Oxford Handbook of Midwifery (146 page)

Prevention of non-infective mastitis

The condition is often a consequence of engorgement and the following simple measures can help to avoid or reduce the risk of mastitis:

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Self-help measures

These measures will help to relieve engorgement and blocked ducts as well as mastitis:

• Breastfeeding must be continued if possible, it is the most effective way to reduce the symptoms
  
• Reassure the mother that her milk will not harm the baby
  
• Ensure correct positioning and attachment
  
• Increase the frequency of feeds and if the breasts are uncomfortably full express between feeds
  
• Ensure adequate drainage of the breasts and express gently following feeds until resolved
  
• Feed from the affected breast first
  
• Try using different positions for feeding
  
• Prior to feeding, apply warmth to the breast and gently express to soften the breast enabling the baby to attach more effectively
  
• If necessary, express breast milk by hand or pump until breastfeeding can be resumed
  
• Gently massage the breast towards the nipple to help the milk flow while feeding
  
• Check positioning of the fingers when feeding and check to see if clothing is restrictive
  
• Rest
  
• Plenty of fluids
  
• An anti-inflammatory agent may help, e.g. ibuprofen. Aspirin should not be taken by breastfeeding mothers. It can result in rashes, platelet abnormalities, bleeding and the potentially fatal Reye’s Syndrome is nursing infants. 4–8% of maternal dose can be transferred.
  

  If no improvement has occurred 12–24h after onset of symptoms, or infective mastitis is suspected refer to the doctor.
  

  Infective mastitis
  

  Bacterial infections result from organisms breaching the preventative
  barrier of the skin and multiplying in spite of the body’s defence system.
  

  The epithelium of the breast and nipple may be damaged by:
  

• Incorrect positioning and attachment
  
• Sensitivity to creams, lotions, and sprays.
  

  Treatment of infective mastitis
  

• The self-help measures above should be initiated.
  
• Systemic antibiotics compatible with breastfeeding should be commenced. This may be needed for 10–14 days.
  
• Beneficial bacteria killed by the antibiotics can be restored by taking live yogurt or
  Acidophilus
  .
  

  Abrupt discontinuation of feeding increases the chances of a breast abscess, as will unresolved mastitis.
  

  Breast abscess
  

  This is a rare but serious medical condition. The mother will be pyrexial, have severe flu-like symptoms, and the affected area will be very painful and swollen. It presents as a localized breast infection with the presence of pus. The pus is not considered harmful to the baby but if blood is also
  

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  present, the baby may vomit. It may occur without prior symptoms but often results from unresolved mastitis.
  

  Actions
  

Insufficient milk supply

This is one of the most commonly quoted reasons for women discon- tinuing breastfeeding. The mother may express concern that she has an insufficient milk supply because the baby is not settling after a feed, is waking frequently for feeds, or the baby is not gaining weight.

Action

Breast refusal

There are two types of breast refusal: the baby who has never had a suc- cessful breastfeed and the baby who has breastfed well but then starts to refuse to go to the breast. Forty per cent of mothers who discontinue breastfeeding within the first week postnatally do so because the baby would not suck or rejected the breast,
²
therefore it is important for mid- wives to have the knowledge to help mothers overcome this problem.

Causes when breastfeeding not established

Breast refusal in the initial stages of establishing breastfeeding may be caused a number of factors including:

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Action

• Reassure the mother and try to establish a relaxed environment.
  
• Observe a feed and check positioning and attachment.
  
• If the breasts are overfull, express a small amount to soften the area around the areola to enable the baby to attach easier.
  
• Stimulate the let-down reflex by massaging the breast prior to attaching the baby.
  
• Express some breast milk onto the nipple or drip EBM in the baby’s mouth to attempt him or her to suckle.
  
• Attempt to put the baby to the breast before they are fully awake.
  
• Try skin-to-skin stimulation and do not offer the breast, let the baby find it.
  
• Co-bathing—where the mother and baby bathe together, this is thought to re-create the birth experience for the baby and has been shown to help. The baby needs to be kept warm by a helper pouring warm water over the baby as it lies on the mother’s chest.
  
• If supplements of EBM are given to the baby this should be given by either cup or spoon.
  

  Breast refusal once feeding is established
  

  The following are various factors that may cause a baby to refuse the breast but a cause may not be found:
  

• Baby ill
  
• Hormonal changes in the mother, e.g. menstruation, ovulation, contraceptive pill, pregnancy
  
• Mother using different toiletries or mother eating spicy or garlicky food
  
• If the mother has undertaken prolonged, vigorous exercise, lactic acid may alter the taste of the milk—but this is usually short lived
  
• If the mother has had mastitis the milk may taste saltier for a short time afterwards.
  

  Action
  

• Check the baby’s health. If he or she appears ill refer to the doctor.
  

  •
  If thrush is present, b see Candida (thrush) infection for action.
  

• If the baby is teething, offer a cool toy to chew on.
  
• Continue to offer the breast.
  
• Change the setting in which the baby is fed.
  
• Try feeding when the baby is sleepy.
  
• Check whether the mother wishes to continue feeding or if she had thought of discontinuing.
  
• If the baby is ill and refusing the breast offer EBM. The baby may take it better by spoon or cup.
  

  Candida (thrush) infection
  

  This is an occasional cause of sore nipples although the incidence appears to be increasing. It is caused by a microorganism
  Candida
  , which is a yeast. It commonly occurs after the mother has received antibiotic treatment. It often occurs after a period of trouble-free feeding and is commonly bilateral.
  

  Signs
  

• Hypersensitive or itchy nipples even when wearing loose clothing.
  
• Pink and shiny nipples and areola.
  

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