Mastitis and breastfeeding: signs, symptoms and how to treat it

Mastitis happens when milk builds up ('milk stasis') and blocks your milk ducts, causing the tissue around it to become sore, inflamed and tender.

What are the signs and symptoms of mastitis?

A tender, hot, painful breast (it can affect both breasts at once but it's much more likely to be just the one) is the key sign of mastitis but there are other symptoms, too, including:

• Breast tenderness or soreness
• Breast pain or a burning feeling – either all the time or while breastfeeding
• Redness on the skin of the breast, often in a wedge-shaped area
• Lumpiness or an area of hardness in the breast
• Fever
• Flu-like symptoms, including shivering, chills, aches, tiredness
• Exhaustion (over and above new-parent tiredness) or a feeling of being really 'run-down'

Symptoms of mastitis can appear quite suddenly, as Amy, a member of our MadeForMums community found: "I felt OK this morning but have gradually gone downhill today with aches all over my body, shivers, feeling hot and cold, headaches and a tenderness in 1 boob up to armpit."

What do I do if I think I have mastitis? How do you treat it?

Often, mastitis can be treated at home with simple remedies and lots of rest. Although it may feel counter-intuitive – and even if it hurts (sorry!) – it will really help a lot if you continue breastfeeding regularly from the affected breast (see Can you still breastfeed if you have mastitis?, below).

Your 1st steps for treating mastitis should be, says Annette, to:

• Continue feeding from the affected breast
• Put warm a flannel/towel on the sore area of your breast before each feed. Or take a warm shower or bath.
• Massage your breast gently (if it's not too painful) during each feed, whenever your baby pauses between sucks
• Express, by hand or pump, if your baby doesn't drain the affected breast at each feed (check out our guide to expressing for help with this)
• Take paracetamol (or ibuprofen, as long as you check with your midwife first; see What painkillers are safe to take while breastfeeding?)
• Drink plenty of fluids
• Avoid tight top or bras
• Get rest. Go to bed with your baby and stay there as long as you can.

These are the steps that Charlotte, a member of our MadeForMums community followed when she had mastitis and it did the trick. "By last night my boob was feeling much better," she came back to say. "All the redness is gone and, although it is still a little sore, it is nothing like it was and I feel tons better in myself. Thanks for all the support!"

However, if your symptoms worsen or your fever spikes or you don't feel better after 24 hours, it's important that you see your GP, says Annette. It's possible that your mastitis has progressed to an infection and, if it has, you may need antibiotics to treat it.

You should definitely see your GP if:

• Your breast doesn't look better and/or you do not feel better within 12 to 24 hours
• You've still got a fever or your temperature is 38.4°C (101°F) or higher
• Your breast has become redder and more swollen
• You can see pus or blood in your milk
• You can see red streaks on your breast, running from your areola to your underarm
• You have a cracked nipple and it looks infected

How long does mastitis last?

If you don't have an infection, mastitis can clear up within 24 to 48 hours, if you continue to breastfeed and get plenty of rest.

If your GP prescribes antibiotics, you should start feeling better within 48 hours of taking the 1st dose – as Emma, a member of our MadeForMums community did: "I found the flu like symptoms went fairly quickly after starting the antibiotics. I also took paracetamol to bring my temp down. My boob gradually improved over a few days. I was definitely back to normal by the end of the course of antibiotics."

If you don't feel improvement within 2 days of taking antibiotics, go back to your GP. Very occasionally, a mastitis infection can develop into a breast abscess¹ (a build-up of pus in your breast) that will need draining, probably in hospital.

Can you still breastfeed if you have mastitis?

Yes, and in fact, you absolutely should, as it's part of the solution for clearing your mastitis up.

"It’s vital to carry on feeding if you have mastitis, hard as it may seem," says Annette, "as continuing to breastfeed will help unblock your milk ducts."

We're not going to lie: it's no fun feeding your baby from a breast that's hot, tender and painful (especially if your nipples have some damage, too). And that's before we even factor in that you're probably feeling pretty unwell, too.

Keep reminding yourself that continuing to breastfeed is the best way to make things better – so 'the pain's for gain' and all that – and that, if you suddenly stop breastfeeding now, your breasts will only get more swollen (with unused breastmilk), potentially making you feel even worse and even more prone to infection in your breast.

