What is mastitis?
Inflammation of the breast involving one or more lobes of the gland is most commonly associated with lactation. The typical presentation includes local inflammation of glandular tissue with spontaneous pain. It is often accompanied by systemic symptoms of varying severity, including a temperature above 38.5°C, headache, muscle pain, drowsiness, fatigue, nausea, vomiting and chills. In some cases, a bacterial infection develops.
! Mastitis presents with severe pain, swelling, redness and increased warmth of the breast. The process begins within the gland but can gradually affect the whole body, so any such symptoms should always be discussed with a midwife or doctor.
Correct and frequent latching of the baby to the breast is both a preventive and therapeutic measure.
Signs of a correct latch:
The baby's tummy rests against your abdomen, their head is not tilted back, and the line running through the baby's ear, shoulder and hip is straight. While sucking, the angle between the baby's lips is wide, the lower lip is turned out and the upper lip is raised, while the cheeks do not hollow. The tip of the nose is close to the breast and the chin touches it. The baby's mouth contains the nipple and 1.5-2 cm of the areola. No smacking or clicking sounds can be heard. The mother does not feel pain. After feeding, the nipples are round rather than flattened.
The most important preventive measures include:
- Frequent skin-to-skin contact, not only after birth;
- Appropriate management when the milk comes in.
- ! An approach that helped a friend may be unsuitable for you and could worsen the problem or contribute to inflammation.
- Effective, painless and regular breastfeeding around the clock (at least 8 times per day);
- Clean your hands after every nappy change and before latching the baby onto the breast.
- The use of Limosilactobacillus fermentum bacteria isolated from the milk of healthy women to improve the balance of the microbiota in the milk ducts as a preventive and therapeutic measure.
- Breast ultrasound during lactation.
Feed the baby responsively and do not try to ‘empty’ the breast
Milk volume depends on a feedback mechanism in which increased milk removal increases production. Excessive feeding from the affected breast or expressing milk ‘until the breast is empty’ drives the cycle of hyperlactation and is an important risk factor for worsening tissue swelling and inflammation. Mothers who use a breast pump should express only the amount of milk that the baby consumes.
There is no evidence to support ‘dangle feeding’ (feeding a baby lying on the floor while the mother leans over the baby with her breast hanging down) or other positions that are unsafe for the baby. Mothers can try different safe variations of standard positions to make feeding more comfortable. However, this does not affect the ongoing inflammation.
During difficult days of feeding, every mother will appreciate the comfort provided by muslin cloths ideal for a baby's delicate skin. It is also worth choosing baby wrap, which will hold the baby snugly and give Mum a moment's respite.
Keep breast-pump use to a minimum
Mechanical breast pumps stimulate milk production regardless of the baby's physiological needs. Expressing milk with a breast pump does not allow bacteria to be exchanged between the baby's mouth and the mother's breast, which may predispose to dysbiosis. Breast pumps can also cause injury to the breast tissue and the nipple-areola complex if the breast shield is the wrong size, the suction is too strong or the mother expresses milk for too long. Expressing milk should be limited to situations in which the mother is separated from her baby or where there are medical reasons relevant to the mother or baby. Women who use a breast pump should express milk at a frequency and in an amount that mimic physiological breastfeeding.
Mastitis is not contagious and is not caused by poor hygiene. Breast-pump parts should be cleaned appropriately after each use, but the source says that routine sterilisation of the pump or other household equipment is not required specifically to prevent mastitis. Avoid scrubbing or repeatedly wiping the nipples, as this may cause skin maceration and pain. The anatomy and physiology of the well-vascularised nipple do not in themselves promote ascending infection.
Emilia Adamczyk