 2: 11. doi: 10.1186/1746-4358-2-11

Cotterman KJ. Too Swollen to Latch On? Try Reverse Pressure Softening First. Leaven, April-May 2003;39(2):38-40.

Hill PD, Humenick SS. The occurrence of breast engorgement. J Hum Lact. 1994 Jun;10(2):79-86.

Humenick SS, Hill PD, Anderson MA. Breast engorgement: patterns and selected outcomes. J Hum Lact. 1994 Jun;10(2):87-93.

Lawrence R and Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. St. Louis: Mosby, 2005, p. 278-281.

Moon JL, Humenick SS. Breast engorgement: contributing variables and variables amenable to nursing intervention. J Obstet Gynecol Neonatal Nurs. 1989 Jul-Aug;18(4):309-15.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010, p. 679-683.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2004, p. 205-207, 228.

Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. J Hum Lact. 1995 Sep;11(3):191-4.

Roberts KL. A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. J Hum Lact. 1995 Mar;11(1):17-20.

Smith A, Heads J. Breast Pathology. In: Walker M, ed. Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett, 2002, p. 175-180.

Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2001;(2):CD000046.

Walker M. Breastfeeding and Engorgement. Breastfeeding Abstracts, November 2000;20(2):11-12.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas, Third Edition. Austin, Texas: LactNews Press, 2005, p. 109-111.

Source: https://kellymom.com/bf/concerns/mother/engorgement/

Plugged Ducts and Mastitis • KellyMom.com

Engorgement and mastitis

A plugged (or blocked) duct is an area of the breast where milk flow is obstructed. The nipple pore may be blocked (see Milk Blister), or the obstruction may be further back in the ductal system. A plugged duct usually comes on gradually and affects only one breast.
Mom will usually notice a hard lump or wedge-shaped area of engorgement in the vicinity of the plug that may feel tender, hot, swollen or look reddened. Occasionally mom will only notice localized tenderness or pain, without an obvious lump or area of engorgement. The location of the plug may shift.A plugged duct will typically feel more painful before a feeding and less tender afterward, and the plugged area will usually feel less lumpy or smaller after nursing. Nursing on the affected side may be painful, particularly at letdown.
There are usually no systemic symptoms for a plugged duct, but a low fever (less than 101.3°F / 38.5°C) may be present.
Per Maureen Minchin (Breastfeeding Matters, Chapter 6), mastitis is an inflammation of the breast that can be caused by obstruction, infection and/or allergy. The incidence of postpartum mastitis in Western women is 20%; mastitis is not nearly so common in countries where breastfeeding is the norm and frequent breastfeeding is typical. Mastitis is most common in the first 2-3 weeks, but can occur at any stage of lactation. Mastitis may come on abruptly, and usually affects only one breast.
Local symptoms are the same as for a plugged duct, but the pain/heat/swelling is usually more intense. There may be red streaks extending outward from the affected area.
Typical mastitis symptoms include a fever of 101.3°F (38.5°C) or greater, chills, flu- aching, malaise and systemic illness.

Common (and not-so-common) side effects of plugged ducts or mastitis

  • Milk supply and pumping output from the affected breast may decrease temporarily. This is normal and extra nursing/pumping generally get things back to normal within a short time.
  • Occasionally a mom may express “strings” or grains of thickened milk or fatty-looking milk.
  • After a plugged duct or mastitis has resolved, it is common for the area to remain reddened or have a bruised feeling for a week or so afterwards.
Side effects may be the same as for a plugged duct, plus:
  • Expressed milk may look lumpy, clumpy, “gelatin-” or stringy. This milk is fine for baby, but some moms prefer to strain the “lumps” out.
  • Milk may take on a saltier taste due to increased sodium and chloride content – some babies may resist/refuse the breast due to this temporary change.
  • Milk may occasionally contain mucus, pus or blood.

What are the usual causes of plugged ducts or mastitis?

