Published: 11 February 2020
Published: 11 February 2020
Mastitis is a common and debilitating condition that affects up to 33% of breastfeeding mothers (Angelopoulou et al. 2018).
Characterised by an area of inflamed breast tissue and accompanied by pain and fever, it is a distressing condition which can negatively impact a mother’s ability to breastfeed.
Most episodes of mastitis occur in the first two months postpartum with recurrence rates of up to about 10% commonly reported (Cullinane et al. 2015).
Milk stasis is usually considered the primary cause of mastitis, as the accumulated milk causes an inflammatory response which may or may not progress to an infection.
Mastitis should be suspected if a woman has:
One of the challenges in caring for women with mastitis is that it’s not possible to distinguish clinically between infectious and non-infectious mastitis. Infection is more likely if:
A severe complication of mastitis is the formation of an abscess, or localised collection of pus within the breast, which can occur even without any apparent preceding mastitis.
Based on recent evidence collected by Cullinane et al. (2015) it’s estimated that approximately 3% of mastitis sufferers go on to develop a breast abscess.
A breast abscess should be considered if the woman has:
Cullinane et al. (2015) note that the most common cause of mastitis is the presence of S. aureus on the nipple, or in the breast milk.
Recent studies have suggested that coagulase-negative staphylococci may also play an important role, but further research is needed to confirm this.
Other common factors thought to contribute to mastitis developing include:
Expressing breast milk has also been linked to mastitis, but again further high-quality evidence-based research is needed to confirm this as many of the studies to date seem to be flawed.
For example, Cullinane et al. (2015) report on a study using a case-control design which found an association between using breast pumps and mastitis.
However, questionnaire data were collected retrospectively, not at the time of the inflammation, so it is unclear if use of the breast pump was a risk for, or a consequence of, mastitis
Early management of a woman with mastitis involves general measures to improve drainage of the breast and reduce inflammation.
It can be an alarming condition for a new mother and reassurance that the breast will return to normal following treatment is important.
Midwives and doulas have a key role to play supporting and encouraging mothers to keep breastfeeding throughout a mastitis attack, as the condition can be exacerbated if feeding is suddenly stopped.
For mild cases, giving advice on hygiene and encouraging good breastfeeding techniques are often the only steps that are needed.
Start4Life (2020) also reinforces the point that after feeds, any leftover breast milk should be drained either by expressing by hand or with a pump.
NICE (2018) also recommends simple treatment methods such as the use of analgesics, applying a warm compress to the breast before feeding and maintaining adequate hydration.
Supporting the breastfeeding mother, or checking breast health if the mother chooses to bottle feed is a core midwifery skill but when mastitis is suspected the following observations become particularly important:
Old wives’ tales, alternative medicine, and self-help measures are often topics that mothers want to talk about concerning breastfeeding difficulties.
Even though recommending alternative approaches to treatment is outside the scope of professional practice for many midwives, it can still be helpful to have an awareness of what they are.
For example, the application of cold cabbage leaves, often described as the poor man's poultice, is a well-known home remedy for breast engorgement and mild mastitis.
As Woodman (2003) reflects, it’s an ancient remedy that has stood the test of time and still remains popular today.
As soon as mastitis has been diagnosed, it is quick and easy to treat. But prevention is always better than cure and maternity staff are ideally placed to offer advice for mothers to reduce the risk of mastitis occurring.
The most important points being:
Abou-Dakn et al. (2010) make the point that because most cases of mastitis occur once the mother has gone home it’s important to cover education on preventative measures before discharge.
It’s a theme echoed by Khanal et al. (2015) who recommend that traditional breastfeeding practices should be encouraged and that the management of mastitis should be included as part of breastfeeding promotion.
Alongside advising new mothers, Cantrill, Creedy and Cooke (2003) also suggest that knowledge variations amongst midwives’ needs to be addressed following reports of conflicting advice experienced by breastfeeding women.
It’s just one of the many areas in maternity care where further research might help to close the gap between theoretical knowledge and actual practical support.