Mastitis Survival Guide: Postpartum Breast Care

By employing practical home remedies at the first signs of sore or engorged breasts, you may avoid developing serious mastitis during your breastfeeding time. Many mothers have avoided hospitalization for mastitis or breast abscess, by beginning home treatments early and doing them often.  

Rest, continued breastfeeding, a compress of strong ginger root tea or warm mashed ginger, sunflower lecithin, cabbage leaves, are all age-old remedies for painful breasts shared by doulas, midwives, aunties, mothers and grandmothers from the beginning of human existence. 

First aid for breastfeeding challenges:

• Rest: Breastfeeding problems, engorgement, plugged ducts and mastitis, often begin with the mother going for an outing before she is ready. She may become over tired. Perhaps she has been sitting in a too hot or cold air-conditioned car. Skipping or delaying baby’s feedings, becoming even a bit dehydrated, can spiral into painful breastfeeding challenges. Nearly every time I have had an emergency call from a new mother, suffering because her breasts are hot, red, and painful, she tells me that she went for an outing, the day before. The first step to remedy painful breastfeeding issues is going to bed with your baby. Encourage your baby to feed often on both breasts, especially the painful one.  Rest, rest, REST and drink plenty of water (no ice drinks, please).
• Hot ginger compress: To create a hot ginger compress, first grate a 5 to 8 cm knot of ginger root into a deep bowl and pour 1 cup of boiling water over the ginger. Make a compress by soaking a small clean white cotton cloth towel in the ginger and apply to your breasts. Use two small cotton cloth towels, so that one is compressing your sore breast, while the second one is soaking in the hot ginger. You may keep adding more hot water. I keep a thermos of hot water handy for this. Or you may simply place the warm, grated ginger mash directly on your breasts, and put a hot water bottle on top of the compress. Keep doing the warm ginger compresses for a minimum of 30 to 40 minutes or more, to improve circulation which will move the stagnant milk and give great relief. Repeat this treatment often, until all signs of discomfort are well gone.  
• Cabbage leaves: Applying cabbage leaves directly on breasts has been scientifically shown to reduce engorgement. It helps mothers with cracked nipples as well.  
• Sunflower lecithin: Organic Sunflower Lecithin is a natural fat emulsifier. Keep some on hand and at any sign of discomfort from engorgement or plugged milk ducts. You may take 1 capsule (1,200 mg) 3 to 4 times per day. It will help keep breastmilk from becoming sticky and prevent it from clumping. After there are no more discomforts or blockages of your milk, reduce the dose to 1 capsule 2 times per day.  After another week free of pain and engorgement, reduce to 1 capsule per day, for a few more days. 

Things to avoid

• Cold: When milk becomes blocked up inside your breasts it causes plugged milk ducts leading to engorgement, and if left untreated may cause mastitis, the last thing you need is to compound the stagnation problem by applying ice. I know some lactation consultants advise mothers to ice their sore engorged breasts for 15 minutes. All too often after following this advice, the mother who is suffering even more, calls me for a consult. I birthed five babies and breastfed each of the for 4 or more years, plus I have 28 years of experience as a primary care midwife and 9 years as a doula. After all this experience, I do NOT recommend ice for engorged breasts, full stop! Cold can cause circulation and milk to stagnate. We see many more cases of engorged breasts in the summertime, when people are sleeping in air conditioned bedrooms.  If you must use aircon, keep the temperature moderate for the comfort and health of your baby and your breasts. 
• Tight bras: Tight bras and wet bathing suits should be avoided. Clothing and underwires that press on your breasts can plug up and block your milk ducts, causing a cascade of painful problems.  Even your usually comfortable yoga bra may be too tight now that you are lactating.  
• Exhaustion: Again, and again when mothers overdo it, and become tired, breastfeeding issues follow. You may think that getting back to your favorite practice of tennis or power yoga, will be fun, so you find a babysitter, and venture out for a couple of hours. Maybe you even pumped your milk, so that your baby would be satisfied during your absence. Only to find yourself facing painful engorged breasts the next day. Please take your full 42 days of BabyMoon at home, reenter the work-a-day world slowly, in baby steps.  I advocate for a full 6 moths of paid maternity leave, so that MotherBaby may be supported to exclusively breastfeed for the first 6 months of a baby’s life. (As recommended by World Health Organization).
• Junk Food: Foods that are full of sugar and packed with empty calories, can deplete your energy, lower your immune response, and leave you open to breastfeeding problems.
• Broken heart: Emotional upsets are powerful, and a broken heart can cause breastfeeding challenges. It’s important that all mothers have a circle of support from their family, friends and community. When you hurt the mother, you harm the baby as well. Being kind is staying human. I navigated the shark infested waters of divorce, while breastfeeding, it was so painful that I find no words to tell the story. My circle of SisStars kept me going in a million ways, including coming over with some ginger roots to make compresses for my painfully engorged breasts. They fed me, my children and restored my belief in myself. 

