BREAST FEEDING 101

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BREAST FEEDING 101

As I recover from my second bout of mastitis, I feel an almost religious urge to write about breast infection today. It has been too long since my last “breastfeeding” installment and there seems to be a high flow of reader traffic searching “how+to+breastfeed”. So, to appease God… and my readers, here is the 3rd installment of Breast feeding 101…

MASTITIS

Courtesy http://grandrapidsnaturalliving.com/cabbage-in-your-bra/

  Breast changes in mastitis
 The first important thing to remember about mastitis is that if you are breastfeeding and feel feverish or flu-y, chances are you have mastitis.
– So feel your breasts and try to feel for any hard areas or any warm, tender areas, or check in the mirror to see if they look anything like the images above
The next important thing to remember is that not all mastitis is infective.
– There is a crazy policy in the medical world (God I’m such a Judas, forgive me Hippocrates) to treat every breastfeeding mom with mastitis with an antibiotic. I hope that after reading this you will think twice before blindly accepting an antibiotic. Sometimes you need one, please don’t get me wrong, but definitely not automatically and not always.
This is what the World Health Organisation has to say about “lactational mastitis”:
” Mastitis is an inflammatory condition of the breast, which may or may not be accompanied by infection. It is usually associated with lactation, so it is also called lactational mastitis or puerperal mastitis…
…Awareness is growing that inefficient removal of milk resulting from poor breastfeeding
technique is an important underlying cause, but mastitis remains synonymous with breast
infection in the minds of many health professionals. They are often unable to
help a woman with the condition to continue to breastfeed, and they may advise her
unnecessarily to stop.”
Mastitis can therefore be classified into 3 broad categories:
  • INFECTIVE

What this means in English is that the breast inflammation is caused by a germ (bacteria) in the breast tissue 

  • NON-INFECTIVE INFLAMMATION
the breast tissue is simply inflamed, but there is no germ causing an infection 
  • MILK STASIS

the symptoms are simply due to milk being blocked in the breast, like with engorgement or blocked ducts.

What are the symptoms?
 What happened to me was I woke up feeling like I had the flu. I spent a day in bed thinking “oh great this too… God really hates me”. You see this ’bout of flu’ followed a week of severely cracked nipples and painful engorged breasts. I had a crying newborn who couldn’t feed properly because I was in too much pain and if there’s line between sanity and postnatal depression, I was barely balancing on it.
My fever went up to 38.5 before it hit me “flu in a breastfeeding mum is mastitis unless proven otherwise!”. I checked my breasts and lo and behold my right breast (thankfully not the side with the worse cracking) had a hard, red swollen, tender area. I couldn’t guess how long it had been there because when you’ve just had a baby, the only thing you look at in the mirror is your baby in your arms (you’ll see). I panicked because I thought mastitis meant taking an antibiotic for sure and other than wanting to remain drug free while breastfeeding, I also feared that if baby got thrush as a side effect of the antibiotic, she would transfer it to my nipples and that would most likely end my thus far hellish breastfeeding career for good. I was also afraid that the dreaded breast abscess complication would soon follow. Needless to say that line before depression was becoming dangerously thin.

So symptoms….

FEVER
temperature of higher than 37.5 C

FEELING OF BEING SICK
run down, achy muscles, chills

BREAST CHANGES

   part or all of one breast is hot, painful, tender to touch, red or swollen

How do I manage it?

Ideally you should get your self-diagnosis confirmed by a doctor, midwife or lactation consultant. My mastitis was obvious, so I called my homeopath for help. Dr Rushmere suggested a remedy called Phytolacca and recommended a lactation consultant/physiotherapist who did house calls, Ruth Katzman. As I waited for Ruth, who could only come that evening, I took 1 Panado and 1 Nurofen tablet. (Panado for fever and pain and Nurofen for pain and inflammation) I had at this stage already had the dreaded Codeine side effect of constipation, so was staying far away from Myprodol. I knew I should be doing breast massage and cool (or was it warm?) compresses, but I felt too sick to move.

My midwife luckily did a house visit on that day so she brought me some phytolacca and bella donna and more importantly held me while I cried. She also counseled me and reassured me that if the sadness went on for too long, help was easy to find.

Ruth arrived later that day and with no idea what to expect, I instinctively breathed a sigh of relief. She took a full history of every problem I’d had since giving birth, including the constipation side effect and painful tear, and promised that she would cover each of my problems. She then watched me breastfeed and taught me to latch baby correctly, she let me do it myself a few times, correcting me each time till I got it right. She then lay me on the bed, covered me in towels, and using an ultrasound probe, forcefully massaged my engorged breasts from the outer edges toward the nipple, focusing mostly on the tender blocked area. I watched litres of milk come out of my breasts, and when she worked on the area that was blocked, the milk came out thick and in strands. After about half an hour of this she showed me how to massage them myself after a hot shower or bath and also how to apply hot cloths over them while I was feeding. She then got baby to drink from me at an angle that would best drain the affected area (in my case this happened to be with baby’s legs over my shoulder, while I lay on the bed). Apparently baby suckling is better treatment than any ultrasound. She also did some lazer therapy on my cracked nipples.