Plugged duct Mastitis
… may be due to:
  • Engorgement or inadequate milk removal (due to latching problems, ineffective suck, tongue-tie or other anatomical variations, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby’s time at the breast, nipple shield use, twins or higher order multiples, blocked nipple pore, etc.).
  • Infrequent/skipped feedings (due to nipple pain, teething, pacifier overuse, busy mom, return to work, baby suddenly sleeping longer, scheduling, supplementing, abrupt weaning, etc.).
  • Pressure on the duct (from fingers, tight bra or clothing, prone sleeping, diaper bag, etc.).
  • Inflammation (from injury, bacterial/yeast infection, or allergy).

Stress, fatigue, anemia, weakened immunity

  • Same as for blocked duct.
  • Blocked duct is also a risk factor.
  • Sore, cracked or bleeding nipples can offer a point of entry for infection.
  • Hospital stay increases mom’s exposure to infectious organisms.
  • Obvious infection on the nipple (crack/fissure with pus, pain) is a risk factor.
  • Past history of mastitis is a risk factor.

It’s always best to treat a plug immediately and aggressively to avoid escalating into mastitis

CAUTION: Do NOT decrease or stop nursingwhen you have a plugged duct or mastitis,as this increases risk of complications (including abscess).
GENERAL SUPPORTIVE MEASURES
Plugged Duct
  • Rest
  • Adequate fluids
  • Nutritious foods will help to strengthen mom’s immune system
Mastitis
  • Bed rest (preferably with baby)
  • Increase fluids, adequate nutrition
  • Get help around the house
BREASTFEEDING MANAGEMENT — SAME for plugged duct or mastitis
— important to start treatment promptly 
“Heat, Massage, Rest, Empty Breast”
  • Nurse frequently & empty the breasts thoroughly.Aim for nursing at least every 2 hrs. Keep the affected breast as empty as possible, but don’t neglect the other breast.
  • When unable to breastfeed, mom should express milk frequently and thoroughly (with a breast pump or by hand).
  • Use heat & gentle massage before nursing- Warm compress. Try using a disposable diaper: fill the diaper with hot water (try the temperature on your wrist first to avoid burns), squeeze the diaper out a bit, then put the inside of the diaper toward the breast. This will stay warm much longer than a wet cloth.- Basin soak. Fill sink or bowl with hot water and submerge breast in water while massaging the plugged area toward the nipple. Some report better results when epsom salts are added to the water — add a handful of epsom salts per 2 quarts (2 liters) of water. Rinse with fresh water before nursing, as baby may object to the taste.- Hot Shower. It can be helpful to massage in the shower with a large-toothed comb. The comb should be drawn through a bar of soap until it is very soapy and then used to gently massage over the affected area in the direction of the nipple.
  • Loosen bra & any constrictive clothing to aid milk flow.
  • Massage will help to improve milk drainage and improve symptoms. See Breastfeeding Medicine of Northeast Ohio’s video for a demonstration of the basics of therapeutic breast massage.
  • Nurse on the affected breast first; if it hurts too much to do this, switch to the affected breast directly after let-down.
  • Ensure good positioning & latch. Use whatever positioning is most comfortable and/or allows the plugged area to be massaged.Note: Advice to point baby’s chin (or nose) toward the plugged area is not necessarily going to be helpful as it is the idea that the milk ducts take a nice, direct route to the nipple – recent research tells us that this is not true, and that a particular duct might begin in one area of the breast but can “wander” in many different directions before terminating in any area of the nipple.
  • Use breast compressions.
  • Massage gently but firmly from the plugged area toward the nipple.
  • Try nursing while leaning over baby (sometimes called “dangle feeding“) so that gravity aids in dislodging the plug.
  • Pump or hand express after nursing to aid milk drainage and speed healing.
  • Use cold compresses between feedings for pain & inflammation.
  • See also How do you treat a milk blister?
MEDICATION *
Plugged duct Mastitis
  • Pain reliever/anti-inflammatory(e.g., ibuprofen)
  • Second choice – pain reliever alone(e.g.,acetaminophen)
  • No: If symptoms are mild and have been present for less than 24 hours.
  • Yes: If symptoms are not improving in 12-24 hours, or if mom is acutely ill.
  • Most common pathogen is penicillin-resistant Staphylococcus aureus.
  • Typical antibiotics used for mastitis:- Dicloxacillin, flucloxacillin, cloxacillin, amoxycillin-clavulinic acid- Cephalexin, erythromycin, clindamycin, ciprofloxacin, nafcillin
  • Most recommend 10-14 day treatment to prevent relapse. Do not discontinue treatment earlier than prescribed.
  • Consider probiotic to reduce thrush risk.
  • Several studies have shown that probiotic supplements (certain Lactobacillus strains) are effective in treating infectious mastitis and also resulted in a lower occurrence of repeat mastitis.
  • Some mothers also use natural treatments.
* Consult your health care provider for guidance in your specific situation. The medication information is taken from the references listed below and is provided for educational purposes only.

