Mastitis

I wish I knew all of the "what ifs" about nursing because it wasn't an easy start, let me tell you. Let's get in the "way, way back machine" and start at the very beginning. When I started nursing, I just went with the flow (tee hee...flow) and let MetaBaby nurse away. He latched on well and was doing a great job. I had a lot of milk -- possibly too much milk. At some point, just after I was recovering from my C-Section, I got a lump on my breast. After doing a lot of research online, I discovered it was probably a plugged duct, which Dr. Sears describes as follows:

Sometimes a milk duct leading from the milk-making cells to the nipple gets plugged, resulting in a tender lump beneath the areola. There may also be a wedge-shaped area of redness extending from the lump back towards the wall of the chest. Unlike mastitis, the pain comes and goes with a plugged duct, and unless the duct is infected, you will not feel generally ill. If left untreated, however, a plugged duct may become infected, resulting in mastitis, infection, or a breast abscess.

I tried the following methods to clear the duct, which were a combination of tips I read online, as well as suggestions from my lactation consultant.

• Nursed from the affected side first at every nursing session.
  
• Pressure massage the lump in the direction of the nipple.
  
• Apply moist heat compresses or take a shower before nursing.
  
• Wear a non-restrictive nursing bra.
  
• Treat self like you have a cold: get a lot of rest (nurse baby in bed), drink fluids, take echinacea, lecithin, and extra vitamin C & E.
  
• Position nursing baby's chin towards plugged duct.

Despite my best efforts, the lump only got worse. I didn't have a fever, so my lactation consultant and I were consoled in knowing that I didn't have mastitis. She really helped me exhaust the natural methods to clear the duct. While I really didn't want antibiotics, in the end I had no choice. I started on them on a Friday, and the next day, I noticed there was an abscess in the affected area. It turns out that I not only had mastitis, it had developed into an abscess, which in case it's not obvious, hurts like you would not believe. A portion of it drained that weekend, and I went to see my ob/gyn on Monday.

She was pretty nonchalant about it until she saw it. She gasped in what I can only assume was horror, and sent me straight to the surgeon two floors down. He took a look and sent me to get an ultrasound to see how much fluid was left and if it was worth draining. It turns out there wasn't much left, but he was pretty concerned, so he drained it to allow the area to heal properly. Out-patient surgery...eek! The sound of that scared me, but it turns out it wasn't too bad. It was quick, and MetaBaby was cooing in his stroller a few feet away. I won't say it was painless, but it didn't hurt as much as the abscess, so I just coped. I went back for a few follow ups and it seemed to have cleared up pretty well. Once I stop nursing, I need to go back and get a mammogram to evaluate the health of the breast when it's off duty and milk free.

The moral of the story?

• You can have mastitis even if you don't have a fever or flu-like symptoms.
  
• When you start nursing, avoid engorgement as much as possible. Allow you're baby to drain each side well, but don't use a pump to finish the job as this will impact your milk supply.
  
• Cabbage leaves on your breasts serve to reduce your milk supply. They're great to relieve engorgement, but do so sparingly so you don't overdo it.
  
• Wear a bra that doesn't dig into any sensitive areas, and avoid underwires entirely, or at least until after your milk supply settles.

Dr Sears' list of mastitis symptoms:

• Part or all of the breast is intensely painful, hot, tender, red, and swollen. Some mothers can pinpoint a definite area of inflammation, while at other times the entire breast is tender.
  
• You feel tired, run down, achy, have chills or think you have the flu. A breastfeeding mother who thinks she has the flu probably has mastitis. Mothers with mastitis will sometimes experience these flu-like symptoms, even before they get a fever or notice breast tenderness.
  
• You have chills or feel feverish, or your temperature is 101F or higher. These symptoms suggest that you have an infection.
  
• You are feeling progressively worse, your breasts are growing more tender, and your fever is becoming more pronounced.
• With simple engorgement, a plugged duct, or mastitis without infection, you gradually feel better instead of worse.
  
• Recent events have set you up for mastitis: cracked or bleeding nipples, stress or getting run down, missed feedings or longer intervals between feedings.

Potential causes, per KellyMom:

• Engorgement or inadequate milk removal (due to latching problems, ineffective suck, tongue-tie or other anatomical variations, nipple pain, sleepy or distracted baby, oversupply, hurried feedings, limiting baby's time at the breast, nipple shield use, twins or higher order multiples, blocked nipple pore, etc.).
  
• Infrequent/skipped feedings (due to nipple pain, teething, pacifier overuse, busy mom, return to work, baby suddenly sleeping longer, scheduling, supplementing, abrupt weaning, etc.).
  
• Pressure on the duct (from fingers, tight bra or clothing, prone sleeping, diaper bag, etc.).
  
• Inflammation (from injury, bacterial/yeast infection, or allergy).
  
• Stress, fatigue, anemia, weakened immunity

The Pump Station's list of possible causes:

• Missed or irregular feedings and/or an unusually long interval between feedings.
  
• Pressing the breast to provide nostril space for the baby.
  
• Wearing a tight or poorly fitting bra that impedes milk flow.
  
• Having an overabundant milk supply and insufficient breast drainage.
  
• Practicing vigorous upper arm exercise.
  
• Extreme exhaustion.
  
• Rapid weaning.

I hope none of you ever have to deal with any of these issues, but you're better off if you know what you're dealing with. That said, this post is only a reflection of my experiences. Be sure to contact your doctor if you have any serious symptoms because time is of the essence. The sooner you resolve the problem, the less drastic your course of action.

Note: October is Breast Cancer Awareness month. Go check out Mom's post at What Works For Us on breast cancer facts and statistics. The numbers are staggering.