Since there have been new guidelines on the treatment of breast inflammation (mastitis) recently, here is a small summary. I am not a healthcare professional. If you suspect that you have mastitis, you must always contact your own health nurse and/or doctor. You can find references and sources on which this article is based at the bottom of the article.
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It is important to talk about breast inflammation (mastitis) as, in addition to being painful, it is one of the most frequent reasons why women have to give up breastfeeding earlier than they wanted. There is no full scientific overview of how many women get mastitis during their breastfeeding process, but it is estimated to be from 10% and up to 25%.
Since the new guidelines on some points contradict previously given recommendations, it is important to be up-to-date so that you avoid aggravating a possible chest inflammation.
If you search the web for advice on mastitis, you will find plenty of advice and guidance (also from official sources) which, in light of the new knowledge in the field, may be wrong.
This older information often describes the importance of effectively emptying the breasts during breastfeeding and possibly supplementing with pumping. This practice can be misleading as the chest can never be completely emptied. Approx. ⅓ of the milk remains even after effective breastfeeding. In addition, correct guidance is essential when pumping, as a possible overproduction of breast milk can worsen mastitis.
It has been the traditional view that mastitis is solely due to the accumulation of milk in the breast. This is not scientifically documented. Research has shown that there are several factors that play a role in the development of mastitis.
One of the most common pieces of advice you come across is hot packs for the breasts - the new advice goes the exact opposite and recommends cool packs to reduce inflammation. More on that below.
There are certain factors that contribute to the risk of getting mastitis. If you have a strong discharge and a large milk production, or if you have previously had mastitis, there is a greater risk of developing it again.
The new guidelines, in contrast to the old ones, do not focus on providing drainage from the breast, but instead on reducing swelling in the breast tissue.
It is recommended to reduce pumping so as not to stimulate production - pumping can in the worst case also damage the nipple if the setting is too effective or the breast funnel is too small.
Breastfeeding is still recommended at least 8 times a day.
It is important to focus on good sucking technique and breastfeeding position. Laid back breastfeeding position can be good because the breast is often so tense that baby cannot get a good grip. Baby's chin should preferably be positioned against the affected area.
One of the new recommendations is to use cool compresses 10-20 minutes between feedings - This will relieve the swelling in the edematous (area with fluid accumulation) area around the milk ducts, which prevents the milk from flowing.
Finally, it is important not to "massage" the breast with hard pressure in an attempt to "help the milk out". It can damage the tissue and worsen the condition.
The health nurse can recommend and instruct you to perform lymphatic drainage instead.
Breastfeeding should not be painful. It is recommended that the breastfeeding woman contact her own doctor to have painkillers prescribed - typically paracetamol (Panodil) and Ibuprofen (Ipren). If bacterial (infectious) mastitis is suspected, it is important to be treated with antibiotics. You can still breastfeed even if you are treated with antibiotics.
The importance of the partner's role is also pointed out in the new guidelines. With mastitis, you are often very exhausted and lethargic and have to use your energy to get well. The support that a partner can provide both practically and emotionally is incredibly important.
So a short summary:
❌ Do n't try to "empty the chest"
❌ Do not stimulate the breast for extra milk production, e.g. with pumping out
❌ No hard massage
❌ Warm wraps are no longer recommended
✅ If possible, try lymphatic drainage in collaboration with the health nurse
✅ Use cool compresses 10-20 minutes between each feeding
✅ Breastfeed at least 8 times a day
✅ If you have very tense breasts, the laid-back breastfeeding position is recommended
✅ The baby's chin should preferably be placed against the inflamed area
✅ Get breastfeeding guidance from a health nurse or breastfeeding advisor
✅ Partner must support the breastfeeding
✅ Contact your own doctor with pain or suspicion of bacterial inflammation
Sources: The above article is summarized from information at: https://www.sundhedsplejersken.nu/mastitis-fra-teori-til-praksis/ by Kathrine Ludvigsen, Charlotte Nøhr-Rasmussen and Kristine Aagaard
Sources used in the above:
- The National Board of Health (2021), Breastfeeding – a handbook for healthcare professionals. https://www.sst.dk/-/media/Udgivelner/2018/2023-03-14-Amning_2023-03_web.ashx?sc_lang=da&hash=E62927D4277ED060701B99B9E0E88AAB
- Wambach, K. and Spencer, B. Eds. (2021). Breastfeeding and Human Lactation. Sixth Edition. Jones and Bartlett Learning.
- Wilson, E., Wood, SL and Benova, L. (2020) Incidence of and Risk Factors for Lactational Mastitis: A Systematic Review. Journal of Human Lactation. 36 (4) 673-686. https://pubmed.ncbi.nlm.nih.gov/32286139/
- Tøkje, you one. eel. (2021) Women's experience of treatment for mastitis: A qualitative study. PubMED Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240874/
- Mitchell et. eel. (2022) Academy of breastfeeding medicine clinical Protocol #36: The Mastitis Spectrum, Revised 2022. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf
- Walker, M. (2021) Breastfeeding Management for the Clinician. Using the Evidence. Fifth Edition. Jones and Bartlett Learning.Douglas (2022) Re-thinking benign inflammation of the lactating breast: Classification, prevention and management. Women's Health, London. https://pubmed.ncbi.nlm.nih.gov/35441543
- Breastfeeding Network (2022) Mastitis and Breastfeeding. https://www.breastfeedingnetwork.org.uk/wp-content/uploads/2022/12/BfN-Mastitis-Leaflet-December-22.pd
- Sundhed.dk (2021) https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/obstetrik/tilstande-og-sygdomme/efter-foedsel/mastitis /
- Ammehjelpen, Reclining breastfeeding – a comfortable breastfeeding position for you and the baby: https://ammehjelpen.no/tilbakelent/
- https://www.lllusa.org/wp-content/uploads/2017/02/laidbackbreastfeeding-1.jpg