Does mastitis always require antibiotics?

No, mastitis does not always require antibiotics.

Mastitis is an inflammation of the breast that is most commonly caused by milk stasis (obstruction of milk flow) rather than infection. Non-infectious mastitis can usually be resolved without the use of antibiotics.

However, per the World Health Organization document Mastitis: Causes and Management, “Without effective removal of milk, non-infectious mastitis was ly to progress to infectious mastitis, and infectious mastitis to the formation of an abscess.”

Per the Academy of Breastfeeding Medicine’s Clinical Protocol for Mastitis:

“If symptoms of mastitis are mild and have been present for less than 24 hours, conservative management (effective milk removal and supportive measures) may be sufficient. If symptoms are not improving within 12-24 hours or if the woman is acutely ill, antibiotics should be started.”

If a mom with mastitis has no obvious risk factors for infection (as noted in the box below), it is ly that the mastitis is non-infectious and, if properly treated, will resolve without antibiotics.

When you have mastitis…Talk to your DR about startingantibiotics immediately if:
  • Mastitis is in both breasts.
  • Baby is less than 2 weeks old, oryou have recently been in the hospital.
  • You have broken skin on the nipplewith obvious signs of infection.
  • Blood/pus is present in milk.
  • Red streaking is present.
  • Your temperature increases suddenly.
  • Symptoms are sudden and severe.

Follow-up

  • Re-evaluate treatment plan if symptoms do not begin to resolve within 2-3 days.
  • Investigate further if mom has more than 2-3 recurrences in the same location.
  • Consider the possibility of thrush if sore nipples begin after antibiotic treatment.

As always, consult your own health care provider to determine how this information applies to your specific circumstances.

Engorgement, Blocked Ducts and Mastitis

Engorgement and mastitis

On the whole, engorgement is a great reassurance for mothers and lovely feedback to tell her breasts are responding to their newborn’s demands, but equally, engorgement is uncomfortable and, if not resolved or if in the presence of feeding issues, can lead to blocked ducts or mastitis.

A mother with a baby who feeds efficiently, frequently or for long periods of time and without restrictions/supplements in the first few days after birth is least ly to encounter painful engorgement. Therefore early support and realistic expectations for the mother are the best prevention for associated problems.

A sleepy baby may need waking to prevent discomfort.

Signs of engorgement:

● the mother’s baby is between 2-6 days old, or older and has been missing feeds.

● feeding is infrequent/baby is sleepy.

● breasts feel uncomfortably full.

● skin on breast is tight.

● areola is hard.

● nipple has possibly been pulled flat.

● engorgement usually affects the whole breast.

How to prevent engorgement:

● positive, timely breastfeeding initiation.

● helpful assistance with latch and positioning.

● frequent and unrestricted nursing.

● waking sleepy newborns every 3 hours with some 4-5 hours stretches for longer sleeps.

● wearing a well fitting bra may be helpful.

How to relieve engorgement:

● increased feeds with particular attention to good attachment and positioning.

● letting the baby finish one breast before offering the other one.

● Use of cool compress (Therapearl/cool pack) to provide relief.

● use of moist heat (compress/shower/heat pack/Therapearl) and gentle massage right before a feed

● draining the breast with an efficient breastpump (link to breastpumps) can potentially decrease severe engorgement by mimicking an efficiently feeding baby. It can also decrease venous and lymphatic congestion in the breast in general and therefore relieve swelling.

● hand expressing a small amount of milk to soften the nipple may ease difficulties in latching a newborn, who may then effectively drain the breast.

● reverse pressure softening works well for some mothers (Cotterman 2003)

Plugged Ducts

A plugged duct is a common complaint in breastfeeding mothers. It has multiple potential causes which need to be explored in order to help avoid a pattern of recurring plugged ducts and subsequent mastitis.

