Mastitis - both sides

[qmedic]

Hi, I have a mastitis since 48 hours now which feels terrible, as it is in both sides. The breasts and nipples hurt a lot, but I cannot feel any large cloggings and the breasts are quite soft. However, some parts are red and I have high temperature. My gynecologist determined the CRP value yesterday, which was way too high and I am taking antibiotics now.
1. I live in Germany where hot showers are recommended before breastfeeding and application of cold curd cheese compresses after. I've found the article with the new recommendations in this sub (ice/NSAID/gentle massage) and wanted to know about your experience? The LO (2.5 m) wants to be carried next to the breasts all the time which is really painful and I wonder how to get rid of this as fast as possible.
2. I've read that giving children antibiotics even once, has an influence on their microbiome. That's why I wanted to wait as much as possible. Now, I am taking it (Flucloxacillin, half life: 0,7 – 1 h; proteine binding: 94%; molar mass 454 g/mol; oral bioavailability: 50%.) and I would like to know if it makes sense to take probiotics (me or LO).
3. I would like to understand how the mastitis develops. Is it plugged ducts or bacteria? Would the exposure to bacteria lead to a mastitis, if all milk ducts / channels (sorry I don't know the exact term) were open and not plugged?
Thank you all in advance!

 

[jaenalyn]

@qmedic This is a really good brief on mastitis from the American Academy of Breasfeeding Medicine. It’s from 2022 and represents a bit of a paradigm shift from previous mastitis management protocols.

Not all mastitis begins from dysbiosis/bacterial infection and CRP isn’t specific for bacterial mastitis.

The most important takeaway is inflammatory mastitis will resolve on its own but you need rest and support, just as much as if you were sick or had a sprained ankle. Your sprained your boob and it hurts.

You don’t need to worry about keeping your breasts empty, and you should manage oversupply. Ice and lymphatic massage is helpful.

https://www.bfmed.org/assets/ABM Protocol #36.pdf

 

[carlamariecainoy]

@jaenalyn This is the way. On a personal level, I highly recommend the new protocol. I had mastitis 5x in 2020 when I had my first including a very severe case which led to a 5 day hospital stay. When I had my second in January I meticulously followed the new advice whenever I felt early symptoms and haven’t developed mastitis a single time.

I think this website gives a nice overview of the new protocol in a way that is easily digestible. No heat, extra pumping or deep tissue massage. Do: rest, ice , ibuprofen, very gentle lymphatic massage and see you’re doctor if it doesn’t improve as it can get worse very fast

 

[basilstaghare]

@jaenalyn Yes, listen to this. I have a rare chronic inflammatory mastitis and this is all correct. Practice BAIT - breast rest, advil (ibuprofen), ice, tylenol. Don't use heat, don't massage it a lot, don't starting feeding/pumping more than you normally would. Basically just leave things alone. The more you mess with it, the more inflamed it gets, and the more likely you will get an actual bacterial infection or cause other issues to worsen.

 

[ssmokin69]

@jaenalyn Came here to say this. I had my last baby in August of ‘22 and I was so glad I found the new guidelines. My mastitis was due to oversupply. The first time I had it I was only 2 weeks postpartum and the docs prescribed abx right away. Within a month I had mastitis again, fever, hot painful breast, etc. I didn’t want to take abx again if I didn’t have to so with the help from my lactation consultant, I treated with ice packs, ibuprofen/Tylenol, and rest and fluids. Nursed normally, didn’t pump, tried not to favor either breast. Long story short, it made its way through both breasts but I was able to clear it without abx. I subsequently had several smaller flare ups (no
Fever but other symptoms) which I treated similarly with success.

This is literally the opposite of the guidance I received when I developed mastitis with my first baby - the hot showers and massaging and trying to pump all the time.

 

[postmalone]

@jaenalyn This is the right answer.

 

[foundwandering]

@qmedic Get Sunflower Lechitin and take it. It thins out the sticky plugged ducts. And get a dry brush and do lymphatic massage, first circular motions on your armpit and then on the breast, circling until the lumps reach your armpit where they can exit your body. Cold compresses.

 

[marked]

@qmedic Maybe try taking lecithin? There is some evidence that it helps with the milk flow

 

[wolfe17]

@marked It helped me! It was recommended by an LC

 

[chelseamcc]

@qmedic Anytime I felt mastitis coming on, I immediately went to the hospital or to a trained physical therapist who would administer therapeutic ultrasound - this is amazing and stopped about 90% of my infections (I’ve had three kids and maybe 10 “almost” infections). Also search for “breast gymnastics” on Instagram - those little exercises work miracles.

 

[ciliegia]

@chelseamcc source?

I know this is an anecdote, I'm not asking for a source on that, rather on the utility and efficacy of US therapy in treating mastitis

 

[chelseamcc]

@ciliegia I don’t have a source - this was proposed to me by multiple lactation consultants. I see there are quite a few articles about the efficacy of US online, but I’m not finding any recent scientific studies (although some more recent research institutions looking to recruit potential participants for upcoming studies). Sorry I cannot be more helpful.

