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Treating/preventing mastitis with a babe who doesn't empty the breast

post #1 of 4
Thread Starter 

I had mastitis one week PP, started antibiotics, it came back 24 hours after I finished the abx. Took another 14 days of abx, and I think it's coming back again. My DD is 5 weeks, and is starting to nurse longer but obviously not emptying the breast. I've tried my best to pump to empty the breast, but it's not always possible to do every time and I'm not sure how much to do and not affect supply too much. And I'm not sure how the pump works to empty ducts- does it always use the same ducts unlike when you change baby's position? I'm at my wits end. I don't want another round of abx because for one thing it may not help again, and they don't seem to agree with the baby. She got diarrhea and had to eat constantly and was really fussy during the last round. And seriously, how much abx should I just take in a row? It's been a month of them now. I'm taking probiotics now and eating yogurt to help restore things while I figure this out. Any advice from those who have BTDT would be appreciated. I am taking raw garlic just for good measure, and trying to get lots of fluids to help fight infection. I've heard warm compresses are good, but how long to hold them there? And how exactly do you know you've emptied the breast well?

post #2 of 4

What a rough start to breastfeeding you've had.  Definitely, it shouldn't be like this.  If you've been on antibiotics for a month and still showing signs of mastitis, then it's likely that you are on the wrong antibiotic.  Did your doctor prescribe the same antibiotic both times?  I would request a culture of your milk and your baby's throat & nose to find out what bacteria is present so you can be prescribed the correct antibiotic.  Otherwise, you're right, it doesn't make sense to keep taking antibiotics.


Besides that, it's important to make sure that other factors aren't making the situation worse.  You don't mention how breastfeeding is going.  Are you having nipple trauma (a common entry point for bacteria that leads to mastitis)?  What's your baby's weight gain been like - higher or lower than expected?  A baby who is not nursing well (you'd likely have nipple trauma and a baby who is not gaining well) will leave areas of the breast unemptied and increase your risk for mastitis. If you've got an oversupply of milk (not uncommon in the early days), then you are at higher risk for mastitis.  Do you have an IBCLC or LLL Leader who can work with you in person to help you find and resolve risk factors for mastitis?


Your breasts are never truly "empty".  A baby who is nursing well is better than a pump at emptying your breast, so ideally nurse your baby often, offering the affected side first for many feedings.  Pointing your baby's chin toward the affected part of the breast will increase the drainage from that area.  Using a pump if your baby skips feedings or if you have to be separated from your baby so you don't feel full.  Delaying feedings, skipping feedings can increase your risk for mastitis.  Anything that puts sustained pressure on one area of your breast can lead to decreased drainage of that area and increase mastitis risk.  So, ideally, go braless as often as possible and make sure none of your bras are constrictive. Baby carriers can also put pressure on your breasts and cause problems. 


Do you have a specific sore area of your breast?  Massaging that area can help, both before and during feedings.  Warm compressing immediately before feeding can help.  There's no "magic" time to leave it on, but probably aim for 15-20 minutes.  Cold compressing between feedings can help with discomfort.  Cabbage leaves help with inflammation and provide cold relief - use green leaves straight from the fridge & replace when wilted.  Ibuprofen is generally considered safe for breastfeeding mothers & can help with the inflammation and discomfort.  Lecithin (1-2 1,200mg capsules taken 3-4 times daily) can help if you're prone to plugged ducts, as can reducing saturated fat in your diet.  Mastitis is often a signal from your body to "slow down" - get as much rest as you can, call in all the offers of help from friends and family, order take-out, skip cleaning and put your feet up. . .


There's good resources for mastitis on-line:  Jack Newman's answer sheets (http://www.breastfeedinginc.ca/content.php?pagename=doc-BD-M; there's an idea for potato compresses on this sheet that has always been effective for me), kellymom (http://www.kellymom.com/bf/concerns/mom/mastitis.html), and La Leche League (http://lalecheleague.org/nb/nbbreastproblems.html).