Here are some tips from Annette for making breastfeeding through mastitis a little easier:

• Try feeding in a different position. You may find a new position or hold is more comfortable while your breast is sore. Check out our guide to breastfeeding positions (with diagrams): there's 1 hold there, the 'inverted side-lying hold', that's said to be particularly good for clearing blocked ducts
• Offer your baby the affected breast first (if you can bear it)
• Express (by hand or with a breast pump) if your baby doesn't drain the affected breast at each feed (check out our guide to expressing for help with this)

What causes mastitis?

Mastitis happens when a milk duct (or 'lactiferous duct'; see the drawing of a breast in cross-section, below) gets blocked and doesn't clear by itself. This leads to swelling and inflammation and a build-up of milk in your breast, called milk stasis.⁵ Sometimes, this built-up milk can then get infected with bacteria (from the surface of your skin or your baby's mouth) that get in though a milk-duct opening or a crack in your nipple.

It can affect any breastfeeding women although it's much, much more common in the 3 months of breastfeeding⁵ and you're more likely to get it if:

• Your nipples are cracked⁶
• Your baby isn't quite latching onto your breast correctly when they feed
• Your breasts have become very engorged – maybe because your milk's just come in or because your baby's ill or teething or has started sleeping longer at night and is, therefore, feeding less often

How can you prevent mastitis?

The best prevention really is all about not getting too engorged, and making sure your baby can latch on well enough to drain your breasts well at a feed.

• Make sure your latch is correct. If your baby's not latching onto your breast quite right, it can mean they don't drain your breast of milk effectively enough or it could make your nipples sore and more prone to damage. Take a look at our step-by-step guide to getting the right latch. If you're still not sure, get some 1-to-1 help from a qualified lactation counsellor
• Breastfeed regularly and try not to put a time limit on the length of feeds. Check that all parts of the breast(s) you fed from feel soft and comfortable after each feed.
• Try not to change your breastfeeding routine suddenly. Abruptly dropping the frequency of feeds from the breast because of work, holidays, special occasions or family events, can also increase the risk of blocked ducts. Not for nothing is mastitis sometimes nicknamed 'Christmastitis'...
• Relieve engorgement as quickly as you can. Try expressing by hand or with a breast pump if your breasts are really uncomfortably full and your baby doesn’t want to feed again yet.
• Look after yourself and eat well. According to experts at La Leche League, women who get mastitis report it strikes "when they are doing too much or when they or the rest of the family are unwell with colds".
• Buy for a comfortable, well-made nursing bra. Have a look at the nursing bras our reviewers rated the best.
• Be kind to your nipples. If your nipples are sore or cracked, soothe them with a cold compress or some nipple cream (check out the nipple creams that our testers liked best), expose them to air as much as you (decently) can, and wipe them gently with water-moistened cotton wool after each feed to remove any debris that might cause infection.

If you find you're getting recurrent bouts of mastitis, do talk to your health visitor or GP to see if there might be some underlying cause.

How common is mastitis?

It's fairly common, though official figures do vary widely, depending on the number of countries surveyed. Also, there is often much variation of opinion about when light breast engorgement can officially be called mastitis, which makes collating figure difficult. But it's thought up to 33% of breastfeeding women may develop mastitis – probably less for women who are not in a developing country.

References

<sup>1. Breast abscess: NHS online
2. Mastitis while Breastfeeding. Michigan Medicine: university of Michigan Health Library
3. Antibiotics and Breastfeeding. de Sá Del Fiol F et al Chemotherapy. 2016;61(3):134-43. doi: 10.1159/000442408. Epub 2016 Jan 19
4. Management of Mastitis in Breastfeeding Women. Spencer J. American Family Physician. Sep 15, 2008 Issue
5. The challenge of mastitis. Michie et al. Archives of Diseases in Childhood. Vol 88. Issue 9. http://dx.doi.org/10.1136/adc.88.9.818
6. A descriptive study of mastitis in Australian breastfeeding women: incidence and determinants. Amir LH et al. BMC Public Health. 2007;7:62. Published 2007 Apr 25. doi:10.1186/1471-2458-7-62</sup>

Pics: Getty

Read more

• Brilliant breastfeeding positions for newborns
• Is it safe to breastfeed when you're ill?
• How to get your newborn to latch on properly – with step-by-step pics
• How to breastfeed in the early days – what to know, and what to expect
• Why does it hurt when I breastfeed?