 

[nimbus]

@qmedic 1) NSAIDS can help with inflammation which can help with clogs and mastitis. Same goes with ice. I always found a hot shower and manual pump to work for clogs, but always said that if it didn't work, I'd do the ice route. No harm in trying the ice.

2) probiotics were recommended for my baby when I'm on antibiotics or he is on antibiotics. Talk to your baby's doctor and see what they recommend.

3) sometimes mastitis is not bacterial, and is just severe inflammation. But the severe inflammation can develop into bacterial mastitis which requires antibiotics to treat. Breastmilk alone contains bacteria so once the lobes and ducts get inflamed, and milk becomes stagnant, it's a breeding ground for bacteria. It's also thought that bacteria from your skin or babys mouth can contribute to mastitis by entering the milk ducts through a cracked nipple.

The stagnant milk/plugged ducts is the issue usually. Most women are exposed to bacteria while nursing or pumping, it doesn't really become an issue if the ducts are working properly and constantly flushing out that milk and not giving bacteria a chance to grow.

 

[elizabeda777]

@qmedic Regarding your second question, about probiotics, the answer is almost certainly “yes, probiotics will help”. The problem is that we don’t yet know which probiotics, in which doses, for which condition (or after which antibiotics) and for which age group. And not all have been proven safe in infants.

I’d talk to your doctor or a local pharmacist asking if there are any particularly recommended for infants. Otherwise, I’ve heard the most proven benefit for infants is lactobacilus reuteri - but I’ve not looked into it for a while.

But equally, your child will probably be fine without probiotics anyway! I didn’t think about it for my first after caesarean section, then for my second I got so caught up looking at different ones I got decision paralysis… I figure I’ll just give them yoghurt as kids. Most of the studies I’d seen showed that the micro flora recovered

 

[ctay6318]

@qmedic Don't forget to look for blebs. If you see milk blisters on your nipples (little white dots), it could be as simple as poking them with a sterile needle. In this case, the blockage is literally just the blebs at the nipple.

 

[qmedic]

It's me - OP. I just wanted to thank everyone for the comments, links and tipps. The antibiotics combined with ice (and some NSAID) helped a lot and it took only two days to get well. After, we had some hard days and the baby was all the time trying to drink. I think I reduced the milk production with the ice and she tried to increase it again. But it went all fine. I've figured out I have to change the position during breastfeeding, as it might help to empty the breast more evenly.

 

[ldingle]

@qmedic For #3, mastitis can be caused either by a clogged duct (leaving milk sitting stagnant and then progressing to bacterial infection) or by bacterial infection through a break in the skin, like if you have a blister or crack on your nipple. If your breasts are soft I would not suspect a clog. Having a clog will make the affected area of the breast quite hard, right where the redness of the infection is. I would also take a close look at your nipples to see if there are any white spots, which could be a blocked nipple pore. Sometimes you can get a plug right on the nipple, or have the skin close over an opening and trap the milk that way. If you find one you can scrape at it a bit and soak it in warm water and epsom salts to try to get it to open up. If it is really not working I have taken a clean needle to mine before but you do need to be careful about potentially introducing more bacteria.

Best way to get rid of mastitis is to take your antibiotics and drain your breasts frequently. Sunflower lecithin can also help with resolving clogs and preventing future ones - it is an emulsifier and helps the fat stay suspended in the milk rather than clumping up. If you cannot feel a clog though it may not necessarily help you.

If you do have a clog and it does not get resolved then mastitis can reoccur. If this happens several times your doctor may recommend an ultrasound to breast it up.

 

[jacotte]

@ldingle FYI this is mostly the older mode of thinking that assumes a lot about breast anatomy and physiology that just isn't true. The new ABM guidelines discuss the reasons for the changing ideas.

ALWAYS leave milk blebs (the white spots) alone. DO NOT try to puncture them on your own - only a doctor should do this in a clinical setting. You do not want to chance getting an infection on your nipple.

What were thought of as "clogs" are inflamed and/or congested breast tissue - and yes it can be difficult to drain the milk ducts in inflamed areas, because inflammation constricts the ducts. But aiming to "drain your breasts frequently" often makes the problem worse because you are asking the body to make more milk by increasing demand - putting more milk into those already constricted ducts, increasing pressure and inflammation.

As you said, take antibiotics when prescribed. But nurse normally and leave your breasts alone.

 

[greenwolf]

@jacotte Sometimes it’s definitely a clog though. I had a little white tiny thing on my nipple one morning after a feed and a hard half a breast. Squeezed out the tiny hard white thing and about an ounce of milk started spraying and then dripping out.

 

[jaenalyn]

@greenwolf The ductal narrowing likely was not caused by the clog, but caused the clog to form.

I know I had a case of mastitis caused by my older kid inadvertently roundhouse kicking me in the boob. Caused the area of the breast to become sore and swollen, which caused ductal narrowing, which caused a clog.

The new approach to managing it is dilation of the ducts by reducing inflammation, vs just mechanically sucking it out like a clogged pipe.

But I know, I’ve pumped out little stringy mozzarella cheese clumps and immediately felt relief. Hard not to imagine it like a boba pearl in a straw. But ducts are permeable and living.

Clogs will eventually breakdown on their own. They will not become solid Parmesan cheese.