Good luck!

post #3 of 4

Mastitis is the WORST possible thing that can happen, I swear! I had it about 5 weeks PP with DS and 6 weeks PP with DD. It took ever fiber of my being not to give up nursing when I had it.It was much worse this time around, and though I desperately tried to avoid the antibiotics, my entire chest/stomach area was completely red and I was hyperventilating, shaking, and crying by the time  I finally went to the doctor. But when I did, and got the antibiotics, I felt significantly better in 36 hours and mostly better in a week. If you're not feeling better, you should check with your doc again about the abx. Also is there a possibility of thrush? The symptoms can be similar and if you are not treating both it may persist. Of course I see now  you're doing probiotics and garlic so certainly that will help if you have thrush also.


Do you have a general oversupply? Does baby ever cough or choke at the breast, be excessively gassy or have an excessive need to burp? I've  had huge oversupply problems for the first 4 months with both babies and it makes you very susceptible to mastitis. The best routine I ever found to keep my ducts moving while my babes were still growing/learning their nursing techniques was this: When I woke up in the morning, typically engorged or at least very uncomfortable, I would pump a decent amount from one side (to slow down the flow) and then feed my LO from the same side so one breast was empty. Then I'd pump as much as I possibly could from the other side, leaving me as "empty" as I could possibly be for the start of the day (which seriously helped pain level and mood). Then when LO nursed again, I used the same side I'd just pumped. And I would use that side anytime they ate for the next 4 hours. And then switch sides for 4 hours, etc.  This really helps drain the breast. While adjusting to this pattern, you may want to hand-express a little milk from the opposite side that you are feeding from to avoid blocked ducts/pain/etc. I find it usually takes 3-5 days for your body to completely adjust but once it does you never get so full it causes pain, and the breasts getting truly emptied helps prevent mastitis. Of course, the breast is never COMPLETELY empty, but you will know when it's drained (a feeling I'm pretty sure I never got to until my second child was 3 months!) - it will feel less full/dense and more floppy/lighter, if you squeeze as if hand expressing, it will likely just drip or spray minimally instead of spraying across the room. While you are going through the awful ordeal of getting rid of mastitis, I recommend warm showers and (minimal) hand expression for some relief. Be careful not to let the shower actually come down on your breasts/nipples as that actually encourages more production.


Word of warning: Careful with the pump! I always found using it to drain one breast in the morning gave me the most amount of comfort, and also helped me build a freezer supply which I find comforting. But overuse of the pump can create a bigger oversupply problem and ultimately bring you back to mastitis. 


I also agree with PP about both ibuprofen, though it should be limited during nursing, has very minimal side effect warning and helps very very much with the pain and inflammation. Cabbage leaves also help greatly, but do not enjoy it too much, too often! Cabbage leaves are used to help dry up a milk supply, so while it will reduce your milk supply in moderation, it could create the opposite problem if you use it to much.


Try to avoid sleeping on your stomach - I know my desperation to return to belly sleeping after my kiddos were born played a role in my mastitis problems. Hours of pressure on your breasts can create a lot of problems in your ducts!


Call in the troops. Having a new baby is hard, having a new nursing relationship is hard, and having mastitis on top of that is hard, hard, hard, hard. I am typically never one to ask for help, but I had both my mom & MIL at my house with me for 3 days while I recovered from the worst part of it. Good luck! hug2.gif


post #4 of 4
Thread Starter 

Thanks for the advice. I never got terribly sick with the mastitis, a few hours of fever and chills, and then immediately better after I started ABX. I so far feel fine, but I saw a little concentrate pinkness starting on my breast which I had the other two times, but it's not bad yet. Is it possible it's a plugged duct and not infected yet? I'll try your recommendations and hope for the best. I think I'll also try to see a lactation consultant at the hospital.  I suspect I have a forceful letdown, because she does gag a little. At 4 weeks, or maybe because I finished the abx, my letdown got much more intense, tingly, etc. She has been gaining weight very well, and I have no other BF issues or nipple issues.Thanks for the help!

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