Mastitis

GENERAL INFORMATION:

What is it? Mastitis (mas-TEYE-tis) is an infection of the breast. Puerperal (pu-ER-per-al) mastitis is an infection that may happen to women that breast feed their babies. Puerperal mastitis can happen after you begin breast feeding. Puerperal means the time from when you give birth to your baby, and to up to six weeks after. Most of the time only one breast is affected.

What causes mastitis? A germ called bacteria usually causes mastitis. Bacteria enter the body through a break or crack in the skin of your breast or nipple. A plugged milk tube or not emptying the breasts of milk completely may also cause mastitis. Using certain creams on your breast may also cause mastitis. If you have had mastitis before, you are more likely to have it again. Because the infection is in the breast tissue and not in your milk, you can usually continue to breast feed your baby while you are being treated for mastitis.

What are the signs and symptoms of mastitis? Engorgement (breast swelling right before you breast feed) may happen before you get signs of puerperal mastitis. You may have the following signs and symptoms of mastitis:

• A small cut in the nipple or the areola (dark area around the nipple).
  
  
• Breast tenderness with redness, swelling, or hardness in one area of the breast.
  
  
• Chills and fever.
  
  
• Tenderness under your arm.
  
  
• The breast may also feel hot or itch.

What may be done to treat mastitis? Your baby will not be affected by your having a breast infection. This is because human milk has special ingredients that will protect your baby. Continuing to breast feed when you have mastitis may help speed recovery.

• Tests: Cultures or gram stains of breast milk may be taken to see the type of bacteria causing your mastitis. For these tests, you will need to express a small amount of milk from your breast. It will be taken to a lab and tested.
  
  
• Treatment:
  
  
  • Continue to breast feed: Frequent breast feeding helps drain your breasts and stop infection from spreading to other areas of your breasts. It is important to keep milk flowing in the infected breast. It may be painful to have your baby nurse on the infected breast. If so, open up both sides of your bra when breast feeding. Breast feed your baby on the breast that is not infected. Let milk flow from the infected breast onto a towel. This will help relieve pressure as you feed your baby on the opposite side. You may also want to pump the affected side to completely drain your breast. You may save the pumped milk to feed your baby.
    
    
  • Use heat on your breast: Apply heat 15 to 20 minutes every hour as long as you need it to decrease pain or swelling. Heat brings blood to the area and helps it heal faster. Use warm compresses or a heating pad. A warm moist compress is a small towel dampened with hot water and placed in a plastic bag. Wrap a towel around the plastic bag before placing it on your breast to prevent burns. If you use a heating pad, keep it turned on the low heat setting. Do not sleep on the heating pad because it can cause a bad burn. Heat also helps your breasts get ready to breast feed, and can be applied before feeding times. Taking a warm shower before feeding your baby also may help.
    
    
  • Use cold on your breast: A cold towel may also make your breast feel better. Cold causes blood vessels to shrink and decreases swelling and pain. You can switch between a heat compress and a cold towel compress when applying these to your breast. Using ice packs between feedings may also relieve discomfort and reduce swelling.
    
    
  • Massage your breast: Gently massaging your breast before and during breast feeding will help drain your milk. This will also help prevent engorgement.
    
    
  • Incision and drainage (I and D): Rarely, swelling of your breast will not go away. When this happens, abscesses (areas of pus) may form inside your breast. You may also have a fever. If this happens, an incision and drainage may need to be done. Your caregiver will make a small cut in your breast to let the pus come out. This cut needs to be kept very clean. Ask your caregiver for more information about abscess incision and drainage.
    
    
  • Prevent breast engorgement: Although it is normal for your breasts to fill with milk, they may become too full. This is called engorgement (en-GORJ-ment). Engorgement may feel uncomfortable or even painful. Feeding on demand helps prevent engorgement, and may also help your baby feel more satisfied. Feeding on demand means that you breast feed your baby whenever he is hungry. Engorgement can be prevented by breast feeding, expressing milk manually (by hand), or using a breast pump.
    
    
  • Treat sore and cracked nipples: The most important way to treat sore or cracked nipples is to find out why you are having them. Caregivers will help you find out if positioning, latching-on, or infection is the cause, and help you treat it.
    
    
  • Use antibiotic medicine if ordered by your caregiver: You may be given antibiotics (an-ti-bi-AH-tiks) to treat your breast infection. Antibiotics kill germs called bacteria. Take this medicine exactly as directed by your caregiver. Do not stop taking it unless your caregiver tells you to. Your caregiver will make sure that this medicine will not hurt your baby.
    
    
  • Over-the-counter pain medicine: You may use over-the-counter (OTC) pain medicines, such as ibuprofen or acetaminophen, for pain or swelling. These medicines may be bought without a caregiver's order. These medicines are safe for most people to use. However, they can cause serious problems when they are not used correctly. People with certain medical conditions, or using certain other medicines are at a higher risk for problems. Using too much, or using these medicines for longer than the label says can also cause problems. Follow directions on the label carefully. If you have questions, talk to your caregiver.

Coping:

• Having puerperal mastitis may cause you and others to feel angry, frightened, or helpless. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you.
  
  
• You may be worried that the medicine or infection may hurt your baby. Usually you can keep on breast feeding without causing harm to your baby. If your caregiver tells you not to breast feed, you may worry about how that affects your baby. Usually, you can return to breast feeding after a few days, when the infection is gone. If your caregiver tells you to stop breast feeding, you may pump your breast milk using a special breast pump. Your baby can be fed breast milk or formula using a bottle. Ask your caregiver for more information about bottle feeding your baby.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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