. Sunday, November 23, 2008
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Molly couldn’t wait to bring her newborn son home from the hospital. She pictured herself breast-feeding Joey in cozy comfort, tenderly caressing his tiny head while gently rocking in the oak rocker.

But molly’s picture-perfect vision of breast-feeding soon developed an ugly blot. After a few weeks, one of her breasts became so tender and swollen, it was hard to tell who wailed louder, Joey or Molly.

Fortunately, a call to her doctor reassured Molly that she was experiencing a mild form of mastitis, an inflammation of the breast that commonly occurs in nursing mothers in the first weeks after birth. Much to her relief, Molly learned that she would not have to give up breast-feeding. In fact, breast-feeding is the prescribed treatment for mastitis.

The Case of the Clogged Duct

When a nursing mother develops a painful area in her breast and there’s no fever, it’s usually caused by a plugged milk duct. This occurs when the breast is not emptying as completely as it should. The milk backs up in the duct, resulting in inflammation.

Take Molly’s case, for example. A few weeks after Joey’s birth, she returned to work. Up until that time, Joey had nursed on and off all day, which stimulated Molly’s breasts to product lots of milk. When Molly’s work schedule abruptly cut back on the nursing schedule, her milk supply exceeded the demand. Her breasts became overly full and, by late afternoon, sore and swollen.

To make matters worse, because her breasts ached, Molly rushed nursing Joey, leaving her breasts only partially drained. Overnight, her right breast became tender, and she stopped nursing from that breast entirely, which was the worst thing she could have done. As a result, milk backed up, a duct clogged, and her sore breast turned scarlet and throbbed like the dickens.

This is a classic example of inflammatory mastitis. “When an abrupt change in the nursing pattern occurs for any reason, it sets the stage for plugged ducts and mastitis,” says Karen Ogle M.D., associate professor of family practice at Michigan State University in Lansing. Also common: Babies who previously nursed all night suddenly become sound sleepers, leaving Mom with breasts filled to the brim.

Your Breast Plan

What can you do to prevent or treat aching, throbbing breasts?

Lessen your load. “Always nurse at the first feeling of fullness,” says Dr. Ogle. Your baby’s body should be fully facing the breast during nursing. This helps him to latch on to the nipple properly and to thoroughly empty the ducts of milk. “If you are away from your baby, hand express or pump enough milk to relieve the overfullness,” says Dr. Ogle.

Break through the pain. If, like Molly, your breast becomes inflamed, you must continue to nurse to drain it. “Despite the discomfort, now is not the time to wean to the bottle,” said Dr. Ogle. Stop nursing when you have inflammatory mastitis, and you risk causing an abscess, which will have to be surgically drained.

Once inflammation subsides, however, you can wean by cutting back one feeding at a time. That way, your breasts will gradually slow down milk production.

But for now, while the inflammation persists, try to breast-feed every 1 to 2 hours, followed by gentle hand expression or pumping if necessary to relieve the plugged duct. Begin nursing on the unaffected breast until you feel milk ready to flow from the inflamed breast, then switch sides. Take acetaminophen for pain and drink plenty of fluids.

Apply a little warmth. To encourage the milk flow, apply a warn, wet towel to the sore breast before nursing. You may also help loosen a plugged duct by learning over a basin of warm water and immersing your breast before nursing.

Free your breasts. Check your bra. It shouldn’t be so tight that it constricts milk flow. Also avoid sleeping on your stomach for prolonged periods, which can cause pressure against your breasts.

When to Call the Doctor

If, despite following these tips, your breasts remain sore and red for 24 hours or you have a fever, chills or other flulike symptoms, call your doctor. It probably means you’ve developed infectious mastitis.
Infectious mastitis is caused when a bacterium such as staphylocossus aureus. The mother’s body, perhaps through a cracked nipple, and the organism settles in a milk duct.

In any case, you’ll need an antibiotic to clear things up. Stick with the full course of drugs your doctor gives you, so that re-infection doesn’t occur.

Once again, continue to breast-feed. “Don’t worry about passing the infection on to the baby,” says Dr. Ogle. It’s the breast tissue that’s infected, not the breast milk. The antibiotic that passes into the breast milk is probably fine for your baby, but you should check with your doctor to be sure.

A final Rx: Rest. You need it to build your resistance and to counteract stress, which can hamper the free flow of milk.


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