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I have mastitis: can I continue to breastfeed my baby?

Mastitis is a disease that quite often affects nursing mothers; some studies estimate that up to a third of breastfeeding mothers experience mastitis at some point.

When this happens, many decide to stop breastfeeding. However, is it contraindicated to stop breastfeeding if you suffer from mastitis? How can we maintain breastfeeding in these cases?

What is a mastitis and what types are there?

The Academy of Breastfeeding Medicine (Breastfeeding Medicine Academy) has recently updated its mastitis protocol and in it it talks about a wide spectrum of situations that fall under this term and are due to the inflammation of the ducts and the surrounding edema .

Thus, a mastitis is an inflammation of the mammary gland . There may be only inflammation, and we will talk about inflammatory mastitis . This inflammation can progress and bacterial infection appear; we will then talk about bacterial mastitis . Acute bacterial mastitis can evolve, if not treated well, into an abscess, a collection of pus in the breast.

Another type of mastitis is subacute mastitis , which is due to dysbiosis, an imbalance in the bacteria that are found regularly and without causing disease in the milk and mammary gland.

Finally, there are also recurrent mastitis , in which the symptoms of mastitis appear every 2 or 4 weeks even more frequently.

What are the symptoms of mastitis?

In acute mastitis , a segment or quadrant is usually affected initially. A red, hot, indurated (that has become hard) and painful area of the chest will appear. Systemic symptoms also appear: chills, fever or tachycardia, even in the absence of infection.

In subacute mastitis, on the other hand, there are usually no systemic symptoms and the symptoms in the breast are milder than in the case of acute bacterial or inflammatory mastitis. Mothers report noticing punctures in the chest, such as “needles inside”, a burning sensation and more indurated areas of the chest.

In abscesses , the general symptoms may have disappeared (there is not always fever) and a well-defined, hard and painful lump will be felt that does not change with feeding.

How is it different from engorgement?

Breast engorgement appears as a result of the rise in milk, between the third and fifth day postpartum (although in some cases it may be delayed until the 9th or 10th). There is excessive accumulation of fluid (edema). The affectation is of both breasts at the same time, bilateral. Both breasts become red, hard, and sore . The baby may have difficulty latching on and expressing milk. Engorgement is pathological, while the so-called “milk rise” (“milk let-down” in other countries) is physiological, that is, normal.

If the engorgement is not treated properly it can progress to mastitis or phlegmon.

Can I continue breastfeeding?

Of course, not only can you continue, but you must . Breastfeeding while suffering from mastitis does not pose any risk to the baby.

Bacterial mastitis is not contagious, so the baby can continue to breastfeed without any problem. The antibiotics used to treat bacterial mastitis are generally compatible with breastfeeding , and if not, a safe alternative should be sought. You can check your compatibility on the web

Breast milk from the affected breast may slightly change its composition, increasing sodium and chloride content and decreasing lactose and potassium, which can give the milk a saltier taste and this could cause some babies to reject it. In no case does this change in composition affect the baby negatively.

Breastfeeding should be continued if the mother suffers from mastitis. Mastitis is not contagious and the milk from the affected breast is perfectly safe for the baby. The antibiotics used to treat bacterial mastitis are usually compatible with breastfeeding.

One of the main disenchants of mastitis seems to be the stasis (stagnation) of the milk, so it is essential that the baby continues to suckle. The American Academy of Breastfeeding recommends that feedings be maintained on demand and that overfeeding or pumping until the breast is empty be avoided, as this would perpetuate the cycle of overproduction of milk.

Only in some very specific cases, of great edema and retroareolar inflammation in which the infant cannot express the milk nor can it be achieved with manual expression, it may be advisable to breastfeed only from the healthy breast during the acute process and resume breastfeeding as soon as possible. as possible. Ice and lymphatic drainage would help in this case.

Not only can you continue to breastfeed, but you must. Breastfeeding while suffering from mastitis does not pose any risk to the baby.

