Monday, October 18, 2010

The Red-Eyed Breastfeeding Monster- Mastitis

Smunchie AKA Mastitis Relief Worker at 9 months old
She looked annoyed, as annoyed as a 9 month old can look.  I gently shook my boob with my hand, hoping to tempt her but she just looked away as if she couldn't be bothered to eat right now.  Obviously she had places to go, things to do, playthings to discover.  Please eat, please, please, please nurse again I begged her.  She all but scoffed at me.  There was no need for the boob right now and we had clearly established long ago that if she needed it she'd ask for it.  Offering it when she wasn't hungry or in need of comfort was just down right insulting.  Biting back tears I mentally called her a brat and immediately regretted it, she wasn't a brat she just didn't need to eat right now and she knows how *this* works.

But I needed her.

This wasn't an emotional need, no, this was a desperate physical need.  Early in the afternoon of that day last week I had the early signs of mastitis and by the evening it was full blown with a fever, aches, breast pain and red streaks across my breast.  The help of my baby was crucial to my recovery.  Since she wouldn't nurse at that moment I decided to hand express into a bowl of warm water.  I nearly cried into that bowl too.  The red-eyed breastfeeding monster had struck.  Mastitis.

Mastitis is interesting.  Not really, actually, it's quite painful.  My friend describes it as a form of torture and thanks to my refresher this past week I'm inclined to agree.  In talking to The Piano Man about it from the shower where I let hot water run over my breast for as long as I could stand it, I realized that a doctor would describe mastitis as "uncomfortable" and then would go on to explain the treatment measures as "uncomfortable" as well.  Meaning: hurts like hell and will feel like someone is kicking you in the chest repeatedly and it's the only way to get better.  I've been told I have a high pain tolerance but the truth is I would rather give birth au naturale than have mastitis.  That may have nothing to do with pain levels however and just reflect the fact that I can be a tad bit goal oriented.  Let me break it down for you.

Labor + child-birth = baby with a bonus that the pain and physical discomfort comes to an end.

Mastitis + frequent painful feedings and massage = get rid of infection and end the pain which hopefully won't reoccur.

It's simple math, I prefer labor.

Antibiotics are the commonly prescribed course of treatment for mastitis but I really wanted to avoid them given that the last time I had antibiotics I wound up with thrush.   When I first suspected at 12.30 pm that Tuesday that the bra I wore was actually a little too tight (why the heck are these things still growing?!) and that missing a feeding on my right side was more than just uncomfortable (by my standards, not what a doctor would say) I immediately took my bra off and tried to convince myself that it would be no big deal once I nursed Smunchie.  But the pain didn't go away.  By 2 pm I was just feeling yucky and my breast hurt more.  Still, I was in denial though I caught myself several times subconsciously massaging the painful breast and thinking "please don't be... please don't be..."  I wouldn't even say the word in my head.  Four o'clock rolled around though and it was starting to hurt to lift my arm, I ached in all of my joints and I just didn't want to even move.  At 5 I finally said that I had the early signs of mastitis.  Ha!  Early signs my foot.  Heat radiated from my breast and pale pink streaks snaked across it and up my chest, getting an angrier shade of red by the minute.  I felt like I could barely move.  When I took my temperature at almost a quarter after 5 it was over 100 and my boob was hot enough to sense the heat through my shirt.

Fine, I'm fighting mastitis I decide.

I took a hot shower, staying in there as long as I could.  Feeling so terrible all over I sat down on the tub floor and shivered against the cold ceramic while hot water streamed over my right breast and I massaged from behind the painful area gradually moving the pressure down toward the nipple.  Eyes glazed over with pain, Smunchie asleep and the big girls distracted with a movie (a rare treat on a week day in our house) I have no idea how long I stayed in there.  Long enough for my butt to be cold and my chest and tummy red from the hot water. 

The rest of my evening was a blur of near tears pain (I would have cried but didn't want to scare my daughters into never being willing to try breastfeeding their own children), breastfeeding, PB&J dinning courtesy of my 7 and 9 year old, getting hit in the sore boob with a wooden toy sword (I'm sorry, wooden knight armor is not welcomed to co-sleep with us right now!), a temp of 103, and desperate texts to The Piano Man at rehearsal:

"Come home soon..."
"When will you be home..."
"My boob hurts..."
"I'm not sure what to do about dinner."
"Can you leave early?"
"The girls are helping, they made dinner."
"There's PB&J all over the kitchen, sorry..."
"OMG I hurt all over!"
"I think the girls made dinner on the floor, sorry."
"I feel helpless..." 
"I just feel so sick."
"I'm sorry I'm so whiney"
"Have you left yet?"
"Call me"
"My temp is 103.2..."
"I think I need to see a doctor..."
"What's worse than having a raging infection in your boob?  Getting hit with a SWORD on the boob with a raging infection."
"Where are you?"
"I really can't take it any more."
"Please tell me you're almost done."
"I can't do this..."
"Can't even pick up my baby without horrible pain."
"You haven't called yet, does that mean you're not on your way?"
"I hope you're on your way..."