Dealing with engorgement 

Just when you think you’ve felt it all—pregnancy, contractions, the birth itself, stitches, or skid marks—and you figure it’s easy from here on out, you wake up in the morning, eager to cuddle your baby, and you feel as if a two-ton truck is sitting on your chest. You may also be running a low-grade fever. 

You are engorged. Sometimes overnight a tremendous amount of hormonal activity caused your milk to come in. My milk dropped in, like a lead doughnut. All humor aside, sometimes it hurts. This early stage of motherhood is painful for some women, while others experience no discomfort at all. Some women have different experiences with different babies.  Remember that once your milk becomes backed up you can quickly become engorged.  If left untreated, you can develop mastitis, a much more acute condition.  

At the first sign of engorgement, go to bed with your baby. Mother Nature is letting you know that you need to rest and stay centered.  If you are breastfeeding and experience a lot of pain, it does not mean you are failing at breastfeeding. It does mean that you will need extra encouragement and help to persevere. 

The best remedy for engorgement is prevention. Prevention is best accomplished by skin-to-skin contact with baby, early initiation of breastfeeding and frequent feeds. Because it was once hospital policy to separate mother and baby after the birth, and babies were given supplemental feedings of infant formula in the nurseries, engorgement was thought to be normal. One is less likely to become painfully engorged if separation from baby never occurs. Breastfeed baby frequently and on-demand and learn to position the baby correctly for a good latch while feeding.

If you do get engorged, you must persevere in letting the baby feed at your breasts. Your baby is the best possible cure. If you have pain, when you put your little one to your rock-hard breast, it hurts even more. But you must nurse often and from both breasts to relieve engorgement. Do not avoid nursing your baby on the side that hurts the most; this will make it worse. Even the areolae around your nipples can be swollen. If the baby can’t get well attached to your overly full breasts to take out enough milk to bring you relief, don’t give up. Your partner can gently suck out the milk, or you may pump out some to relieve the internal pressure.  However, don’t pump too much, as your breasts work on a supply and demand system, the more you pump, the more milk you will produce tomorrow! Pump just enough to be more comfortable and to soften your breasts, so baby can get properly latched on. 

Warm showers are helpful when the breasts become hard and painful. Let the milk flow in the shower to relieve the pressure. Then breastfeed baby, taking a deep, cleansing breaths as the baby latches on, because that first latch can cause toe curling pain.  Following a dairy farmer’s trick, especially if you have had painful engorgement with previous births, may help to lessen your discomfort: Farmers give new mother goats no alfalfa on days two and three postpartum. This is because alfalfa increases milk production tremendously. So, on day two to three postpartum and anytime you feel engorged or have any breast discomfort, eat no alfalfa sprouts. If you feel your milk supply is low, alfalfa and moringa are good galactagogues.  

An effective homeopathic remedy for engorged breasts is Phytolacca 30X, which is prepared pokeweed root. This remedy may be purchased without a prescription at drugstores, some health-food stores, and herb shops. At the first sign of hot, swollen breasts and/or painful breasts, take according to package directions or follow the advice of your homeopathic healthcare giver. 

Engorged breasts are very sensitive. Centering your nipple in baby’s mouth reduces the pain. If you experience severe pain while nursing, you may consider taking acetaminophen (aspirin is not advised for new mothers due to its anticoagulant effect) about twenty minutes before feeding. Consult your health-care giver before taking this or any other over-the-counter products. 

If you have a brand-new baby, take heart, even if these suggestions don’t help much, keep in mind that the pain goes away within a day or two or so. Your hormones will stabilize and balance the signals sent to your milk-producing glands. With some practice and time, breastfeeding will not hurt over the long run. Engorgement can occur at any time during the period you are breastfeeding, but most often it happens when you are first beginning or when you miss feedings, especially when you are weaning your baby and cutting back the number of feedings. Following the advice given here will help whenever engorgement occurs. Someday you will be telling an expectant mother about the joys and trials of early motherhood and may even forget to mention engorgement. 

When you have cracked or sore nipples 

To prevent sore nipples when first starting to breastfeed, the most important thing is to help baby to attach well from the very first feed. This involves getting the baby to open his or her mouth very wide before latching on. If the breasts are not over-full, it is easier for baby to open wide and get well attached. 

If baby pulls and bites, it is sometimes helpful to start your milk flowing by hand before putting her to your breast. Do this by massaging your breasts or taking a warm shower. Pulling the baby off too quickly is another cause of nipple injury and soreness. When removing your nipple from baby’s mouth, break the suction gently by pressing your breast away from the corner of her mouth with your finger, leaning forward, toward baby. This is a better way to remove her from your breast than pulling forcefully away. Even better, allow your baby to suckle until s/he is totally satisfied simply lets go of your nipple.  

