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Friday, March 9, 2012

Mastitis - Don't have a cow

When I was little I remember reading James Herriot, and one story that stuck with me was about a farmer whose one and only cow got mastitis. He couldn’t afford antibiotics and the cow was in bad shape.  James Herriot gently told the farmer that that cow would likely not make it and maybe she should be put down peacefully to prevent her suffering. The farmer told him to come back in the morning as he couldn’t bear to let her go just yet. When Dr Herriot returned in the morning he found an exhausted farmer and a chipper cow. To save his cow the farmer had sat up all night milking her and saved her life. That story always brought me to tears. I am a soft touch when it comes to animals.



Ever since then I have always associated mastitis with creatures of the bovine nature and hearing women talking about having mastitis always evoked a jarring contradiction for me. Which really talks about how our society approaches the topic of women lactating in a way. Luckily I have been able to leave that association behind and realise that mastitis can occur in any lactating mammal. Which is not lucky.

You can imagine my chagrin when a friend told me that upon her second bout of mastitis her dad told her that if she were a cow they would have her put down.

I was even less amused when a certain NZ celebrity of sorts made out that women who breastfeed are dairy cows, those sort of comparisons are not helpful and simply reinforce the idea that breastfeeding is an exception rather than the rule.

All of this aside, Mastitis is one of the bigger challenges of a breastfeeding mama, it can go from almost undetectable to extremely serious overnight and for many mamas it can also spell the end of breastfeeding. It doesn’t need to though if it is detected early and treated effectively.

How do I know if I have mastitis?
Usually there will be pain and inflammation, your breast may feel tender and hot.  You will also likely feel ‘fluey’ with a headache, fever and body aches. Without the fever or flu like symptoms it is unlikely that you have mastitis and more likely you have a blocked duct – which is a main cause for mastitis and should be treated immediately.  Visually the breast may have an apparent lump or red streaking at the site of the pain. Your milk may be lumpy, stringy or blood tinged and in some instances the elevated levels of sodium and chloride can make your milk taste saltier and baby can go on nursing strike.

What causes mastitis?
Mums who are worn down, tired, stressed and anaemic are at a higher risk of mastitis, but the main direct causes are blocked ducts, infection and possible allergic reaction. Blocked ducts are the most common cause. It’s interesting to note that mastitis has a much higher occurrence in countries where breastfeeding is done to schedule or is not truly on demand. Draining the breast frequently is a huge preventative factor. Engorgement can increase risk which is why it is so important to drain the breast, the supply and demand balance needs to be protected. Oversupply with limited feeding can lead to engorgement which can lead to blocked ducts or mastitis.
Other causes can be bacteria entering through a cracked nipple or damaged breast. Being in hospital is an increased risk factor as well.

How do I prevent mastitis?
Mastitis is most likely to occur in the first 2 weeks after birthing your baby, it’s very important in this period of time to let baby have uninhibited access to the breast, especially at night time. Because stress is such a key risk factor it is ideal to have as many people helping out as possible. Don’t try and be superwoman, even if you invested in the costume.  I’ve always thought the idea of a baby moon was lovely – where your feet don’t touch the ground for a month pretty much and you have family and friends there to see to your every need while you see to baby’s needs. This is different from the baby moons that travel agents promote where you go on a preggo holiday and have swollen ankles, heartburn and avoid deli foods in another country instead of at home.
The real key to preventing mastitis is the prevention and quick treatment of blocked ducts. Ensure that your bras fit well and are comfortable, when you sleep make sure your breasts aren’t compressed or obstructed and when you feed make sure the latch is nice and wide to ensure the breast is evenly drained. Blocked ducts should be massaged to free them and baby can be latched with the jaw or nose pointing to the blocked duct to ensure optimum drainage. A hot wheat bag before or during a feed can help loosen any blockage and ease inflammation.

The mantra Heat, Massage, Rest, Empty Breast is the basic first aid for plugged ducts AND mastitis.

Just as importantly lifestyle and what we eat can impact on our overall health. Advocates for natural health state that mastitis is a sign that you need to slow down and support your immune system. Keeping well hydrated and well rested  as well as eating nourishing foods is optimum.

How do I treat mastitis?
I’m the first person to seek alternatives to conventional treatments but in the instance of mastitis if it hasn’t resolved or started to resolve within 24 hrs or the symptoms are severe and worsening  then you need to seek medical assistance and usually the recommendation will be to take a course of antibiotics. I am not a huge fan of antibiotic overuse but in this instance they are well warranted.

Signs that a visit to the Doctor is necessary:

·         There is pus or blood present in your milk.
·         There is red streaking or marking on your breast
·         Your temperature increases suddenly
·         Symptoms are sudden and severe
·         You have broken skin on the nipple
  with obvious signs of infection. (redness, pus etc)
·         Both breasts are affected
·         Your baby is 2 weeks old or younger and/or
  you have recently been in the hospital.