You may read those texts and think I was being melodramatic.  Maybe I was.  Or maybe you've never had mastitis.

The next 36 hours I breastfeed Smunchie as often as possible, I took hot showers and massaged my breast as hot water ran over it, I took more Ibuprofen than I did after I was in a car accident, I draped hot wet washcloths around my breast, I canceled everything and pretty much laid in bed for 24 hours, I ate PB&J made by my kids, I researched treatment options and read them multiple times praying reading them would somehow cure me, I nursed in different positions every feeding and sometimes more than one for a single session, and I seriously considered burning that bra.  Sleep that night was fitful, I couldn't sleep on my stomach and for the first portion of the evening I couldn't stay asleep thanks to the fever.  Wednesday morning there was no fever but still the red streaks and slightly less achy all over I had hope that I could beat this on my own.  A low grade fever came back late morning but I hydrated, took a nap, put heat on it, did some hand expression, and breastfed Smunchie again and again and by the time 2pm rolled around I felt confident that I was out of the woods.  By Wednesday evening I felt well enough to brave going into my kitchen and tackling sticky spots with a rag and some elbow grease from the girls' meal-time help.  Thursday I was able to get back into my routine with only faded red streaks and some soreness in my breast to remind me of the previous 40 hours.  I felt a bit like a survivor, like I felt when I completed a pregnancy mostly intact.  There was a taste of bitter victory from having passed a test I wasn't expecting, a test that cost me even though I succeeded.

In the couple of days I pushed through mastitis I found myself thinking "I wish I could quite breastfeeding."  Call me weak, point at me and question my commitment but when I felt so terrible I couldn't prepare a healthy meal for my other children and I knew that even if I kicked it this time there was no guarantee that I wouldn't get it again I wondered if putting the needs of my youngest not just above my own needs but above those of my other children was really worth it.  Though I had signed on for sacrifice in becoming a mother 5 times over, was it fair that they had too as well?  These thoughts aren't new to me, I have them any time I'm pregnant or any time I realize that we all do with less because we have more.  The difference this time was that I had a community, education and experience that I would get through it that it indeed would be worth it.  My friend Sue checked on me and took Lolie to ballet so I could stay in bed and my little online community gave words of encouragement, shared links and information, personal stories and tips and asked me how I was doing.  Even for me, as an experienced breastfeeding mom of 5, I find a huge difference in my breastfeeding experiences between when I had very little support and when I had a lot of support.  In our new way via the internet women have found the community that used to be present in our villages and families, swapping breastfeeding advice, reminding each other how it is, and troubleshooting from a well of experience that is as deep as it is fresh.  While I don't think it makes up for in person contact and community completely I do feel it stands in the gap, a gap left by bad advice and marketing of formula to women that didn't need it a few generations ago.  I love my little community.  It is my hope that every breastfeeding woman can find a community that encourages and supports her breastfeeding.

Here are a few tips and some of what I did to help prevent my mastitis from getting worse and cleared it up.  Please note that

"Heat, Massage, Rest, Empty Breast" if you even suspect mastitis, chant it with me... it's good to go ahead and start this protocol.
  • Heat. Moist heat- I liked to stand in a hot shower, or lie down with warm wet towels or a clean warm wet diaper wrapped around the breast, soak your breasts in warm water either in a bowl or in the tub. 
  • Massage. Massage the breast gently, you may need some lotion or oil to keep from irritating the skin. The massage can help clear a plugged duct by starting behind the lump or painful area and massaging it down toward the nipple.  This is particularly helpful following heat and done while the nursling is at the breast.  
  • Rest. Rest is crucial, the body does most of it's healing repair work when we sleep.  If you can, go to bed with your nursling, plan to breastfeed and sleep doing heat and massage in between.  If you can't go to bed to stay for the day, set up an area for you and your nursling and other little ones that may need you.  You need to rest so movies, drinks, snacks, books, toys, diapers, wipes, even a change of clothes for your nursling so you don't have to get up except to use the loo.  If you work outside the home, treat this like the flue and call in sick.  Trust me, if you don't at first you will be later and it will be longer and much worse.  And doing housework is not resting.
  • Empty Breast. Breastfeed as often as your nursling is willing, start on effected side first each time and check for a good latch.  Don't cut back on frequency, in fact, increase it if you can.  Even though it may hurt more to breastfeed cutting back will only make things worse.  If your little one isn't interested in helping as often as you need it, hand express or pump to keep the affected breast as empty as possible.  Remember though, your nursling is far more effective at this than any machine will be.  Use breast compressions either way.

