The pain and fatigue associated with blocked ducts and mastitis can often lead to mothers feeling they can’t continue breastfeeding.  Knowing how to identify blocked ducts and treat them promptly and effectively, can avoid the problem progressing to mastitis.

WHAT DO BREASTFEEDING MOTHERS NEED TO KNOW ABOUT BLOCKED DUCTS AND MASTITIS?  No one knows the specific cause of blocked ducts in breastfeeding women (called Plugged Ducts in the USA), however we know they occur more commonly in women who have an abundant milk supply, or when the breast has not been effectively and regularly drained.  Many factors could contribute to blocked ducts such as poor attachment technique, or perhaps something physical which affects the baby’s ability to breastfeed effectively – eg. Tongue-tie.  Stress and fatigue are often identified by mothers as contributing to episodes of mastitis.

Other contributing factors can be delayed breastfeeds, such as when the baby sleeps for a longer period than usual, and also tight clothing especially bras that cause part of the breast to be compressed when it is full. Straps or pressure points from baby carriers or slings can also temporarily cause areas of the breast to be constricted and lead to a blocked duct. Whatever the cause, the milk flow in part of the breast has been restricted and “stasis” has occurred – the milk has accumulated in a defined area.

WHAT ARE THE SYMPTOMS? Symptoms of blocked ducts include tenderness, heat and redness in the specific area of the breast which are signs of INFLAMMATION.  If the blocked duct is located close to the skin it can be felt as a lump with quite defined edges.  Sometimes the mother may have a white spot visible on the nipple pore (outlet) of the duct, but most often this is not seen. The mother does not have a fever with a blocked duct, but is likely to have increasing pain in the affected area if the blocked duct is not relieved quickly.

Untreated blocked ducts are the most common cause of mastitis – when the mother is likely to feel hot and cold with aching joints and also feel very tired.  Mastitis is INFLAMMATION of the breast tissue which CAN lead to infection. The breast will feel hot and sore, and a red area will surround the section of the breast which is affected.

HOW CAN BLOCKED DUCTS AND MASTITIS BE PREVENTED AND TREATED?  The prevention and treatment of blocked ducts and inflammatory mastitis are the same.

Breastfeed as often as your baby needs (normally  8-12 times in 24 hours for a new baby).  If the breast has a tender inflamed area, breastfeed from that breast FIRST, positioning the baby so his chin is pointing towards the area of the breast which is congested. Alternating breastfeeding positions helps drain the breast differently each feed.

Applying moist heat ( eg. a hot wrung out face washer) to the congested area prior to the breastfeed will help with letdown and vasodilation, and be soothing.  Make sure your baby is attaching well and feeding effectively.

Massage the breast DURING breastfeeds to assist breast drainage in all areas, particularly massaging the tender areas. This particular technique is the most effective to release blocked ducts:

• Massage at the leading edge of the congestion, closest to the areola. Gradually work back from that leading edge and the sides of the lump, rather than from the back of the lump, forward.

Other tips – Don’t miss or delay breastfeeds. Wake baby for a feed if your breasts become too full.  If baby doesn’t want to feed express some milk, by hand or pump.

Avoid pressure on the breast during breastfeeds from your hand position or clothing, eg bras and feeding tops and carriers.

If baby feeds only from one breast per feed, make sure to offer the alternate breast at the next feed.  If either breast still feels full after a feed, express a little milk until the breast feels comfortable.

For stubborn blocked ducts, sometimes the application of a vibrator on the inflamed area can enhance release and drainage.

Pain relief – placing a cool pack such as a packet of frozen peas wrapped in a cloth on the breast after feeding for a short time can be soothing.  Oral pain relief can be taken safely – Ibuprofen and/or Paracetamol according to the directions.

Rest (in bed) with baby is best, and drinking plenty of water will help the recovery. The fatigue is the last symptom to leave a mother who has had mastitis.

If the breast pain and inflammation does not resolve as a result of these actions, the inflammation can progress to INFECTION which will need to be treated with antibiotics prescribed by a GP. Avoid giving formula feeds unless clinically necessary due to poor weight gain or no breastmilk being available temporarily. Continue Breastfeeding!

WHAT ELSE CAN CAUSE INFECTIVE MASTITIS? Nipple injury (cracked nipples) are a common cause of infective mastitis.  If a mother has nipple trauma and mastitis she may want to rest her AFFECTED breast from breastfeeds, but continuing to express the affected breast during treatment is essential, even if the mother decides to stop breastfeeding.

If nipple trauma is a feature of the mastitis episode it is essential to address the cause of the injury. A Lactation Consultant can assess and “trouble shoot” the whole breastfeeding story to identify contributing factors, and there are usually a few, and devise a plan that will help the mother in her recovery to avoid a reoccurrence of the problem.  Doctors rely heavily on Lactation Consultants to review the breastfeeding mother and baby’s unique story, and to provide insight that they may not uncover during their own treatment of the case. GP’s rarely have time to observe a whole breastfeed to watch how the mother and baby are interacting and examine breastfeeding technique. Sometimes it is as simple as how the mother has been holding her breast during latching and breastfeeding.

