Most women have heard of mastitis if not experienced it on their breastfeeding journey. For some it will be the painful end to their nursing days while others will endure several bouts, often when they are run down, tired or coming down with a cold. A welcome night’s sleep when baby drops a feed may be unfairly rewarded by a full, red and tender breast by morning. Or a night out in a fancy ‘non maternity’ bra may result in the squishing of sensitive breast tissue and inflammation. The penalties for attempting to reclaim a little bit of pre-baby life can indeed be severe.
To establish breastfeeding relies on good teamwork with the smallest person in the house and perhaps a bit of luck. You may need to support feeding with expressing to build your supply. You may be pumping to feed a babe with a poor latch or using a nipple shield due to flat or inverted nipples. Informed is best when it comes to breastfeeding and there is plenty of support and information out there to support your individual journey.
The symptoms of mastitis likely occur on a continuum from milk stasis to inflammation resulting in blocked ducts or non-infective mastitis. This can progress to infective mastitis and if left untreated become a nasty breast abscess which may eventually and thankfully rarely here in Australia result in sepsis. Most women with inflammation and blocked ducts complain of local pain, redness and a palpable lump or wedge of breast. These symptoms can crop up remarkably quickly and when things tip over to the infective side can include fever and flu like symptoms such as chills and body aches and pains. Women can feel like they’ve been hit by a truck and put themselves to bed but mastitis needs timely management. So, what is the best course of action and why involve a Physio?
Physio’s with special interest in Women’s Health are well placed to educate and reassure women with blocked ducts and mastitis. Encouraging women to seek help with toddlers/babies and household chores is first priority. In fact, we spend a lot of time giving supermums permission to lie down and rest during the day. Better for pelvic floor recovery too but let’s not get distracted! As with any illness we are more susceptible when we are run down. Try to ensure you are prioritising the basics such as enough water intake and good quality nutrition. You may like to continue taking your pre natal supplements to help up your nutrient intake in this challenging time.
Frequent feeding and feeding from the affected side first to try to completely drain the breast is encouraged. It is okay to wake a sleeping baby for the sake of preventing suspected mastitis, despite the narrative saying otherwise. Keeping up or increasing fluids for breast milk production and to encourage lymphatic flow. Checking the fit or loosening bras/crop tops to avoid unwanted pressure. Ice can help with pain between feeds while a hot pack or warm compress prior to feeding may help to improve milk flow. Mastitis is an inflammatory condition so the use of anti- inflammatories such as Nurofen is safe and recommended. You may also prefer to take a more natural approach using anti- inflammatory supplements such as curcumin and fish oil. We can assess and advise on breastfeeding positions to maximise milk flow and drainage but also to relieve other aches and pains in neck and shoulders that may result from poor positioning.
Two years ago, the International Academy of Breastfeeding Medicine updated its recommendations on how to manage mastitis. They have now included the recommendation for therapeutic ultrasound. Ultrasound treatment can commence with first signs of non-infective mastitis or infective mastitis. If commenced in the first 48 hours treatment may prevent the onset of infective mastitis and the need for antibiotics or in fact reduce the length of their use. There is growing evidence it may even enhance the effect of antibiotics by disrupting the bacterial biofilm.
Ultrasound has the potential to improve milk flow and women are encouraged to feed after their session to enhance this effect. Treatment should be followed up daily for 2-3 sessions or until symptoms improve or resolve. There is no need for referral to Physio for mastitis but we may communicate with your lactation consultant to ensure any other underlying issues are resolved to prevent recurrence or with your GP if your symptoms are not improving.
Breastfeeding can be an emotive rollercoaster for many women so it’s important to know what supports are out there to assist. Physio can be an important part of your journey.
Same day treatment is the ideal either in rooms or by home visit to manage symptoms in a timely manner. Please call the clinic on 9751 0400 to discuss or arrange an appointment with Jen Vardy or Paris Houeix our Women’s Health Physio’s.
By Jen Vardy & Paris Houeix, Women’s Health Physios