Dress for Success. As soon as I feel pain or any hardness in the breast I change into soft, unrestricted clothing.  I prefer PJs myself.  Going topless is good too, particularly if you're able to stay in bed with your nursling. 

Fuel. You still have to eat even if you don't really feel like it but you need it to give your body some fuel to work with not only to feed your little one but also to heal itself.  Hydrate often to help your body fight back.  If someone is willing to bring you food so you can stay in bed take them up on it even if it is just PB&J and you'll have to clean the kitchen later.

Medicines.  Ibuprofen, seriously, I don't take meds often or easily but this helped get me through and the inflammation reducer was an important piece of my recovery. I did 400mg every 4 hours from pretty early on.  If my symptoms had persisted without improvement for more than 24 hours or if I had become acutely ill I would have headed in to the doctor for an antibiotic.  Remember, most antibiotics are safe while nursing but if you and your doctor aren't sure you can check here, here or here.

Herbs and natural options. Obviously, breastfeeding, massage, heat and rest are natural but there other options to try as well.  I did green cabbage leaves, keeping them in the fridge and put them on for 20 minutes at a time but for no more than a couple of times in a 24 hour period.  The coolness felt so good after all that heat too.  I also greatly increased my garlic intake as garlic helps your body to boost it's own antibodies and beefs up your immune system.  To get my garlic in I crush a few cloves raw on a baked potato, slather it with plain yogurt and sprinkle on some cheddar cheese along with salt and pepper and maybe some green onion.  I also swallowed a couple of cloves cut in half.  I didn't use any herbs this time around, just some Arnica but a few Leakies suggested Phytolacca and Pokeroot.  I don't know anything about these but have heard good things, be sure to get the help of a trained professional before using any medicines and herbs.  Lecithin can also help clear it up and help prevent it in the future.  If I had ended up on antibiotics I would have upped my probiotic intake and completely cut refined sugar from my diet to minimize my chances with a candida yeast over growth.  When Leakies started talking about Lactation Cookies on Facebook I didn't ask anyone to make me some and I didn't eat oatmeal or any other known galactagogue.  While I didn't want to diminish my supply I also don't want to increase it as this could make things worse.  So pass on the oatmeal until your feeling better.

At The Breast.  Alternate feeding positions,  I've been mostly using the cradle hold,  so I mixed it up with some reverse cradle, football hold, side-lying, side-lying upside down (feet going in the direction of your head), baby sitting up in my lap, and hands and knees with Smunchie underneath me (think cow for this one) to name a few.  And because I'm so devoted to breastfeeding education I even had a helper take pics of my on all fours showing off my stretched out belly (x5) and sick face smiles just to demonstrate this position.  I was feverish and weak, this wasn't nearly as fun as it looks.  And I apologize for the quality, since I wasn't feeling up to locating the camera these were taken on my phone.

Smunchie didn't mind our creative positioning

Dangle feed position for breastfeeding allows gravity to help drain the breast

Prevention.  Sometimes the causes of mastitis are clear, others not so much.  If you can identify why you developed the red-eyed monster destroyer of breastfeeding in the first place you can hopefully avoid it in the future.  That bra?  Yeah, I won't be wearing it again until my breasts have either gone down in size or I'm no longer breastfeeding.  It's just not worth it.  The La Leche League link below has a great list of possible causes.

I hope you are never a part of the 20% of breastfeeding mothers that know the feeling of mastitis first hand but if you do join our club (sorry) don't hesitate to go to your sister breastfeeding mothers for encouragement, help and advice.  As always, be sure to seek medical advice from your health care provider in addition to reaching out to the sisterhood of breastfeeding moms.  Whatever course of treatment works for you, the sisterhood understands and cheers you on and we totally understand the manic texts.

Some helpful information and resources for dealing with mastitis or a plugged duct that may become mastitis.