However if the case is mild or slow moving then you do not necessarily have to take antibiotics and can seek to treat with alternative methods. All of the following techniques can be used in conjunction with antibiotics as well unless your Dr advises there is a contraindication. 

The first and most important step is not to stop breastfeeding. Ceasing feeding will actually increase your risk of severe infectious mastitis and possible abscess. An abscess is no fun. Is usually involves drainage and then packing of the wound.

1.    Drain the breast, let baby feed as often as possible and from the affected breast – every 2 hrs is a good guide. If baby is on strike due to a milk flavor change then you can pump or hand express, sometimes pumping a little before the feed starts can help clear the worst of it meaning that baby will happily feed. However do not neglect the unaffected breast. Line the jaw or nose of baby up with the affected area. A great tactic is to dangle the breast into the mouth of your baby so that the whole breast drains freely

2.    Get plenty of Rest. A mother with mastitis should go straight to bed and stay there, take baby with you to feed and get loads of skin on skin time. Arrange for someone to do everything else for you. If they could go to the toilet for you as well that would be ideal.

3.    Heat the affected area with a wheat bag or hot flannel on the area before or during a feed. A hot shower beforehand is nice and a basin soak directly on the breast can help. Make up a hottish salty bowl of water and soak the breast in it. Adding a teaspoon of Epsom salts can help. Another soak to use one made of marshmallow, not the delicious fluffy candy, the marshmallow plant.

4.    Massage the affected area, when baby feeds massage towards the nipple, during a shower you can soap up a wide toothed comb and use that to massage any lumps or infected areas.

5.    Protect and boost the Immune system by taking a high dose of Vitamin C, 1000mg every hour on the hour for a short period can help boost your immune response.
Fresh garlic can be taken orally to assist, a couple of cloves freshly crushed and taken with a spoon full of honey or swallowed in pieces like tablets. You can take tablets but not the deodorised kind as allicin is the active component and is also the source of the garlicky smell. Echinacea or Oregon root tincture can also aid your body to fight off any infection. Echinacea works by boosting your natural killer cell action, there haven’t been any conclusive studies to show Echinacea is safe during breastfeeding but it has been shown to be safe for short periods of use in pregnancy which leads me t believe that it should be fine for use in lactating women. It certainly has not been shown to be dangerous.
I also swear by a high dose Vitamin D 1000iu - 10,000iu daily to support the immune system.
Susun Weed suggests using a tincture of pokeroot, a couple of drops a day in a glass of water. A mother I know swears by drinking chamomile tea in vast amounts when mastitis is indicated. As it has anti-inflammatory properties and is a mild sedative/pain reliever it would be a good adjunct to any of the other treatments.

6.    Using poultices can help address any pain directly, cool compresses can reduce inflammation and can be used alternating with hot compresses. Fenugreek, Rosemary and Dandelion are the most common ones. Rosemary is a strong antimicrobial as well as a circulatory stimulant. Dandelion helps reduce swelling and Fenugreek is a strong anti-inflammatory.  Cabbage leaves can be used to ease discomfort but be aware that they reduce supply which may not assist in the healing process.
A strong healing poultice is one made from comfrey and calendula, you can make this by blending comfrey and calendula together until it’s like gelatin before freezing into folded cloths.  Comfrey is a wonderful healer as is calendula. Calendula is a strong antiviral and antimicrobial when used topically.
A handy poultice to draw out heat and infection is grated potato, it has the added benefit of being cheap and readily available.

Some homeopathic remedies for mastitis are Phytolacca, Belladonna, Bryonia and Hepar Sulph - all 30c.

Phytolacca is good for slow moving infections or when the breast is lumpy and hot, Belladonna is for when it comes on hot red and fast and is worse on the right side, Hepar Sulph is for when you are getting chills and are irritable with sharp needle like pains and Bryonia is if you feel irritable and the pain from mastitis worsens with movement.

Some  women are so lucky they get repeat bouts of mastitis, if you thought one lot of mastitis was enough then imagine getting it every week. This is a huge issue for a few mamas and can spell the end to breastfeeding permanently. Luckily there is a lot that can be done to address it, with prevention being the key.  This article is a comprehensive guide on how to approach recurrent bouts of mastitis. If you try everything and it still continues, providing you are only getting mastitis in one breast you can actually successfully feed your baby from one breast only. If you want to keep breastfeeding and have tried everything else then this can be a workable solution to an unworkable situation.

So if you get mastitis, don’t have a cow, or be a cow but act quickly and give yourself a break. 


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