The common breast condition we have been treating wrong

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Treatment for mastitis – an excruciating ailment that affects up to 20 per cent of breastfeeding mothers – is undergoing a dramatic shift.

For decades, the routine medical advice given to women battling the condition was to feed or pump more frequently on their sore breast, massage out lumps and to apply heat to their chest. If they developed a fever or redness on their chest, women were told to see a doctor immediately where antibiotics might be prescribed.

“Mastitis is rarely an infection, it is just inflammation. If we can manage the inflammation, we can calm it down and calm down the mother.”Credit: Louise Kennerley

But new guidelines by the Academy of Breastfeeding Medicine, an international organisation of medical doctors who support breastfeeding, say these strategies may have been exacerbating mastitis.

Women are now advised to use ice instead of heat, avoid vigorous massage of their breasts and to feed normally.

The Australian Breastfeeding Association overhauled its guidelines for mastitis in February following the release of the protocol and no longer tells women with mastitis to massage, apply heat to their breast or feed more frequently on their sore side.

“There really was no hard evidence on any of those things,” said Naomi Hull from the Association.

The Association previously told women to see their doctor as soon as possible if they thought they had mastitis. They are now urged to seek medical help if they don’t start to feel better, or get worse, within 12 to 24 hours of following the new strategies.

Grampians Health, which operates five hospitals, and Queensland Children’s Health have taken these developments on board, but Hull expects it will take years for the changes to filter down to most health professionals.

She said these were the most significant changes to mastitis treatment in the Association’s 60-year history.

Katrina Mitchell, a breast surgeon from California and the lead author of the Academy’s new protocol, said mastitis was an inflammation of the breast, which occasionally turned into an infection.

“The previous advice was not remotely applicable to a breast that has this very complex system of blood vessels and lymphatic drainage,” she said.

“It was oversimplified because of a lack of education in medical and nursing school and among allied health professionals.”

The changes debunk the theory of “clogged ducts” that underpinned previous advice and led to women trying to “empty” their sore breasts by feeding their babies more regularly or pumping. This theory also prompted women to massage lumps in their breast, which were believed to be pools of milk.

It’s now believed that mastitis is caused by a narrowing of the milk ducts that can occur when milk flow is restricted by inflammation. This occurs when too much milk is being produced. The lumps that women with mastitis might feel in their breasts are a build-up of fluid linked to this inflammation, according to Mitchell.

She said the fever and chills that often accompany mastitis are symptoms of an inflammatory response and not necessarily an infection. Over-the-counter medication such as ibuprofen and paracetamol can help with pain relief and inflammation.

Georgia Ymer and her seven-month-old daughter Yindi with lactation consultant Tracey Davey.Credit: Chris Hopkins

There may have been something in the age-old treatment of cold cabbage leaves for mastitis, with the new protocol acknowledging that while cabbage is no more effective than ice, its cooling effect might deliver some therapeutic benefits.

It says antibiotics are being over prescribed for mastitis and often make women feel better because they contain anti-inflammatory properties.

Tracey Davey is among a small but growing number of lactation consultants following the new protocol.

“When I opened up my practice I felt really scared about having the responsibility of managing mums with a rogue bacteria in their body,” said Davey, who is also a paediatric nurse and lives in the Dandenong Ranges outside of Melbourne.

“I have now realised that mastitis is rarely an infection, it is just inflammation. If we can manage the inflammation, we can calm it down and calm down the mother.”

Georgia Ymer sought Davey’s help in February when she developed the telltale signs of mastitis: a sore breast and a flu-ey feeling. Her daughter Yindi was three-months-old at the time, not sleeping well, and Ymer was terrified of becoming seriously unwell.

“I put packs of frozen peas in my bra, I didn’t overdo it with the feeding and I stopped the massaging,” she said. “Within 72 hours the pain had gone.”

Australian Medical Association Victorian chair of the section of general practice Ines Rio said she rarely prescribed antibiotics for mastitis, but did so if there was sign of a bacterial infection or ongoing fever.

“By the time women come to me, they are not well and have had symptoms for a few days,” she said.

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