How is mastitis treated?

As we have said previously, mastitis is an inflammation, which is not always accompanied by a bacterial infection, so antibiotics are not always needed for its treatment. It is important that treatment is early and adequate , to avoid progression to infectious mastitis or, from this, to other complications such as abscess or recurrent mastitis.

General measures

Maintaining breastfeeding is essential . The baby should suck frequently and on demand , that is, whenever he calls for it and until he is full (we will know this because he lets go or falls asleep). The Breastfeeding Academy emphasizes, in its latest protocol, the importance of not overfeeding the affected breast or pumping until it is empty, as this can lead to hyperproduction of breast milk and worsen swelling and edema. Placing the infant with the chin in the indurated area can help, but the Breastfeeding Academy advises against unsafe positions such as the wolf position.

We must avoid chest massages , both manual and with electrical devices. It is true that they can relieve pain, but a deep and energetic massage can also increase inflammation and edema, and even damage small blood vessels, so it is not recommended to recommend it routinely.

As for medical treatment, non-steroidal anti-inflammatory drugs (such as ibuprofen) and local cold help reduce inflammation and pain. Paracetamol also decreases pain. Although heat may provide relief for some patients, it causes vasodilation and may worsen symptoms; hot showers do not seem to improve mastitis.

Therapeutic ultrasounds used by trained professionals can improve symptoms in some cases.

Specific treatment

Antibiotics will be used only in cases of bacterial mastitis and those compatible with breastfeeding will be chosen (most antibiotics are). If the evolution is not good, a breast milk culture could be done to identify exactly which bacteria is causing mastitis and choose the most suitable antibiotic for that specific one. Breast milk culture is especially useful also in cases of recurrent mastitis.

Some studies have shown the usefulness of probiotics , specifically those containing Lactobacillus fermentum or Lactbacillus salivarus , in the treatment of mastitis, especially subacute ones, although more studies are still needed to have more scientific evidence.

Can I prevent the appearance of mastitis?

There are many factors that can contribute to the appearance of mastitis. Stasis or retention of milk seems to be one of the main triggers. A poor latch , an inadequate breastfeeding technique (for example, rigid schedules and not on demand), an overproduction of breast milk , alterations in the milk microbiota , or the use of antibiotics and probiotics are other factors that influence.

As for subacute mastitis, many mothers who suffer from it report having had a previous acute bacterial mastitis, a cesarean delivery, using nipple shields and/or expressing exclusively (without putting the baby to the breast, for example, in the case of premature babies who cannot yet suckle directly).

Different treatments have been studied and there are no clear conclusions that they prevent mastitis. It is advisable to breastfeed frequently and on demand, ensuring good latching and good milk transfer; avoid the use of breast pumps and nipple shields if it is not essential and properly manage engorgement if it occurs.

When do I consult?

With the rise in milk, the breast feels fuller and harder and can be annoying. We can even have sweats and hot flashes, which can be confused with a fever, due to postpartum hormones. This is prolonged and magnified in the case of engorgement, in which both breasts become very hard, red, swollen, and swollen. In this case, we have to take measures to prevent it from progressing to other situations such as bacterial mastitis.

It is also not uncommon that after a long period of sleep we notice the chest reddened and even painful; this could be due to distention of the alveoli and inflammation, rather than infection.

If we notice a reddened and indurated area of the chest and we have general symptoms (fever, chills…) that persist for 24 hours despite conservative measures (anti-inflammatories, cold, breastfeeding on demand) we should consult a health professional.

If there is no fever, but the area remains indurated, painful and red despite general measures, we should also consult, as if we notice symptoms compatible with subacute mastitis (burning, pricking in the chest) that do not improve.

If we palpate a well-defined, hard and painful lump, even in the absence of fever, we should consult.

Faced with any of these problems, the mother should consult a health professional who can make a proper diagnosis and apply treatment.

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