Mastitis

 I went to the Korean Spa with my daughter yesterday.  If you haven't experienced a Korean Spa- find one near you! It is a series of pools of different temperatures with jets that massage different parts of your body. There is usually a set of co-ed pools in one area and a set of gender separated pools in the locker room that is mandatory nudity because they don't want bathing suits messing up their pool systems.  They also have a huge co-ed room with lots of saunas and sweat lounges to just relax.  It can be very awkward your first time getting in a pool with a bunch of naked ladies and then you develop a sense of empowerment and freedom.  I like taking my daughter every few years to help her understand that we are all unique in our bodies and they aren't something we should be ashamed of.  It isn't everyone's cup of tea but I love it.  Anyway, in all of the five hours I was away from my baby, I developed a painful lump in my breast. I immediately knew what was happening.  

After Judah was born, I felt like I had the flu for about three weeks.  I kept deteriorating little by little.  At first, I thought I had a piece of placenta left in me that was causing an infection (this happens).  Then I thought I was just low on nutrients and I ate a ton of liver and started taking iron supplements (post about supplements here). I just kept getting worse.  I finally called my midwife and told I felt like I was actually dying.  I felt septic (essentially a full body infection that usually leads to death if untreated).  She said even though I didn't have the classical very painful breast or red streaks (my breast was hurting but I thought it was just new nursing mama pain), she would prescribe antibiotics.  I was better within 12 hours. 

Mastitis is an inflammation of the breast tissue that often involves infection. It usually starts with a clogged  milk duct.  Your milk ducts are a network of canals that bring the milk from their storage areas (alveoli) to the nipple for baby to drink. When it is clogged, the area becomes inflamed, painful, red, hot, and the milk can't get past the clog so you'll feel a lump. Left untreated, this can develop into an abscess which has to be drained by your doctor.  

It shouldn't get to that point.  If you develop pain in your breast while you are nursing or pumping, treat it immediately.  There are a few stages before antibiotics that would have worked for me if I had realized this was my problem earlier. I learned most of these things from my last three midwives- this is great stuff from all over the country. 

Early Detection (you feel the lump but you don't feel sick):

• get the hottest water you can stand and immerse your breast for ten minutes
• pump or nurse for ten minutes, massage the area in a motion towards the nipple. This is not a gentle massage, you have to really mash it to help build pressure and push out that clog.
• Repeat this process a few times or until you feel relief.
• try nursing baby from a different angle, you want his nose facing the clog so he can put direct suction on it.  This could mean you are nursing him on all fours, side lying, or upside down (as in you are facing his belly, not actually in a handstand :))

Possible infection: (you feel sick and just noticed this bump as well)

• Chop 10 cloves of garlic into very tiny pieces, mix it with honey to make a chunky paste.  Take one spoonful of this every six hours (set an alarm on your phone to wake you at night) for 24 hours. These are both powerful natural antibiotics that won't wipe out baby's gut flora (post on gut flora here). This works for me every time I catch it early enough.
• Take 2400 mg of sunflower lecithin (or soy lecithin if you prefer) every 6 hours for 3 days, then down to 2400 mg twice a day for 3 days, then down to just 2400 mg once a day for maintenance while nursing.  Lecithin is an emulsifier. In salad dressing, the oil and vinegar will separate unless you add an emulsifier (like mustard) to hold the fat and vinegar together. In breastmilk, the fat likes to separate as well from the watery part of the milk- you've probably seen this in your stored breast milk. Lecithin can keep it more uniform so the fat in your milk does not congregate and cause clogs.  My fatty milk likes to do that- I blame quesadillas. 
• Take Bromelain 500 mg once a day to help with inflammation

Infection: (you see red streaks, you feel terrible)

• try everything above while calling your provider
• don't be afraid to request antibiotics, when you are too far gone the above fixes may not work
• start probiotics the next day to start recolonizing your gut bacteria 

Prevention: 

• this is really key. I take sunflower lecithin and bromelain for a couple of months after I have a baby to avoid mastitis. 2400 mg lecithin, 500 mg bromelain daily. 
• when your milk first comes in, just free flow. Place a towel under your breasts and just let them air dry and free flow.  It will be messy but it is so worth it. Just don't wear anything for that few days- any pressure can lead to a clog.
• avoid tight fitting bras and underwires
• Don't miss feedings/pumps.  If you decide to have a few drinks and feel tipsy, make sure to pump instead of just skipping that feeding. 

Resources: 

Bromelain study about nursing goats

Cool website about what is safe to take during breastfeeding

How milk is made

What is sepsis?