The best way to prevent mastitis is to avoid the situations that predispose you to it.Here are my tips for preventing mastitis.

  • Relieve engorgement as quickly as possible - Milk that doesn’t flow gets thicker and can cause blocked ducts, which can easily lead to mastitis
  • Breastfeed frequently
  • Don’t restrict the length of breastfeeds
  • If you feel your breasts getting full, encourage your baby to breastfeed. You don’t have to wait for your baby to be hungry
  • Avoid sleeping on your stomach or so far over on your side that your breasts are squashed
  • Take care of yourself and get plenty of rest

Recurrent mastitis

The usual suspects

  • Missed breastfeeds
  • Giving bottles in place of breastfeeds
  • Not expressing enough if separated from the baby
  • Compromised immune system due to being run down tired and stressed

Recurrent mastitis can be taken as a sign that you need to take a closer look at your lifestyle and breastfeeding relationship and make some adjustments.

What to do about it

Treating mastitis is much like treating engorgement only more urgent.

The following suggestions may be helpful. You might also find it helpful to look at our information on engorgement and blocked ducts .

Get plenty of rest . Mastitis is an illness, so take a ‘sicky’. Find someone else to take on all of your responsibilities other than breastfeeding. Take your baby to bed with you to breastfeed and try to arrange for your partner, a friend, relative or neighbour to look after older children or toddlers. Rest relieves stress and replenishes your immune system.

Use alternating warm and cold compresses on your breasts . Cold compresses relieve pain; warm compresses increase the blood flow to the area, which brings the infection-fighting white blood cells to the inflamed area. You can lean over a sink of warm water, stand in a warm shower, or soak in a warm bath. Warm water or a warm, wet towel is more effective than the dry heat of a heat pack. For cold compresses you can use crushed ice in plastic bags or bags of frozen peas, covered with a tea towel or a cloth nappy to protect your skin.

Gently massage the area of tenderness. This increases circulation, helps to loosen any blocked ducts in the area, and brings white blood cells to the area to fight the infection. Some mothers find it easiest to do this while soaking the breast in a warm shower or bath.

Breastfeed frequently on the affected side . If it hurts to breastfeed your baby, start the feed on the breast that is not sore, and change to the sore side as soon as you notice a let down. Breastfeeding is usually more comfortable when the milk is flowing. It’s important to empty the affected breast. Your baby can empty your breast more efficiently than a breast pump but if your baby is not breastfeeding well, you may need to express the milk to empty the breast.

Use a variety of breastfeeding positions. This will ensure you empty all of the ducts.

Relive the pain. Paracetamol and ibuprofen are considered safe to take while breastfeeding. Unrelieved pain not only decreases your ability to produce milk, but suppresses your body’s ability to fight infection. You can also try the reflexology routine for pain relief and or EFT.

Drink lots of fluids. Fever and inflammation increase your need for fluids.

Eat good, nutritious food . This will help your immune system fight the infection

Sleep without a bra . At other times, wear a looser fitting bra that does not put pressure on the affected area. Or if possible, go without a bra.

Keep on breastfeeding . During a bout of mastitis is not a good time to wean. Weaning increases the risk of a breast infection turning into an abscess that may require surgical draining. Continuing to breastfeed your baby is the best treatment for engorgement, blocked ducts and mastitis.

If your baby refuses to breastfeed on the affected breast, it may be because inflammation of the milk glands increases the salt content of your milk. Most babies either don’t notice or don’t mind, and continue to breastfeed with no dramas. Some may object to the change and fuss or refuse the breast from that side. If this happens you can try starting the feed on the unaffected side and finishing on the salty side. As you get better, your milk will soon return to its usual taste.

Antibiotics and mastitis

You can experience the pain and inflammation of mastitis without necessarily having a bacterial infection. Yet it is often difficult to tell whether mastitis has become a breast infection. Some believe it is O.K to wait a little while to make sure that you have a bacterial infection before treating with antibiotics, though most would recommend treating mastitis as a bacterial infection just in case. A moderate course of action would be to consult a trusted, breastfeeding friendly GP as soon as you suspect mastitis, take the prescription and wait to see if you are getting worse. That way you have it on hand if things get worse. Try all the herbal, homoeopathic, reflexology, acupressure, aromatherapy and EFT suggestions you can from my ‘Breastfeeding help with Natural therapies’. If none of this seems to be helping after 24 hours or you are getting worse very quickly or you have a temperature that is getting higher, take the antibiotics.

There is a fair amount of research which suggests that it is better to give antibiotic treatment early in the course of mastitis. Mothers who are given antibiotics later are more likely to wean their babies, to have a more severe infection, and to have the infection recur.

The following guidelines can help you both determine whether or not antibiotics are necessary.

You may not need an antibiotic if:

  • You do not have a history of frequent episodes of mastitis.
  • You don’t feel that sick.
  • You have not gotten progressively sicker over the last few hours.
  • You don’t have a rising temperature
  • The breast pain and tenderness is not increasing
  • You can easily correct whatever factors may have set you up for engorgement in the first place

Signs suggesting you do need antibiotic treatment:

  • A history of frequent mastitis
  • A fever that is rising
  • You are feeling progressively sicker as the hours go by
  • You have cracked nipples, which allow bacteria to get into your breast tissue more easily
  • Your baby has a bacterial infection that could be transmitted through the nipple such as a gooey green nasal discharge or bacterial conjunctivitis.