Ruth then showed me a few tricks to manage my constipation and vaginal tear. (I will hopefully get a chance to blog this at a later, less breast-centred date)

She also taught me how to feed baby from a cup, and left me a baby feeding cup she happened to have with her, and then she rearranged my feeding schedule so that I was efficiently draining my engorged breasts, while still giving my cracked nipples a rest with nipple shields intermittently, and she showed my exactly how to use my breast pump. She also left me the prescription for All Purpose Nipple Ointment, which cleared up the sore nipples in about 3 days. Believe me when I say, I owe this woman everything.

Ruth came again the next day to ensure that I was doing everything correctly and to give me another ultrasound massage. I was already feeling better and by the end of that day I wasn’t having any more fevers and the redness in my breast had disappeared. We were in agreement that there was never any need for antibiotics as there was never an infection, and also that the homeopathic remedy had definitely made an enormous difference in my healing. After that, I felt like a new person, ready to face the next hurdle!

So management
1. Continue feeding! And correct your latch! Baby feeding is best way to drain the blocked areas. In fact if you want to do the worst possible thing for yourself right now, then stop breastfeeding. It is NOT an option, and if you do have to stop feeding, do it after the mastitis has cleared up.
2. Rest.. HA HA I hear you say… but as much as you can. Feed in bed, get someone to stay with you, get a maid, order in, keep baby in bed with you… whatever it takes. And eat well and gets lots of fluids.
3. Heat. Warmth helps milk to flow before a feed and is also great for healing. For warm compresses use cloths soaked in hot water or poor hot water into nappies. The gel holds the warmth well, but don’t pour too much, the nappies swell more than you think. A warm bath with a few drops of lavender (washed off before nursing) or a hot shower has the same effect before feeding or expressing. You can also soak your breasts in a basin of hot water with some lavender or epsom salts.
4. Cold packs also help with pain between feeds, and you can use ice packs or packets of frozen veg. I put cabbage leaves in the freezer and later tried wet nappies in the freezer. The nappies are great because you can refreeze them easily and cabbage leaves are believed to work by releasing a chemical that is both anti-inflammatory and antibiotic. I have entered into numerous debates with doctors on this topic, as many believe it is old wives tale, and that it is simply the coolness of the leaf that helps. Read this article on a study done on the topic and decide for yourself http://www.breastfeedingonline.com/cabbage.shtml
5. Gentle massage. Massage from outer edges inward toward the nipple, using your warm compresses or during a bath or shower. It is also useful to massage toward the nipple while you feed.
6. Medication.
Don’t be afraid to use pain relief… pain restricts healing and worsens your chances of depression. I used Paracetomol and Ibuprofen for pain and fever.
Anti-inflammatories are self explanatory. I used Ibuprofen for this
Antibiotics are necessary only if there is an infection. So consider it if you have a persistent fever of more than 24 hours or if you are acutely ill. A breast abscess will also require antibiotics and possibly surgery. Doctors usually prescribe Flucloxacillin or Augmentin. Don’t forget to use a probiotic whenever you use an antibiotic.
Homeopathics work wonders if used correctly and I used Phytolacca for the breast inflammation and Belladonna for fever.
If you are open to alternative methods of management read this blog, I found it very accurate and well written: http://www.authenticparenting.info/2012/02/mastitis.html
7. Avoid tight constricting clothes and if possible sleep without a bra. I say this tongue in cheek because in my opinion it is impossible to sleep without a bra while your breasts are leaking milk everywhere and your nipples are cracked and over-sensitive. I bought a few elastic feeding bras like the ones from Yummy Mummy and ditched the bras with a very tight support strap across the boob, like the ones from Woolworths.
8. Empty the breast. Feed 2 hourly if possible and don’t neglect the other breast. Try to feed in different positions to drain all parts of the breast and if breastfeeding is impossible, express with a pump or by hand. This is the best time to start your milk storage with a bang, I’m still using milk I stored from my mastitis episode.
This was something I knew in theory but really needed to learn first hand… your body will eventually make just the right amount of milk for your baby at any given time. The key here is ‘eventually’. You see, it takes a few weeks to get the balance right, and for some it under produces and for other it over produces (AT FIRST). If it seems as though your breasts are going to burst, (like mine nearly did) express the extra milk and save it for later, but be patient, it won’t always be like this.
See what La Leche League have to say about oversupply: 
MY MASTITIS ROUTINE looked something like this…
I had a cracked nipple on the left and mastitis on the right
  Before feeding time I would apply heat or have a hot bath or shower and express some milk by hand. I would then pump express completely from the left and feed baby on the right in cross cradle hold, while applying warm cloths to my breast. Because I was resting the left side, I would then try to feed about 30ml of the expressed milk with a cup or syringe.
  I then applied cold packs and took whatever medication was due at the appropriate time.
  At the next feed I would once again apply heat then hand express, then feed on the right in a rugby hold. I would then feed baby on the left using a nipple shield.
  At the next feed I fed on the right again and then the left without a nipple shield. All the while applying All Purpose Nipple Ointment after each feed, and if she didn’t feed enough on the left I would empty my breast by expressing.

I kept a meticulous diary of exactly what happened at each feed and what happened in between. I also had a “colicky” baby I was trying to treat in the middle of all of this so  needed to keep track of her progress too. I recommend you write things down, if not to keep sane, then at least to keep you remembering what you did last.

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