Expert: Sally Wendkos Olds - 11/17/2009

Question
Dear Sally
I stopped breastfeeding about two and a half weeks ago when my son was three and a half weeks as he was tongue-tied, had it clipped and then was in extreme pain because of the formation of an ulcer, then I had to go on meds that I would not have been able to breastfeed/pump for him on so we decided enough was enough (after so much hard work to keep it going!).  I was only producing max 1oz from each breast at any given pump (hospital grade) so thought the milk would dry up pretty quickly.  In a week and a half there was none coming from either breasts on to breast pads worn round the clock (changed regularly though) so I thought it would be safe to go for a gentle jog with two tight fitting bras to restrict movement.  Two days after the second run (my son was now 5.5 weeks) I developed a very sore areola, thought it was mastitis, decided to pump to try to clear the plug and just made the situation worse as it seems more ducts were plugged too - as I really don't want to encourage any more milk production - my son is eating very well now from bottles and.  That night i was put on antibiotics and have now been on them three days.  The redness does seem to be going down slightly, but the hard bits (covering a good third of my breast) seem the same and swell up every time I wake up from a nap - I suppose that was the pumping I did which told my breast to produce more milk?  My fever is also still slightly high.  What can I do, apart from resting, taking the medications, and cold compresses, to help these lumps go down along with my fever, without trying to express and risk more milk being encouraged and without letting abscesses form (I am hoping the speed of introduction of antibiotics will prevent that).

Sorry for the long winded question!
Caroline

Answer
Dear Caroline,

First, congratulations for giving your son the best start in life by breastfeeding him. By nursing him right from the start, you gave him precious antibodies as well as great nutrition. I'm so sorry to hear of the problems you have been having, and hope you'll be feeling better soon.

I'm attaching an excerpt from the forthcoming edition of my book (see below)with suggestions for dealing with mastitis. I hope some of them will help you. However, they are not a substitute for seeing your doctor, so if the pain and the hard lumps persist, call your doctor again. You mention cold compresses -- some women seem to find more relief from warm compresses, especially moist heat.

Good luck,

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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  Treat a breast infection right away. With treatment, the fever should drop within thirty-six to forty-eight hours, and the soreness and hardness will go away soon afterward.  The usual treatment for mastitis is an antibiotic for ten to fourteen days, plus other measures, like those below. This will be safe to take while you continue to nurse. The antibiotic should be taken for its full course, even if your symptoms have gone away before then.
• Go to bed and stay there as much as you can. If you can’t stay in bed, rest as much as possible.
• Apply moist heat to the infected breast with one or more of the following: moist-heating pad, hot water bottle, hot wet towel, soaking in a basin of warm water, warm shower, or warm bath. Nurse soon after application of heat.
• Offer the sore breast first at each nursing so that it can be drained more completely.
• Be sure your bra is not too tight. Try one in the next larger size. Or try going without one, at least while you’re nursing. Also check other items that may be putting too much pressure on your breasts, like a baby carrier or a shoulder bag.
• Drink plenty of fluids.
• Don’t wean suddenly if you can help it, since this can contribute to an abscess, a serious and painful infection. An abscess is a localized collection of pus surrounded by swelling, which is usually treated with antibiotics, but may require surgery.

• If you suffer repeatedly from breast infection, see your doctor, especially if a lump is not reduced in size after three days of treatment, if the mastitis keeps reappearing at the same place on your breast, and/or if you have dimpling on the breast. Breast cancer is extremely rare in lactating women, but it does occasionally occur and you must have it ruled out.
• If you have been checked out for repeated breast infection and been reassured that it is not caused by a malignancy, check for other factors that may be causing the mastitis—allowing your breasts to become too full, not alternating them, improperly positioning your baby, not washing your hands well enough before nursing, using an unclean breast pump, or not getting enough rest. Change what you can and seek medical help at the first sign of infection.