Signs of a plugged duct:

● gradual onset of symptoms.

● hard lump or wedge within the breast which may or may not move location.

● mild to moderate pain, possibly increased before feed and reduced after.

● lumpy area may become smaller after feed but not disappear.

● generally no warmth or redness in the affected area.

● mother is generally well apart from the localised breast discomfort.

● no fever/normal temperature.

● potentially decreased yield from the affected breast if pumping.

● stringy or fatty looking lumps in expressed milk.

How to prevent a blocked duct:

● make sure latch and positioning are good to enable good milk transfer.

● ensure unlimited access to breast/feeding on cue.

● be mindful of restrictive clothing/sling/bags and adjust if necessary.

● feeding position may contribute to uneven pressure on the breast and lead to a blocked duct.

● a lecithin supplement (Scott 2005)

How to relieve a blocked duct:

● most of the preventative and relieving measures for engorgement are ly to be helpful in relieving and preventing further episodes of painful blocked ducts.

● rest with baby.

● always feed from the affected side first.

● moist heat and massage before a feed either with a compress, Therapearl, immersion or shower.

● massage can be done manually or with a wide toothed comb (use oil, HPA Lanolin or soap to make the comb glide smoothly).

● moist heat and massage DURING a feed to facilitate draining the blockage within the ducts (baby’s position may have to be adjusted to allow this – Baby’s chin over the affected part may also help).

● pumping sessions in between feeds may be necessary.

● breast compressions may help.

● cold compresses (Therapearl) after feeds to reduce swelling and pain can be used.

● anti-inflammatory/analgesic treatment with ibuprofen can be very effective.

● keep in mind a plugged duct may also be caused by a nipple bleb, a thin membrane of skin covering one of the milk ducts exiting the nipple. It often presents as painful nipple when latching.

Attempting to hand express often shows up the bleb, looking similar to a whitehead on the nipple. Softening the skin covering the bleb with some olive oil on a cotton wool ball may be enough for the skin to be lifted off it during the next feed.

Sometimes lifting the skin off the bleb with a sterile needle can bring forth an immediate spray of milk and relief for the mother.

Signs of mastitis:

● signs and symptoms are often very similar to the ones accompanying a blocked duct.

● pain and redness are usually more severe than with a blocked duct. There may be red streaking radiating from the affected part of the breast.

● mothers tend to feel unwell and have a temperature. They may also have body aches, nausea and chills.

● mastitis often comes on suddenly un a blocked duct which may develop more gradually.

● Mastitis is more ly if nipple trauma is present or has been recently, presenting an entry point for pathogens.

● previous history of mastitis makes diagnosis more ly.

● exposure to hospital pathogens may make infective mastitis more ly.

● a stressed/’run down’ mother is more ly to get mastitis.

● a mother with low iron count or history of poor diet generally is more prone to infection.

● potential breast aversion from baby due to elevated sodium and chloride levels in milk, making it taste salty.

How to prevent mastitis:

● see ‘How to prevent a blocked duct’ (* link)

How to treat mastitis:

● the treatments for a blocked duct are also applicable to mastitis treatment.

● treatment needs to be commenced promptly.

● bedrest with baby (Mohrbacher 2008); discuss safe co-sleeping, and advise responding to early feeding cues.

● possible antibiotic therapy for 10-14 days (a shorter course makes relapse more ly), indicated if fever/symptoms do not decrease after 24 hours or the fever suddenly increases.

● the most ly organism causing mastitis is staphylococcus aureus.

● consider a probiotic in case of antibiotic therapy to avert an increased risk of breast thrush (Gyte 2014)

● if mastitis does not seem to respond to treatment, consider culturing the milk to pinpoint pathogen.

Keep in mind that re-occurring blocked ducts and mastitis originating in the same (quadrant of) breast may[SS1] , in rare cases, be a sign of a breast tumour. Referral to a doctor may be indicated.

Bilateral mastitis, though rare, may be a sign of hospital acquired infection and streptococcal in nature. Always advise women not to cease breastfeeds during an episode of engorgement, blocked ducts or mastitis. Milk removal is of utmost importance to avoid problematic recovery.