CASE STUDY – A mother requested my help when her second baby was two months old, having had three episodes of mastitis in the previous 6 weeks which were treated each time by her doctor with antibiotics.  The inflammation reduced partially each time it was treated, but never completely resolved and pain continued in the outer quadrant of her left breast. The mother developed vaginal thrush as a side-effect of the antibiotic treatments, and the baby also had signs of oral thrush in her mouth. The breast pain remained after the redness reduced, and the mother and doctor then suspected she may have thrush in the breast so commenced a course of antifungal oral and topical treatments  for both mother and baby.  She had also started Qiara probiotics following the second mastitis episode. After taking a careful history I asked to examine her breast and observe a breastfeed. I noticed a yellowish crusty area on her left nipple which she explained was a cracked nipple which had not healed since appearing when baby was about a week old.  She began to breastfeed from her left breast by laying baby across her knees, and leaning forward to drop the sore breast into baby’s mouth, grimacing as she latched. To keep the breast in the baby’s mouth she held it with her thumb positioned on top of the breast – exactly below the location of the painful area.  She focussed fully on the baby’s sucking until I mentioned to her “look where your thumb is resting on your breast while feeding”.  She looked down at her hand and immediately realised this hold, which she had adapted to tolerate the nipple pain, had quite likely caused the blocked duct initially and continued to inhibit milk transfer from that part of the breast.  She told me she held the breast the same way when lying down, or leaning over the baby to breastfeed in bed. The answer? Baby was repositioned in an underarm (football) hold and guided to latch deeply rather than taking only the nipple. The breastfeed was instantly more comfortable, and I was able to gently massage the blocked duct during the feed, providing some relief.  She recovered completely following this change of positioning, plus treatment of the cracked nipple with antibiotic ointment, and ongoing use of Qiara and “Breastwarmers” Mastitis pads.

IS THE BREASTMILK SAFE FOR BABY WHEN THE MOTHER IS ON ANTIBIOTICS? YES, the breastmilk from a mother who has mastitis and is on antibiotics is safe for baby to drink. A small amount of the antibiotics will pass to the baby via the milk and may cause some tummy rumbles. The breastmilk is more easily digested than formula, so the mother can continue to breastfeed from the unaffected breast. This is important as the milk production is likely to reduce temporarily on the affected breast, and continuing breastfeeding will support the recovery of the mother’s supply over the following weeks.

In some cases the mastitis has already become infective prior to treatment and an abscess can form in the breast. The collection of pus is identified by ultrasound examination and usually treated in hospital by needle aspiration during ultrasound examination to extract the fluid, and intravenous antibiotics. It may take several treatments of needle aspiration to remove the abscess sufficiently for the antibiotics to reduce and eliminate the infection.  Even in this scenario, it is recommended for the mother to continue breastfeeding from the affected breast if possible, or to express the breastmilk by pump to enhance the drainage and recovery of the breast from the infection.

Breastfeeding mothers who experience repeated episodes of blocked ducts and/or mastitis can benefit from the following strategies:

Taking Lecithin – 1600mg daily can alleviate and prevent  blocked ducts (Scott, 2005 cited in Riordan).   Probiotic treatment is usually recommended to assist the recovery of the mother’s gut microbiome following the administration of antibiotics.  QIARA is an Australian product developed specifically to aid mothers’ recovery from mastitis. The actives ingredient of this probiotic was originally derived from human breastmilk and provides the specific strain of lactobacillus fermentum which the mastitis affected breast requires for recovery.  Another very helpful product for blocked ducts, mastitis and vasospasm are “Breastwarmers” Mastitis Pads which reflect the mother’s body heat back to the breast aiding vasodilation and let down.  More information about these two products is available on my Lactation Consultancy website:  www.birthjourney.com   

REFERENCES:

https://www.betterhealth.vic.gov.au/health/healthyliving/breastfeeding-dealing-with-mastitis

Breastfeeding and Human Lactation, University of Kansas School of Nursing.  Karen Wambach, Jan Riordan   Pages 321-328 https://books.google.com.au/books?id=lDb3BQAAQBAJ&pg=PA323&lpg=PA323&dq=mastitis+human+lactation&source=bl&ots=NrFYtukjXM&sig=IELcbzdj9ONKw2ZwJpOFGblCrbE&hl=en&sa=X&ved=0ahUKEwir2Ozc6ZbUAhWHmJQKHetKCFEQ6AEIKjAA#v=onepage&q=mastitis%20human%20lactation&f=false

https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-problems/mastitis/#_information