F+F Mastitis Protocol
First things first: mastitis is a bit misunderstood.
Mastitis simply means "inflammation of the breast tissue.” But when we talk about mastitis, we’re usually thinking about infectious mastitis - inflammation -plus- bacterial infection.
When we talk about clogged ducts, technically those are also mastitis - swelling & inflammation in the breast. Ok, Meg - we’re splitting hairs now, no?
Here’s the point: We used to think clogged ducts happened because milk, for whatever reason, got stuck in the breast’s milk ducts. That’s why we used to recommend vigorous massage, vibration & heat to get milk moving out. But these are all things that worsen inflammation! So, now that we know the root cause is inflammation, up-to-date recommendations include ice, anti-inflammatories and gentle movement to promote reducing swelling and congestion. Ideally, this allows milk flow to improve while prevent recurrence.
Is it clogged, or do I have infectious mastitis?
☆ Really important to know: Mastitis always starts as just inflammation (or “a clog”) but left inadequately addressed, an environment ripe for bacterial growth may advance to an infection. Because if there’s no bacterial growth, starting antibiotics won’t help treat the problem. So which is it?
Pulling in some help from the amazing lactation consultants over at Your Two Jugs…
Feedings + Feelings Mastitis Protocol
These steps are the same whether you think it’s infectious mastitis or the early stages of clogged ducts,
the only difference is calling your provider for antibiotics if you suspect infection.
The goals here are to…
Remove milk frequently, especially in any areas of congestion/clogs
Decrease inflammation & swelling to prevent recurrence.
If necessary, treat infection.
First Priorities
Continue breastfeeding: Most parents find nursing, if possible, to be more effective at effective removing milk from an inflamed breast, but whether nursing or pumping it’s important to stay on schedule.
For most people, this means their baby’s feeding routine or about every 2-3 hours.
Goal: frequent + effective milk removal
Ice regularly: 10 minutes of ice to the breast tissue within 30 minutes of nursing/pumping
Also can be done as needed for pain or engorgement
Goal: pain relief, decrease swelling & inflammation
Anti-inflammatories: 600-800mg ibuprofen (generic over-the counter, aka Motrin, Advil; or other NSAID like Aleve/naproxen); maximium of 2400mg per day.
Typically dosed as 600mg every 6 hours or 800mg every 8 hours.
Goal: decrease swelling & inflammation, pain relief
Drainage massage: In between sessions, 2-4x/day, do lymphatic drainage massage.
You can do this for yourself or have someone do it for you.
This is also a service some massage therapists offer, if they have the training.
Goal: encourage extra fluid (swelling) to return back to circulation (lymph & blood)
Breast gymnastics: Prior to breastfeeding or pumping, do ”breast gymnastics” for 1 minute each side.
You can also gently massage the breast tissue during pumping with your hands or with a lactation massager (vibration only, avoid heat).
Goal: promote milk flow, reduce swelling
Tylenol for pain: Take acetaminophen (Tylenol) 650-1000mg every 6 hours.
This one is optional since it doesn’t really address the root cause, it just helps relieve pain. Some people feel that the pain is well controlled by the methods above.
The best way to dose the OTC medicines mentioned here are to take something every 3 hours.
Ex: 9am - ibuprofen 600mg, 12pm - acetaminophen 650mg, 3pm - ibuprofen 600mg, and so on.
Goal: pain relief
Infectious Mastitis
If you suspect an infection, such as in the case of a high fever (>100.5F or >38C), call your medical provider. Many of my clients’ providers will see them ASAP or do a phone/telehealth visit and, if needed, call in antibiotics ASAP. Your OB or midwife should be your first call, but a primary care doctor can also treat mastitis.
Continue the strategies above. For most clients antibiotics alone won’t fully address the issue.
Rest! You’re sick! Your body needs everything it would need when you’re sick - fluids, rest, protein.
Continue breastfeeding. The antibiotics used for this kind of infection are safe to continuing offering breastmilk and in fact an important part of the treatment is effective + frequent milk removal.
Consider a probiotic. We always want to help promote a healthy microbiome, but in particular for mom + baby, antibiotics can increase risk of developing thrush (fungal) infection.
Mom: Lactation Hub | Garden of Life
More tactics to clear clogs + mastitis…
This page is meant to help you figure out if you have clogs or an infection, and know the most important things to do right away. There are a variety of other resources and tactics to help address mastitis. For more, see our full page on preventing + clearing clogs here.