Breastfed Matters:
Dealing With Mastitis
by Michelle Branco

Q: I am nursing my seven-month-old, but have been battling mastitis and plugged ducts for over two months now. Every time I think I have finally beaten it, it comes back with a vengeance – I can’t deal with constantly feeling sore and sick anymore. What should I do?

A: Let’s get one thing straight right off: Feeling well and being healthy should not require weaning your baby. Breastfeeding should make mothering easier and improve your family’s health.

Plugged ducts are often the canary in the coal mine that tells mothers something is not quite right with their breastfeeding relationship. Milk ducts that are flowing freely and often don’t become plugged; generally, infections like mastitis occur after the plugged duct has a made a “nest” for them.

Are you feeding often enough? If you abruptly start going longer between feedings, even for just part of the day, you may find that you need to express some milk (or shorten that interval by nursing). This sometimes comes up when Mom returns to baby-free activity like going to the gym or work.

Are you pumping? Regular pumping can contribute to plugged ducts in some women by increasing milk production while being less effective than her baby at emptying the breast. If you are trying to build a stash, try pumping once a day at around the same time. Make sure that your pump is fitted properly, is operating correctly (suction can slowly die off), and that you are not creating pinch points by pushing the pump into your breast as you pump.

For clearing plugged ducts, pumps can be useful because they keep going longer than a baby will once full! Many mothers find that for plugs, a manual pump where they control the pace and suction helps.

Are you getting enough rest? Just like a cold will often catch up to us when we’ve been burning the candle at both ends, exhaustion and stress often precede a bout of plugged ducts and mastitis.

Is your baby breastfeeding effectively? The first sign of a baby not feeding effectively is usually poor weight gain – but not always. Having breastfeeding assessed by a lactation consultant (IBCLC) will help to identify the root cause and allow you to create a plan to address it.

Do you have “sticky” milk? While breastfeeding mothers can largely eat whatever diet they prefer, diets high in processed foods that contain large amounts of saturated and trans fats do affect the type of fat contained in breast milk. These types of fats seem to be more prone to creating blockages. The foods they come in are also not generally particularly nutritious, doing nothing to prevent infection and increase overall well-being.

Are you creating blockages? When I was breastfeeding, I had a particular handbag that I really loved, but I didn’t use very often because I was usually wearing my babies. As they got older and walked more, I did use it for fancier outings – and invariably, the next few days I would be working out a plugged duct in the same place in my right breast. It took me several bouts to figure out there was something about the way the strap pressed against my shoulder that caused a plug – every time. I’ve heard similar stories about backpacks, bras, and even baby carriers. While going bra-free is often helpful, mothers with very large breasts may prefer wearing a soft, comfortable support.

Here are some preventative measures:

• Get help with the breastfeeding: Minor adjustments to latching or the identification of physical barriers to good milk transfer (like tongue tie) can help you get back to a pleasant and enjoyable breastfeeding relationship.

• Protect your health: Eating a nutritious whole foods diet, getting enough rest and addressing any underlying health concerns you have will not only leave you in the best position to fight off infection, you’ll be better able to enjoy mothering your baby.

• Lecithin: Lecithin is a food additive used as an emulsifier. It is thought to make the breast milk less sticky when it is converted into choline in the body. Soy lecithin is widely available in both capsule and granules – 1200mg taken three or four times a day is the usual dosage. If you avoid soy (which is mostly GMO), you can also now find sunflower-based lecithin.

• Use massage or vibration at the first sign of a plugged duct: Keep the milk moving using gentle massage. Some mothers find that the vibration of an electric toothbrush or personal massager keeps things going.

• Address inflammation immediately: If a plugged duct is heading towards infection, take steps to reduce the inflammation early. And remember that it usually won’t get better by doing the same things that caused the duct to get plugged in the first place. If mastitis does occur despite your best efforts, treat it with the seriousness it deserves.

• Get to bed and call in the troops: Your focus must be on recovery, which includes breastfeeding often and getting as much rest as possible. Someone else should be doing everything else.

• Nutritious, comforting foods: This is the time for broths and immune-boosting foods like garlic and ginger. Get plenty of fluids and begin taking probiotics if you don’t already.

• Cooling poultices: Grated potato laid over the hot breast until it warms is a folk remedy that many mothers report is very effective; however, any cool compress will provide comfort.

• The right antibiotics: If the infection does not clear with the measures above, antibiotics may be needed. Most antibiotics are compatible with breastfeeding; abruptly stopping breastfeeding (even if you pump instead) is likely to make things worse. Make sure that you get an appropriate prescription and take it all the way through.

Breastfeeding should be enjoyable for both you and your baby – and enhance your health as well as your baby’s. Constant infection is a sign that there is something wrong. I hope that you can figure it out and continue to enjoy this relationship until you are both ready to wean.

Michelle Branco is an International Board Certified Lactation Consultant in private practice, a La Leche League Leader, and mother to Isabelle and Thomas, both breastfed. She provides evidence-based breastfeeding care to mothers at Latch Lactation through phone, email, and in-person consultations.