Kellymom's plugged duct/mastitis chart
Dr. Jack Newman on Blocked Ducts and Mastitis
La Leche League Mastitis-Plugged Duct information

Edited to Add: If you have any helpful links to share, please do so, I'd like to add them here.
The Breastfeeding Network (UK) PDF


  1. My sister had what appeared to be mastitis (same symptoms although she's never been pregnant or breastfed). It turned out to be a linoleic acid (an essential fatty acid) deficiency, which they treated with high doses of primrose oil supplements.

  2. Ugh... I'm actually feeling sick to my stomach reading this. I had mastitis twice in a 6 week period more than four years ago. I too would rather give birth with no drugs than have mastitis again. My second child is now nine months old and so far, so good but I was so scared of getting it again after he was born. Thankfully my wonderful doula encouraged me through my worries and we're still going strong with nursing.
    Congratulations on getting through it without antibiotics. I hope things continue to heal up for you and that you never see that awful red-eyed monster again!

  3. Here's some info I can share on Mastitis (I've now had it 5 times!!!). I had a breast reduction and have found out I am more prone to it due ti scar tissue :( When you notice early signs of Mastitis start taking Vitamin C, Lecithin & Echanacia. Those three, along with NOT wearing a bra and only wearing loose fitting clothing, will get rid of it pronto. I only had to take antibiotics the first time, then the other four times knocked it out even before I got the fever. Hope that will help some other readers! (My babe is now 9 months old and we are still breastfeeding :)

  4. When nursing my first I had all those symptoms except bady fever (did have heat in my breast) and a large, hard lump on my left breast...for over a week. It was utterly miserable. Doc told me it was just a plugged duct, not mastitis since no fever and wouldn't give me anything. It eventually went away, nursing, heat, massage, but goodness! What a long 8-10 days that was!

  5. there is a supplement from standard process called ALBAPLEX. you can order it from some heath care prof or mostly chiro. if i feel im coming down with a plugged duct/mastitis i start taking it every few hrs untill its gone. i have only had it 2 but i tell you it works fast

  6. After reading this I have learned that I have had mastitis two three times in the last six months and have not realized it. I thought they were just clogged ducts...but the fever, chills and shakes tells all. What was I thinking?!
    Yes- I'd rather give birth to my ten pound son au natural at home, (like I DID) again than have mastitis. Its so crazy painful.

    I've found that the "cow" position works best for draining the boob fast- and I'll do it even though I FEEL ridiculous doing it!

    Thank you for your blog. I've needed a lot of extra encouragement with nursing this second time around.

  7. My husband and I are laughing (not at you) but at the situation (can't we do that once we are through a hard trial in our lives?) as I read this post it was exactly how I felt and exactly what I went through with my first 2 kids- I would much rather go through labor and delivery natural than have mastitis... it is the worst!

  8. Ladies. When you are in the middle of this torture, please remember the Shower Hug. It is an inexpensive nursing tool that helps with all kinds of breast pain and is great in the Shower especially for a prolonged warm compress effect. Created by moms, myself included who suffered through our share of breast pain while nursing. It works great! And I agree I would rather give birth naturally than endure the breast pain I have experienced. I often" told myself in the middle of my suffering , I can get through this... I gave birth to this baby with Pitocin and no pain meds."

  9. Mastitis is hell! Thanks so much for posting this informative post. Glad you are doing better.

  10. I have had mastitis so many times I can't even count them any more. I half joke with my husband that it is now ingrained in my body and I can literally feel it creeping down my arms, into my wrists and then to my stomach and beyond. It is the MOST brutal thing I have been through to date, including a 3 day induced labour, and I wouldn't wish it on my worst enemy.

    I "enjoyed" reading this as it makes me feel a little less alone. Hope you never have to battle it again.

  11. Thank you so much for your encouragement & for sharing your story! I am in the midst of my first bout with mastitis currently and am painfully pumping away as I type. I am taking the antibiotics because I was told it would speed the process, but it seems to only be helping a little & is adversely affecting my milk supply in the process. I'm already more than 36 hours into the meds so I don't want to quit, but if my milk supply keeps being so low I may have too. Nursing through has been harder since my poor five month old gets upset just minutes in because she's not getting much and pumping takes forever. I hadn't heard of the "cow" position, but if it will help I'm trying it! I so related to your post, especially your response to possibly being thought to be melodramatic. I laughed out loud! I have a number of friends with no kids yet. They just can't relate at all and I'm temped to send them this link ;) I only have one other child (3 yrs) so I can't imagine how it was for you with 4! Way to soldier on and again thank you so much for sharing!!


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