Medical (mis)management of mastitis

I have had several gobsmacking breastfeeding enquiries from mothers over the past week. Gobsmacking because they have been so poorly advised by health professionals, people who really should know better. This post will deal with the most notable for the week and I’ll look at others in a Breastfeeding Myth Busting series.

The consultation with this Mamma went a little like this: “Can you tell me how to wean my 4 month old baby?” I kind of got the feeling that she didn’t really want to talk about it, just wanted the info. I got half way through the sentence “It depends on the reason you need to wean” and was cut off by her hurriedly asking “Should I go cold turkey or do it slowly”? I answer the question telling her that it needs to be done as slowly as possible since sudden weaning will cause blocked ducts and mastitis. She then tells me that is the very reason she needs to wean. She became teary and said that she keeps getting mastitis and has made the decision to wean so that she is doing her best for her baby. She feels she can’t look after him properly if she is sick.

I ask how many times she has had mastitis and she tells me twice in the last month. She then said it was her Doctor who told her that weaning is the best way to prevent her from getting mastitis again. Hmmm…… I get the feeling this Doctor does not know much about breastfeeding management.

We continue...

Me: “Do you remember how long you had the antibiotics for when you got mastitis the first time”?
Her: “Not long, I think it was 5 days”.
Me: “Do you know what antibiotic you were given?”
Her: ”I’m not sure, he said it was a low dose of penicillin, he said we should try that first and if it doesn’t work to try something stronger”.

I suggested as delicately as possible that she find a Doctor who has some training in breastfeeding management. She tells me she has been seeing this Doctor for a long time and trusts him.

Internal sigh… I really like to work in harmony with medical professionals and hate to be seen as a kooky natural therapist rebelling against modern medicine but… sigh. Even as a naturopath I recognise that if the infection is so severe that Mum has fevers and is vomiting as this Mamma was, she will probably need antibiotic treatment. You’ve got to get rid of the infection as quickly as possible and deal with it thoroughly. There are certainly natural therapies that we can use to treat mastitis, but once I see a vomiting, feverish mother, I would never wait to see if the infection will respond to herbs, nutritional therapies or homeopathics. I would say go ahead and use the antibiotics, we can use natural therapies to minimise any potential problems this may cause and prevent this from happening again. The time for a gentle approach is before the Mamma is so sick she can’t move.

I have two major problems with the way this Mamma was treated by this Doctor.

1. If you’re going to give antibiotics, they have to be given for an appropriate amount of time, at an appropriate dose and be appropriate for the type of bacteria causing the infection. If any part of this prescription is wrong, you are better off never having taken it in the first place. If an antibiotic is given at too low a dose or not long enough, the infection will come back, only this time it has developed resistance to the original antibiotic and we are on the way to breeding a super bug in Mum’s breasts. This is likely to result in an abscess requiring surgery and of course, more antibiotics.
2. Weaning or even beginning to wean while you have mastitis is a really bad idea. Why? Well… breast milk is a wonderfully warm and nourishing environment for bacteria to grow in. It takes many months and sometimes more than a year for the breast to completely stop making milk, so even though you no longer give your baby breast milk, you still have it in the breast providing the perfect medium for bacteria to grow in. Only now, you don’t have the baby removing the milk on a regular basis to prevent bacterial overgrowth.
3. A 4 month old baby needs breast milk. I’m not going to spend any time going into the benefits of breastfeeding, if you need convincing I have some info here. If a mother wants to breastfeed and the baby is able to breastfeed, why tell Mum to stop? It is detrimental to both the mother and the baby. I think I’m being very restrained with this… I really want to type a rambling paragraph of bad language in capital letters. This guy is a doctor for goodness sake.

So here’s my advice for a feverish, vomiting Mamma with severe mastitis.

1. Never, ever stop breastfeeding while you have mastitis or blocked ducts. Never… ever… ever. You are just giving the bacteria time to breed as well as providing the little suckers with the perfect medium for growth. Even while you have a really bad active infection and are expressing lumpy discoloured milk, it is still absolutely 100% safe to breastfeed your baby.

