It is a scary time for new mums.  Most of us don’t want to “bother” the NHS with anything and definitely don’t want to leave our homes for support. However, I am hearing from a number of women who are battling severe mastitis (and worse) at home and not seeking the vital care they need.  Let’s look at how you can tell whether you have mastitis and what you can do about it.

What is mastitis?

Mastitis is an inflammation of the breast, which left untreated can rapidly lead to a nasty infection. Mastitis is most often caused by an area of the breast not draining effectively, so milk stays there (milk stasis). This can happen for a number of reasons, including baby not latching well, baby having problems sucking (for example if they are poorly or premature or have tongue tie), missing feeds or leaving long gaps between them, clothing or a woman’s fingers digging into her breast and blocking her ducts, bacteria entering a crack in the nipple (often linked with a poor latch and the associated damage), or rotten luck.  Sorry.  Sometimes we never find out why it has happened.

Mastitis feels different from a blocked duct, which is often a lumpy area or wedge in the breast that might go during feeds and come back between them, or engorgement which tends to affect the whole breast and make it feel full or tight all over (see my article on engorgement here ).

Have I got mastitis?

As with most infections, if you have one, you know about it. A mother with mastitis will feel unwell and may have ‘flu-like symptoms.  She may have a temperature so may be hot to the touch.  She might have “chills” and feel cold and shivery. She will have an angry, hot, tender red area of her breast which will feel swollen and painful.  It might cause a burning pain all the time, or hurt to breastfeed or express. Some mothers will have nipple discharge, or notice pus or red streaks in their milk.

There are some images of mastitis in this article

Yikes, I have mastitis, what do I need to do?

Don’t panic. Start some self help measures and please call your GP or 111.

As mastitis is generally caused by milk hanging around, you really do need to get the breast working by feeding your baby and/or expressing the milk frequently. Aim for every three hours (or less) including through the night.  If feeding is painful or you need some help, please reach out for support.  Many women find the laid back feeding positions help with mastitis, you could try to vary whatever position you are doing.

The absolutely worst thing you can do is stop feeding or expressing.  There is nothing wrong with the milk, even if you are taking antibiotics.

Warm compresses (a flannel soaked in hot water or a heat pack designed for the purpose) or a nice warm shower can help milk to flow, so use them 5-10 minutes before a feed or expressing session.  After a feed, cool compresses can help to reduce the pain.

Avoid tight fitting clothing, including bras.  Use hydrogel pads to treat nipple cracks.

Rest, nice food and plenty of soft drinks can help.  Ibruprofen (400mgs 3x a day) and paracetamol (1g 4x a day) can be used according to packet instructions. Do not take aspirin.

Consider massaging the breast or use breast compressions during the feeding or expressing sessions.  You may need to be relatively firm.  Put your fingers on one side of the breast and thumb on the other and squeeze them together through the breast. Try not to drag the skin down towards the nipple as this can cause friction burns.

You need to speak to your GP the same day that you first have the symptoms.  Explain that you have a baby and what is going on for you.  Many GPs are able to prescribe antibiotics and have them couriered to you the same day. If this is not possible, please call 111.  If your symptoms are still mild, you could hold off taking the medicines for a few hours as you use the self help methods to see if you get better.  It is still advisable to have your prescription though, as mastitis can get bad quickly.

Antibiotics should start working within 12-24 hours and you should start feeling better. If you are getting worse, or you have mastitis in both breasts, or if your baby is under two weeks old, please call 111 for urgent medical attention.

Right now people are worried that the symptoms of fever could be linked to COVID-19 so healthcare professionals are being cautious and may suggest extra measures to protect you and your baby.  If you feel like you have COVID-19 symptoms you might be advised not to cough or sneeze on the baby, to breastfeed wearing a face mask if available, to wash your hands thoroughly before and after touching your baby, or to pump your milk and have someone else feed your baby. Pump parts, bottles and teats should be thoroughly cleaned in hot soapy water and sterilised after use. As far as we know, COVID-19 is not transmitted through breastmilk. Breastfeeding is one of the best ways to protect your baby especially if either you or baby have symptoms. A useful source of updated guidance can be found here

As ever, this is general advice. Please call your healthcare professionals for detailed support for your own unique situation.

Hang in there everyone. Mothering in a pandemic is especially hard and you are doing an amazing job.