Mastitis affects about one in five breastfeeding women, but experts say there are treatment knowledge gaps
Just a few weeks after giving birth to her son, Katya Daniel’s right breast became painful, red and hot to touch.
She quickly developed nausea and a fever.
“I got up one night and basically crawled to the toilet because I felt so dizzy,” Ms Daniel said.
“I felt like I was going to pass out and when I started to feed him on that breast, it was so painful when he latched.”
Ms Daniel suspected she had mastitis — inflammation of the breast tissue commonly caused by a blocked milk duct during breastfeeding.
She had been seeing a physiotherapist during her pregnancy so booked an urgent appointment and was given ultrasound therapy to try to unclog the duct.
But the mastitis progressed and her lactation consultant sent her straight to hospital.
“By the time that I actually presented to emergency, I was really quite unwell. “
Ms Daniel had developed an abscess in her breast and was in hospital on an IV for antibiotics and pain relief for six days, followed by three months of having needles inserted into her breast to drain the blockages.
“Every time I had the aspiration, which were quite painful, I was under local anaesthetic.
“Over three months, I had nine drainages … so it took quite a lot out of me.”
‘I didn’t have any personal stories to draw on’
Ms Daniel worked in healthcare alongside midwives and obstetricians.
Even though she “had a hunch” she had mastitis when she first noticed her symptoms, she said she still did not know enough about the condition.
“When I had my experience, I was looking for information and I wasn’t able to find a lot,” she said.
“I didn’t have any personal stories to draw on, like here’s someone that’s overcome it to give me hope.”
For fellow Melbourne mother Holly Breheny, ultrasound therapy did work.
Ms Breheny was diagnosed with mastitis with her second baby, and on reflection, believes she may have had several bouts with her first.
Both mums agreed there was not enough education for parents about the symptoms and treatment options for mastitis.
“Probably a lot of it’s word of mouth and if you’re lucky enough to be in the circles that know, that helps,” Ms Breheny said.
“I think it would be really valuable to be something that maybe people are told about at birth, probably, or even beforehand.”
Researchers look at whether common treatment works
About one in five lactating mothers are affected by mastitis, according to the Australian Breastfeeding Association, most likely during the first few months after giving birth.
Mastitis causes flu-like symptoms, including shivers, aching bones and a general feeling of being unwell.
There is often a sore spot on the breast, redness, pain and swelling.
It can develop quickly.
Women’s health physiotherapist Emma Heron said it could have a significant impact on a mother’s physical health.
“But also their mental health and also the cessation or early, I guess, discontinuation of breastfeeding,” Ms Heron said.
“And the benefits of breastfeeding to both mum and bub are well established.”
Ms Heron is also a PhD student at the School of Allied Health at Curtin University.
She and the Monash School of Rural Health are recruiting Melbourne mothers for a trial into whether therapeutic ultrasound is an effective treatment for mastitis and other Inflammatory Conditions of the Lactating Breast (ICLB), such as engorgement and blocked ducts.
Ultrasound therapy involves using sound waves to penetrate deep into the lactation glands to try to break down blockages.
Ms Heron said it was the most common treatment used by Australian physiotherapists for ICLB, but its application could vary in the intensity at which the soundwaves are delivered and the number of treatments given to patients.
“It’s a tricky area for research to be conducted,” she said.
“Funding is one side of it but also women with mastitis and these conditions are often acutely unwell and they’re caring for a little baby, if not other children at home as well, so it’s hard to recruit women and conduct research in this area.”
Co-leader of the study, Monash’s Adelle McArdle said the international Academy of Breastfeeding Medicine revised its protocols for mastitis for the first time in 20 years in 2022 to include the use of ultrasound as a therapy.
But she agreed there was a lack of evidence around how often treatments should be administered and how long it should be used.
“Some hospitals may recommend it. Some hospitals we know around Australia don’t recommend it. Some GPS would recommend it. We know some GPS don’t,” Dr McArdle said.
“There’s a lot of research out there about the huge benefits of breastfeeding, both for the breastfeeding parent … but also for the child.
“But there’s not really great evidence on how to treat these conditions.”
GPs, health professionals need more evidence
The lack of research about the effectiveness of ultrasound therapy is stopping the Australian Breastfeeding Association (ABA) from making a decision on whether to recommend it as a treatment for mastitis.
“There are some studies, but they are poor in quality in that they’re small sample sizes, they weren’t randomised controlled trials and so ABA doesn’t recommend ultrasound at this stage,” said executive director Victoria Marshall-Cerins.
She said there were also gaps in the medical community’s understanding of best practice care of breastfeeding mums and babies.
“More could be done there to support health professionals so that when women present with complications with lactation, they know exactly how to provide support and care,” Ms Marshall-Cerins said
A spokesperson for the Royal Australian College of General Practitioners said GPs followed the official therapeutic guidelines for mastitis which focused on the prescription of antibiotics and the use of cold packs and anti-inflammatory medication.
The Australian Physiotherapy Association said it looked forward to seeing the results of the ultrasound trial.
“The APA welcomes further robust exploration into the application of (therapeutic ultrasound) across different settings and at different intensities,” the association said.
How to minimise the risk of developing mastitis
Melbourne’s Royal Women’s Hospital says it can be difficult to pinpoint what causes milk duct blockage.
It says some reasons can be long gaps between feeds or difficulty feeding, nipple damage, suddenly stopping breastfeeding and wearing tight or underwire bras that put pressure on the breasts.
The Australian Breastfeeding Association recommends a number of steps to try to avoid developing mastitis:
- Allow a baby to feed as long and as often as they want
- Start each feed on alternate sides to ensure milk is removed from both breasts
- Immediately treat sore or damaged nipples by lightly pressing with a warm washcloth, dabbing with a little breastmilk and keeping them dry between feeds
- Change breast pads regularly to avoid holding moisture against the skin
- Get as much rest as possible, drink plenty of water and eat nutritious foods
- Weaning should be done gradually by reducing breastfeeds over several weeks
- And despite the mantra “never wake a sleeping baby”, the association says avoiding mastitis is an exception. It says babies should be woken for a feed if one or both breasts become uncomfortably full. If your baby is not feeding well, it recommends expressing to remove milk.
If someone thinks they have mastitis, the Association urges them to start treatment as soon as they notice a lump, sore spot or red area on the breast. It says early treatment can help a mother feel less ill and recover faster.
The Royal Women’s Hospital suggests wrapping a cool pack in cloth and placing it on the breast after feeding or expressing to help reduce inflammation.
It says paracetamol or ibuprofen is safe to take while breastfeeding to help with the pain.
Healthdirect.gov.au suggests a warm shower can also relieve symptoms, and applying a warm treatment just before feeding for a few minutes can help to trigger the “let-down” reflex which will help to clear the blockage and relieve pain.
If soreness persists, the Association says mothers should speak to their midwife, lactation consultant or doctor before using creams or ointments.
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