Whatever the cause of a sore breast, there are three basic rules to follow: Apply HEAT, get plenty of REST, and keep the breast comfortably empty by FREQUENT NURSING.
If you notice a tender spot, redness, painful lump, or swelling in the breast, it may be a plugged duct. Frequently this arises from improper positioning of the of the baby at the breast . (See the section below on positioning). Often a plugged duct occurs when the time between nursings is too long because of the baby sleeping through the night, supplementary bottles, or over use of a soother. Another contributing factor is constriction by a overly tight bra or the bottom band of a fastened, non-nursing bra which has been lifted over the breast for nursing. Sometimes a plugged duct is caused by dried milk secretions covering one of the nipple openings.
- Apply Heat, wet or dry, e.g. warm showers, hot wet packs, or a heating pad. Remove any dried milk on the nipples by soaking with plain warm water. Massage the area gently and nurse the baby or hand express some milk after treating the area with warmth.
- Nurse the baby on the affected side first at each feeding. Nurse often and long enough to keep the milk moving through the ducts. The more frequently you nurse the better. Encourage the baby to nurse at least every two hours, including during the night, for as long as the breast is tender.
- Slow down, get more rest, stay off your feet, and stay in bed with the baby, if possible. Rest the mother, not the breast.
- Loosen constrictive clothing, especially your bra, or discontinue wearing your bra for a few days. If plugged ducts recur frequently, you may want to try a bra of a different style or size, such as one with a fuller deeper cup.
- Check the baby's position at the breast. Baby's whole body should be facing you and he should have at least an inch or more of the areola (dark area surrounding the nipple) in his mouth. Try changing nursing position from time to time, e.g., lie down, sit up, use the "football hold", etc. (Click Here or see the WOMANLY ART OF BREASTFEEDING, available from La Leche League). One position that some mothers have found helpful in clearing a plugged duct is to place the baby in the middle of a bed or on a quilt on the floor and get down on hands and knees, allowing the breasts to fall free from the rib cage. In this position you can lean over the baby to nurse.
A plugged duct will usually show improvement in twenty-four hours if the treatment described here is followed, but we suggest that you "hibernate" by taking it easy for several days, as a plugged duct may lower your resistance and contribute to a breast infection.
If you have the type of soreness described as a plugged duct, accompanied by a fever or flu-like symptoms (feeling tires, achy, and run down) you may have the beginning of a breast infection/mastitis.
It is best to start treating a breast infection as soon as possible and it is safe to continue nursing on an infected breast. Studies show that the baby is not harmed in any way by nursing when his mother has a breast infection.
Antibodies found in the milk protect the baby from the bacteria causing the breast infection. Moreover sudden weaning makes the infection worse. Research on mothers with breast infections shows that continued nursing helps to clear the infection much more quickly. Follow the treatment outlined for a plugged duct: Heat, Rest and Frequent Nursing.
Generally if the infection gets steadily worse, or noticeable improvement does not occur within 24 hours, it is wise to contact your doctor who may prescribe an antibiotic. Even if an antibiotic is necessary, continuing to breastfeed is best for you and your baby. Most antibiotics are compatible with breastfeeding. If an antibiotic is prescribed, be sure to take it for the whole course of the treatment.
With some types of breast infection, a doctor should be contacted without delay. For example, if both breasts are affected, if the nipple looks infected, if there is any pus or blood in the milk, if there are red streaks near the sore area, or if the symptoms came on suddenly and severely, these re signs of a bacterial infection that should be checked out by a doctor immediately.
Some mothers confuse a breast infection with a breast abscess. An abscess is an infection which has "come to a head" and it either requires incision and drainage, or may open by itself and drain. Rarely does a breast infection develop into an abscess, and it is much less likely to do so when the treatment outlined above is begun immediately.
If an abscess does develop, the doctor may decide to open and drain it. If, however, you are hospitalised for a few hours, you should not have to be separated from your baby for long. In some cases the baby can continue nursing on the affected breast, if his mouth does not come in contact with the incision. If the incision is near the nipple, you can continue nursing on the unaffected side and hand-express the milk from the affected breast while the abscess is draining. You do not want the breast to become engorged.
In a few days, you will probably be able to resume nursing on the affected breast. Keep in touch with your medical advisor and your La Leche League Leader until breastfeeding is completely re-established.
Breast infections which recur within a few weeks of each other are often the result of the original infection not being completely cleared. By exploring possible causes of breast infections, you can work towards preventing them.
Factors to be considered include:
- General Health - if you are feeling run down or tired, a medical check up with blood count is advisable. Anaemia is a common contributor to repeat infections. Some doctors may suggest the addition of vitamin C to combat infections. The possibility of thrush might also be considered.
- Nutrition - Extra vitamins cannot replace a good daily diet. If you are not already in the habit of eating well, this is a good time to start. Don't hesitate to enjoy nutritious snacks throughout the day, and drink plenty of liquids. Include fresh fruits and vegetables and whole grains in your daily diet. (See chapter on nutrition in the WOMANLY ART OF BREASTFEEDING, available through La Leche League Groups).
- Pressure on the Breast - Avoid anything that puts constant or sustained pressure on the breast. Possibilities include a tight bra, a bra that does not support the breasts well, a baby carrier with constricting straps, Pressure on the breasts from sleeping on your stomach, pressing down on the breast with a finger during feeding.
- Extra Activities - Avoid overdoing extra activities such as cleaning, entertaining and involvement in organisations. Relax and enjoy your baby, and ask someone else to do these jobs for a while.
- Attitudes and Emotions - The early weeks at home are a period of adjustment for you and your baby. Getting off to a good start can do much to prevent breast infections both now and later. Depend on family members for help and support, and to act as buffers against too many visitors and extra activities. "Hibernate" for a while with your baby, feeling free to cuddle him and love him as much as you like. Those nice warm, motherly feelings help your milk to flow freely and may help to prevent plugged ducts. Emotional well-being affects physical health as well.
By considering all the possible causes of breast infections, you may be able to determine why they are recurring. It is always helpful to discuss the situation with your health care professional or a La Leche League Leader as they may be able to offer further suggestions.
BREASTFEEDING CAN AND SHOULD CONTINUE
At one time it was standard procedure to recommend weaning to a mother with a breast infection. However, even a temporary weaning is stressful to the nursing couple, particularly when a mother is not feeling well. As for baby, antibodies in the mother's milk provide protection from bacteria associated with an infection. Experience has shown that a breast infection clears faster when breastfeeding is continued and the baby is nursed frequently. There is also less risk of an infection developing into an abscess.
In almost all cases, the best thing a mother with a plugged duct or breast infection can do for herself and her baby is to keep nursing.
Of necessity the information in this leaflet is of a general nature. If you need help or support, or if you have a specific concern, contact your local La Leche League Leader.
Although babies come in both genders, in this leaflet we have referred to baby as "he", for clarity's sake, since mother is unquestionably "she".
You can get a copy of this and other La Leche League of Ireland leaflets from a La Leche League Leader or at any of our meetings. Click here to find your nearest Group.
Do get in touch, we look forward to meeting you!
ŠText and Illustration La Leche League of Ireland