Treat cracked nipples by applying a little bit of your own vitamin- rich colostrum or breast milk. Keep your nipples clean and dry between feedings, but don’t wash with soap. Soap dries out the nipples, further compounding the problem of cracked nipples—and your baby won’t like the taste. Don’t forget to nurse on both sides, even if one breast is sorer than the other. Don’t apply tea bags to your sore nipples. The pure (pesticide free) lanolin ointment is affordable and has been endorsed by La Leche League International. It can be found in many drug- stores and is hypoallergenic. It does not need to be washed off before breastfeeding. Only apply a tiny bit on your nipples, big globs of lanolin ointment too generously applied, may make your baby feel like choking.  

What to do about plugged ducts 

If you notice a tender area or a lump in your breast that is sore and may be hot, you probably have a plugged duct. This can happen when your baby decides to sleep through a night. Your breasts may be accustomed to being sucked upon several times during the night. An overly tight bra or damp bathing suit can press on a milk duct and clog it. Avoid letting your baby tweak and twist your nipples, this can also cause plugged milk ducts. Lack of rest, however, is what I consider the leading cause of plugged ducts. Sometimes when they occur, you cannot figure out their cause. 

The first thing to do is downsize your stress level. Let all unessential responsibilities become someone else’s job. Plugged ducts can develop into mastitis if not cared for properly. Don’t try to do anything more than be with the baby. Nurse often and long. Also gently massage the hardened area while your baby is nursing. This helps move the stagnant milk along and out. A continual flow of milk will loosen the duct that is plugged. Rest and a hot soothing bath are good medicine. This is the time to take homeopathic Phytolacca 30c and sunflower lecithin. 

Breast infections, the dreaded mastitis

Inflammation, soreness, redness, or excess heat anywhere on your breast indicates that you have mastitis. If your breasts become infected, don’t stop nursing your baby. Unfortunately, some people are still quick to recommend that mothers with mastitis stop breastfeeding. Because mastitis is often caused by incorrect milk flow, discontinuing is not only unnecessary but makes things worse in most cases. The pain from breast infections can be a throbbing, burning sensation. Fever and a low level of energy often accompany the infection. Plugged ducts, poor diet, lack of rest, emotional stress, or a weakened immune system can all lead to breast infection. 

Get help from your health-care giver. If you need to be treated with antibiotics, make sure the medication is safe for your baby. Tell your doctor that you are breastfeeding and that it is imperative you get an antibiotic compatible with breastfeeding. I repeat, do not stop breastfeeding. By continuing to feed your baby, you will recover more quickly, without sacrificing your nursing relationship. If you possibly can, let the baby nurse on the sore side first. The baby’s initial sucking is more efficient and will keep the milk flowing in the affected breast. Drink plenty of liquids to help flush toxins from the infection out of your body and to promote healing. 

To prevent abscess, immediately upon noticing signs of mastitis: rest, employ the first aid measures described here, stay well hydrated, eat well, keep your milk flowing by feeding your baby more often or expressing your milk, and use a variety of nursing positions to ensure that all your milk ducts are being used. If a fever should develop, call your health provider immediately. 

If you get an abscess 

Breast abscess are a complication of mastitis, especially if it is not treated quickly. Abscess is a painful build-up of pus in the breast caused by an infection. If you feel a hard red hot painful mass on your breast, you likely have an abscess, one of the biggest challenges for lactating people. If you find pus draining from your infected breast, wash gently with water and allow it to air-dry. 

The fastest treatment is antibiotics.  But if you quickly begin taking sunflower Lecithin and do hot ginger compresses often, gently massage your affected breast, and keep breastfeeding the baby, you may still be able to avoid antibiotics, however, really take care, if you need antibiotics, bless it as a benefit of science to cure. If it’s just too painful to breastfeed in the affected side, you may gently use a breast pump to keep your milk flowing. Be sure to resume breastfeeding on both sides, as soon as possible.  

If the antibiotics and/or other remedies do not cure the abscess it may require surgical drainage, through a small incision. Not at all fun, but survivable. 

Your health care provider may tell you to temporarily stop breastfeeding if you have an abscess, I find that is never helpful advice, breastfeeding will help to clear the milk ducts, relieve symptoms, and help prevent and absolve a breast abscess or infection. 

Do not attempt to violently drain the abscess by squeezing or pressing on it. This can push the infected material into the deeper tissues. Gentle massage, following hot compresses, and if need be, you can use a wide-toothed comb to gently comb-massage the lump toward your nipple.  

*Newborn babies should be feeding well latched on your breasts, 8-12 times per 24 hours.  

Is my baby staying well hydrated?

Counting wet diapers is a simple way of feeling certain your baby is getting enough of your milk. Minimum number of wet diapers per 24 hour day by baby’s age:

• 2 days old: 2 wet diapers or more
• 3 days old: 3 wet diapers or more
• 4 days old: 4 wet diapers or more
• 5 days old: 5 wet diapers or more

Once your newborn is a week old he or she will ideally be wetting 6 to 8 diapers in 24 hours.  

Tender loving support, Mother Nature and Father Time, plus devotion to your baby will resolve and cure breastfeeding challenges… Take Heart mOM.