by Amy Spangler
September 09, 2008

If you are a breastfeeding mom or a health worker who cares for breastfeeding moms and their babies, you won’t want to miss the recently revised clinical protocol on mastitis from the Academy of Breastfeeding Medicine (ABM).

For those of you unfamiliar with ABM, it is an international multi-specialty physician organization, with approximately 500 members from 50 countries. It was founded in the mid-1990s to help physicians become more knowledgeable about breastfeeding. As the spouse of a physician, I can testify to their need for knowledge, but admittedly they are not unique among health workers, as many lack basic breastfeeding knowledge including nurses, dietitians, and midwives. While efforts are being made to incorporate breastfeeding knowledge into health professional education, much remains to be done, which makes organizations like ABM a great source for evidence-based information.

ABM Clinical Protocol #4: Mastitis is one of 18 protocols developed by ABM on a wide range of breastfeeding topics. The protocol on mastitis was first released in 2002 and recently revised in 2008. A summary of the guidelines contained in the revised protocol follows.

It is estimated that 3–20 percent of breastfeeding women suffer from one or more episodes of mastitis. (On a positive note, 97–80 percent don’t experience mastitis.) Given that 1 out of 5 women may experience mastitis, health workers as well as moms need to know how to manage or better yet, prevent this condition.

Mastitis is defined in the protocol as inflammation of the breast that may or may not involve a bacterial infection. Symptoms can include redness, heat, pain, and swelling. Factors that can increase the risk for mastitis include:

• nipple damage
• restricted feedings
• poor positioning
• illness in mother or baby
• oversupply
• rapid weaning
• stress or fatigue

The key to treatment is milk removal—any way, any how! The easiest way to remove milk from the breast is to breastfeed, assuming the baby can latch on well. If breastfeeding isn’t possible, then any of a variety of breast pumps can be used (as well as hand expression which many moms find less painful than a pump.)

According to lead author, Lisa Amir, MBBS, NMed, PhD, “Rest, adequate fluids, and nutrition are essential measures,” along with, “…appropriate medications as indicated.”

Medications can include an antibiotic for the infection (assuming infection is present) and an anti-inflammatory such as ibuprofen for relief of pain. The choice of antibiotic depends on the infective agent and is discussed in detail in the protocol. Amir cautions that repeated use of antibiotics increases the risk of candida infections (commonly referred to as yeast infections) of the breast and vagina—candida infections are commonly referred to as yeast infections—which means antibiotics should be used only when there is evidence of infection.

Complications of mastitis are rare but include abscess formation and premature weaning. As long as a mom can keep the milk moving out of the breast and (ideally) into the baby, the inflammation usually resolves without complications. If you’re a mom who tends to worry a lot, you may find it reassuring to know that less than 3 percent of women with mastitis develop an abscess.

The adage that an ounce of prevention is worth a pound of cure certainly applies in the case of mastitis. Suggestions for preventing mastitis include:

• Position your baby well.
• Don’t delay or skip feedings.
• If you delay or miss a feeding or if your baby breastfeeds poorly, hand express or pump to relieve fullness.
• Use several different breastfeeding positions each day to relieve fullness in all parts of the breasts.
• Avoid bras that are too tight or bind.
• Wean gradually.
• Eat healthy.
• Drink adequate fluid.
• Rest when possible.

For information on a wide range of breastfeeding topics such as hypoglycemia, supplementation, co-sleeping, and contraception check out the complete list of ABM Clinical Protocols.