Managing Mastitis
Published: 25 June 2023
Published: 25 June 2023
Mastitis is a spectrum of painful conditions that affects approximately one in five breastfeeding mothers in the first six months after birth (Mitchell et al. 2022; Liotta 2021).
Characterised by an area of inflamed breast tissue and accompanied by pain and fever, it’s a distressing condition that can negatively impact the ability to breastfeed.
Note: This article has been updated in response to updated guidelines from the Academy of Breastfeeding Medicine.
Mastitis is believed to be caused by inflammation of the breast tissue, leading to the narrowing of the milk ducts. This can occur due to hyperlactation (oversupply of breast milk) and/or mammary dysbiosis (disruption of the milk microbiome due to factors such as genetics and the use of antibiotics and probiotics) (Cook 2023; Minnesota WIC Program 2023; Mitchell et al. 2022).
In cases of infective mastitis, the bacteria responsible is usually Staphylococcus aureus. Other causative bacteria include beta-haemolytic Streptococcus, Escherichia coli and methicillin-resistant S. aureus (The Women’s 2020).
Mastitis should be suspected if a patient is experiencing:
(ABS 2023)
Treatment for mastitis should start at the first signs of the condition (ABS 2023).
Management should include:
(ABS 2023; Minnesota WIC Program 2023)
Paracetamol and ibuprofen are safe to take while breastfeeding and may help to alleviate pain (note, however, that aspirin is not safe to take while breastfeeding) (Pregnancy, Birth and Baby 2020).
Antibiotics should only be prescribed for bacterial mastitis; the use of antibiotics for inflammatory mastitis can disrupt the breast microbiome and result in bacterial mastitis (Mitchell et al. 2022).
Antibiotics are generally safe for breastfed infants; however, they should be monitored for any systemic issues during the antibiotic regimen (The Women’s 2020).
If the patient is severely unwell or is showing signs of sepsis, they will require antibiotics administered intravenously (The Women’s 2020).
Supporting the breastfeeding mother, or checking breast health if the mother chooses to bottle feed, is a core midwifery skill. However, when mastitis is suspected, the following observations become particularly important:
If not appropriately treated, mastitis can develop into a breast abscess (collection of pus in the breast).
While breastfeeding with mastitis can be an uncomfortable and painful experience, it’s important to maintain a normal breastfeeding routine (ABS 2023).
Make sure the infant is positioned and attached optimally, and start each feed on alternate breasts (ABS 2023).
Milk from the affected breast is safe for the infant to drink, although it may have a saltier taste (ABS 2023).
In some cases, the milk from the affected breast will flow more slowly. In order to help stimulate the let-down reflex, patients can try:
(ABS 2023)
If the breast still feels full following a feed, the patient should express to alleviate discomfort (ABS 2023).
Prevention is always better than cure, and maternity staff are ideally placed to offer advice to patients to reduce the risk of mastitis occurring.
The most important points being:
(ABS 2023)
Question 1 of 3
True or false: People with mastitis should continue breastfeeding.