If you have blocked ducts that have turned into mastitis: Continue to follow these management guidelines until they are gone. This will help resolve the infection more quickly.

• Apply heat to the affected area of the breast – you can use a heat pack or soak a hand towel in hot water (but not hot enough to burn) then wrap the breast in it. Do this before every feed.
• Gently massage any breast lumps – start on the outside of the breast and use the heel of the hand to massage towards the nipple.
• Breastfeed or express the breast until the area is softened and feels more comfortable. Feed with your baby’s chin pointing towards the reddened area. Often this is hard due the position of the sore spot, you may need to get creative – where there’s a will there’s a way.
• You may need to repeat this process a number of times before the blockage resolves.
• Keep the breast as empty as possible. Feed your baby as frequently as they will feed and express after a feed to ensure the breast is completely emptied.

2. Between feeds use a cold pack to relieve swelling and pain. You can fill a zip lock bag with rice or lentils and put it in the freezer for a quick homemade cold pack. Don’t use it directly against the skin. If engorgement is a problem you can use cold cabbage leaves, but don’t use them for too long as they are really effective at reducing supply.

3. Go and see your doctor – If you have a favourite and trust them; great but don’t be afraid to question the wisdom of their prescription. If possible, find a GP who keeps up to date with breastfeeding management. If you can’t access a Doctor who specialises in women’s health, I recommend asking for a women who has children of her own. They are more likely to know about breastfeeding than a 60 year old man.

Mastitis is usually caused by a Staphylococcus Aureus bacteria otherwise known as golden staph.  Amoxycillin, plain penicillin and other antibiotics are usually ineffective against this type of bacteria. If you need an antibiotic, you need an effective one. Effective for this bug are: cephalexin, cefaclor, cloxacillin, flucloxacillin or dicloxacillian, amoxycillin-clavulinic acid, clindamycin and ciprofloxacin. The last two are effective for mothers allergic to penicillin. Flucloxacillian and dicloxacillin are the recommended first choice. You can and should continue breastfeeding with all of these medications. The antibiotic needs to be given for a period of at least 10 days.

Many years ago, on my second bout of mastitis, I had the unfortunate experience of taking an emergency trip to a medical centre with a pounding headache, fever and chills, along with a red, throbbing breast. After the Doctor had roughly manhandled my excruciatingly painful breast and told me it was indeed mastitis, I handed him a note which the hospital lactation consultant had written for me with the correct antibiotic treatment regime. I was told “Sometimes these birds (yes, he used the term bird) like to think they are doctors and I can assure you that what I am prescribing you will be just fine”. He tried to give me a short course of amoxycillin. He was an unprofessional, chauvinistic knob, end of story. Be warned, they are out there. If you are concerned that you may find yourself in a similar situation, take a look here for some very good print friendly Clinical Practice Guidelines for general practitioners from the Royal Children’s Hospital Melbourne – you can print it out and take it with you.

Make sure you complete the course of antibiotics. Never stop them early because you are feeling better.

4. To help maintain balance in your digestive system while taking antibiotics you can take a supplement of Saccharomyces boulardii (SB). This is a probiotic which is related to brewer’s yeast and is naturally resistant to antibiotics. Other probiotics such as acidophilus will be killed off by the antibiotic you are taking. In USA and Europe SB is sold over the counter in health food stores to prevent traveller’s diarrhoea. In Australia, there are several companies that sell it as a practitioner only product, so you will need to get it from a naturopath or GP. Many health food stores and pharmacies have a naturopath on site who will be able to supply it for you.

5. Rest, drink plenty of fluids and take care of yourself!

6. See an IBLC lactation consultant if you get more than one bout of mastitis. She will be able to work with you to resolve any issues causing the infection.

This post deals with severe mastitis requiring medical treatment. There is soooo much more to this issue that I want to write about. Diagnosis and misdignosis is another issue that deserves a post of its own. Then there is using natural therapies for the treatment of less severe mastitis. I’ll get to these over the coming weeks.

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