Mastitis is a common and often painful condition affecting breastfeeding mothers, and is traditionally associated with milk stasis, blocked ducts, and bacterial infection. However, recent updates to the clinical protocol by the Academy of Breastfeeding Medicine (ABM) have significantly shifted our understanding of this condition. Mastitis is now described as a spectrum of conditions, starting with oversupply (hyperlactation) as the first marker, which can lead to painful inflammation causing narrowing of the milk ducts (previously termed ‘plugged duct’), and potentially progressing to inflammatory mastitis.
Key changes in the protocol
Understanding mastitis as a spectrum
The first key takeaway from the new protocol is the shift in understanding mastitis as a spectrum of conditions rather than a single entity. Oversupply (hyperlactation) is now considered as the first marker on the mastitis spectrum, which can lead to painful inflammation and narrowing of the milk ducts, and potentially progress to inflammatory mastitis.
Ductal narrowing instead of plugged duct
Previously, the term ‘plugged duct’ was used to describe a condition where a milk duct gets blocked, leading to milk stasis and inflammation. However, the new protocol states that this condition is more accurately described as ‘ductal narrowing’ due to inflammation.
Use of cold compresses instead of heat
Traditionally, the use of hot or warm compresses was recommended to manage mastitis. However, the new protocol highlights that heat does not help reduce inflammation. Instead, the recommendation for managing painful ductal narrowing due to inflammation is to use cold compresses, which will reduce blood flow and swelling.
Minimising extra pumping
Previously, extra pumping was advised to help drain or unblock the breast. However, the new protocol states that extra pumping may actually exacerbate the problem by signaling the body to produce even more milk, thus perpetuating the cycle. Instead, it is recommended to feed the baby on demand or pump on a normal schedule and minimize extra pumping.
Use of Ibuprofen
The new protocol highlights that ductal narrowing is actually an inflammation, not a milk blockage as previously thought. Therefore, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be helpful in managing the inflammation.
Gentle hand expression and massage
To relieve discomfort from the breasts, gentle hand expression is now advised to avoid overstimulation. Additionally, aggressive massaging of the breast is ineffective and results in tissue trauma. Instead, gentle lymphatic draining massage, involving a light sweeping of the skin rather than deep tissue massage, is recommended.
Consideration of probiotics
Antibiotics were traditionally advised immediately for mastitis and sometimes as a precautionary measure. However, the new protocol states that antibiotics may not always be necessary and should only be reserved for bacterial mastitis. Instead, it is recommended to consider taking probiotics for mastitis prevention.
Key Recommendations from the New Protocol
👉🏼 Feed on demand
Feeding the baby on demand or pumping on a normal schedule is recommended to avoid signalling the body to produce even more milk and perpetuating the cycle of oversupply.
👉🏼 Use ice instead of heat
For inflamed ducts and inflammatory mastitis, ice packs or cold compresses are recommended instead of hot or warm compresses.
👉🏼 Use ibuprofen
NSAIDs such as ibuprofen can be helpful in managing the inflammation associated with ductal narrowing.
👉🏼 Gentle hand expression
To relieve discomfort from the breasts, gentle hand expression is advised to avoid overstimulation.
👉🏼 Gentle massage only
Gentle lymphatic draining massage, involving a light sweeping of the skin rather than deep tissue massage, is recommended.
👉🏼 Consider probiotics
Taking probiotics for mastitis prevention. Antibiotics should only be reserved for bacterial mastitis.
The new protocol for treating mastitis by the ABM represents a significant shift in our understanding and management of this condition and importantly, providing breastfeeding mothers with the most effective care and support.