Midwife Andrea Jordan
HOW TO MANAGE
MASTITIS OR A BREAST ABSCESS
We have all heard of a mother experiencing painful feeding at the nipple, difficulty with latching baby on, or fears of not having an adequate supply; however, many of these issues can usually be resolved with the right support. Let’s face it, breastfeeding, although the most recommended option for infant nutrition is not always easy! Many mothers end up not breastfeeding because of one problem or another that creates difficulty and contributes to the mother giving up, but early support is the key.
Engorged breasts, mastitis and breast abscesses are similarly related problems – one often a follow on from the other. Engorgement can lead to mastitis and mastitis can lead to a breast abscess. Let’s explore what these three breastfeeding problems are and how they’re resolved with ease.
Engorgement is the term used when a lactating mother has breasts that are overfull and need emptying. Her breasts will feel very firm or even hard to touch and usually very uncomfortable to the mother. The engorgement may extend up under the armpits and around the nipple /areola, making it almost impossible for baby to achieve a grip with his mouth for a correct latch. This can occur when the milk first comes in on day 3-5 after birth, or if a feed or two has been missed.
The solution for this condition is to use a hot compress with breast massage and empty the breast as completely as possible, either by breastfeeding directly or a breast pump. Using the hot compress and massage helps the milk to leave the breast more easily. Using a cold compress (in between feedings) without the massage helps to decrease milk production and ease some of the fullness. The mother should be encouraged to continue breastfeeding or pump if baby isn’t latching. Act fast to easily resolve this breastfeeding problem!
Mastitis can occur where the mother has skipped or not fully finished feeds resulting in the breasts not being completely emptied; this leaves some areas within the breasts still full with milk. The backup will create a lump which leaves the area sore, hot to touch, red and hard.
Tell-tale symptoms of mastitis can make it easy to spot: a lump or lumpy areas in the breast that are hard, red, usually painful and accompanied with flu-like symptoms of aches, pains and a fever.
The solution for mastitis, if caught early is ensuring that baby (or breast pump) empties the breast completely for the next few feeds, along with the magical hot compress and massage of the affected area (using a heated ‘muscle pack’ or a washcloth dipped in hot water), particularly just prior to and during the feed or pumping session. If the breast isn’t emptied well, and the lump does not diminish, the mother may need to see her doctor for antibiotics, but if caught and dealt with early, antibiotics are not always needed. The mother should be encouraged to continue breastfeeding
or pump to make sure breasts are well emptied. Again, act quickly to resolve this breastfeeding problem with guidance from a lactation specialist.
A Breast Abscess can occur by itself, but mastitis preceding is the most common scenario. Thankfully, not as common an occurrence as engorgement or mastitis, this particular breastfeeding problem is quite unpleasant, taking longer to treat and resolve, also requiring medical/and nursing care (out-patient) for full healing.
Symptoms of a breast abscess are a lump in the breast that is hot, red, swollen/hard, very painful and usually localised in one specific area. This lump does not seem to decrease with the remedies of hot compresses, massaging and breastfeeding or pumping the milk. The abscess can also worsen over the days or weeks with no significant feeling of it reducing its size or ‘emptying out’ after feeds.
An ultrasound would be required and once confirmed that the lump is pus-filled, it will need to be opened/excised by a doctor. The mother is often referred to a breast surgeon for the procedure. The abscess is actually a build-up of pus from the infection within the breast, where the milk has been unable to leave the area allowing for re-filling; this pus will need to be drained from inside out and the wound dressings changed daily. Frequent doctor reviews and antibiotics are also necessary.
The mother should still be encouraged to continue breastfeeding or pump making sure breasts are well emptied. Even if there is pus draining, as long as the excision is not close to the areola where baby will latch, there is no evidence to suggest that mother should avoid breastfeeding or should discard her milk.
With early support, dedication and a little know-how, breastfeeding problems like these can be overcome. It’s not always easy, but it’s usually always worth it!
Andrea Bonita Jordan is a registered (freelance) Midwife, Breastfeeding Specialist, and co-founder of two charities: The Breastfeeding and Child Nutrition Foundation (The BCNF charity # 1169) and Better Birthing in Bim.