Medicines for Breastfeeding mastitis

What it is

Mastitis is inflammation of the breast tissue, and it is common in women who are breastfeeding (though it can occasionally occur at other times). During breastfeeding, it often develops when milk is not drained well from part of the breast (for example from a blocked duct, infrequent or missed feeds, pressure on the breast, or problems with the baby attaching), causing milk to build up and the tissue to become inflamed. Sometimes bacteria (which can enter through a cracked or sore nipple) lead to infection. Typical symptoms are a painful, red, warm, and swollen area of the breast, often wedge-shaped, sometimes with a hard, tender lump; the breast may feel hot and tender, and there are frequently flu-like symptoms — feeling hot and shivery, aching, and generally unwell, sometimes with a fever. Mastitis usually affects one breast. Although it can make you feel quite unwell and is uncomfortable, it often improves with self-care and continued effective milk removal, and breastfeeding can and usually should continue (it is safe for the baby and helps clear the affected area). However, if symptoms do not improve within a day or so of self-care, or if they are severe or worsening, medical assessment is needed, as antibiotics may be required for infection. Occasionally, untreated or severe mastitis can lead to a collection of pus (a breast abscess), which needs treatment, so it is important not to ignore symptoms that are not settling.

How it is treated

The mainstays of managing breastfeeding mastitis are ensuring the affected breast is drained well and relieving symptoms, and — importantly — continuing to breastfeed, which is safe and helps clear the blockage. Helpful measures include: continuing to breastfeed frequently, starting with the affected breast, and ensuring the baby is well attached (a midwife, health visitor or breastfeeding supporter can help with positioning and attachment); if the breast still feels full after a feed, expressing a little more milk gently; varying feeding positions to help drain different parts of the breast; gentle massage towards the nipple during feeding or expressing; warmth before a feed (which can help the milk flow) and cool packs afterwards for comfort; resting as much as possible, and drinking plenty of fluids; and simple pain relief that is suitable while breastfeeding, which a pharmacist or GP can advise on. If symptoms do not improve within around 12–24 hours of these measures, or if you feel very unwell, have a high temperature, notice a cracked nipple that looks infected, or the symptoms are getting worse, see a GP — antibiotics that are suitable during breastfeeding may be prescribed. If a painful lump remains after the infection settles, or if an abscess is suspected (a very tender, fluctuant swelling), further assessment is needed. The reassuring message is that mastitis, though it can make you feel unwell, often improves with continued breastfeeding and self-care, that breastfeeding can safely continue, and that effective treatment (including antibiotics if needed) is available if it does not settle.