Be vigilant to the formation of breast abscesses and refer to an appropriate clinician.

Bibliography/ ReferencesConner A (1979) “Elevated levels of sodium and chloride from mastitic breast.” Pediatrics 63:910Cotterman (2003) “Too Swollen to latch on? Try Reverse Pressure Softening first”, Leaven, Vol. 39 No. 2, April-May 2003, pp. 38-40Fetherston C (1998) “Risk Factors for lactation mastitis.” J Hum Lact; 14(2):101-09Gyte, Dou and Vazquez (2014) “Different classes of antibiotics given to women routinely for preventing infection at caesarean section” Cochrane review. Wiley and Sons. Accessed April 2015 at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008726.pub2/fullMoon J. and Humenick S (1989) “Breast Engorgement: contributing variables and variables amenable to nursing intervention.” JOGNN; 18:309-15Minchin M (1998) “Breastfeeding Matters.” 4th ed. Armadale, Australia: Alma PublicationsMohrbacher, N., Stock J. (2008) “La Leche League International: The Breastfeeding Answer Book, 3rd revised edition, LLLIScott CR. Lecithin (2005) “It isn’t just for plugged milk ducts and mastitis anymore. Midwifery Today Int Midwife. 26-7

Breastfeeding   Breastfeeding Challenges

Source: https://lansinoh.co.uk/engorgement-blocked-ducts-and-mastitis/

Engorged Breasts – avoiding and treating – La Leche League GB

Engorgement and mastitis

Engorged breasts are painful. They feel heavy, hard, warm and sensitive —as if they are ready to burst!  As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases.

It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production.

 This causes congestion and swelling which will decrease as your body adjusts.

Minimizing early engorgement
Treat engorgement to…
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis

Minimizing early engorgement

New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling
watermelons!

Try these suggestions

  • Breastfeed your baby frequently from birth—at least 8–12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.
  • If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.
  • Aim to be comfortable while  breastfeeding, and learn how to get your baby latched on well.
  • If your newborn is unable to breastfeed, hand express frequently until your milk ‘comes in’, then combine with using a hospital-grade electric breastpump to help establish your milk production and relieve engorgement.

    Your milk can be given to your baby until he is able to nurse.

Treat engorgement to…

Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production
When milk isn’t removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. When milk is removed, blood circulation improves and swelling reduces.

Use the suggestions below to reduce swelling and keep your milk flowing. Many mothers have a slight temperature when their breasts are engorged. Temperatures under 38.4ºC are not usually associated with infection.

Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:

  • A missed feed or expressing session.
    This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you’re apart from your baby.
  • Feeding a baby on a schedule
    Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.
  • Expressing milk.

    Some books advise expressing to keep milk production one step ahead of a baby’s needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

  • A baby who is unable or unwilling to nurse well for any reason
    Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.
  • Weaning from the breast too quickly
    If you experience engorgement during weaning, you may need to slow down the process.

    This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement

Reduce swelling and keep milk flowing:

  • Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2–3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second
  • Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.
  • Between feeds, apply ice for 15–20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.
  • Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water.  Then, express to comfort if your baby isn’t ready to feed.
  • Use gentle massage from the chest wall toward thenipple area in a circular motion.

Be sure your baby is sucking effectively:

Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he’ll take a large mouthful of breast. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on – when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

Reverse pressure softening

works by moving fluid away from the nipple area.

  • Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.
  • You can also press with the sides of fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be.
  • If this isn’t enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

  • Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.
  • A well-fitting, supportive bra may help.

    Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

  • Cold, raw cabbage leaves worn inside a bra can be soothing.  Change when they become wilted or after about 2 hours.

    Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

  • Inflamed, hot, red, localised areas of your breast.
  • Temperature over 38.4ºC or flu- symptoms.
  • Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids.

    If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis

Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby’s breastfeeding technique or find ways to reduce your milk supply.

These are not difficult problems to solve, especially if treated promptly.

Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain

Further Reading

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.

Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won’t Breastfeed
Nipple Pain – why and what to do
Positioning and Attachment
Sleepy Baby – why and what to do

This information is available to buy in printed format from our shop

Copyright LLLGB 2016

Source: https://www.laleche.org.uk/engorged-breasts-avoiding-and-treating/

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