A Pain In The Breast

Tips for preventing mastitis—and what to do if you get it.

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When Marcie Richardson first developed mastitis, she pretty much took it in stride. As an OB-GYN, she'd treated dozens of women for this painful breast infection and figured this would be her first and last bout. As it turned out, though, it wasn't—not by a long shot. She had four more cases in 10 months. And she had the infection three times while breastfeeding her second child.

Richardson, who practices at Harvard Vanguard Medical Associates in Boston and is an instructor of obstetrics-gynecology and breastfeeding at Harvard Medical School, admits the infections tested her resolve to keep nursing. "Every time I got mastitis, I thought, 'I can't stand it, I'm going to quit,' " she says. "But I kept going, and I'm glad I did."

Only about 1 in 4 women gets mastitis during the first 12 months of breastfeeding. And even if you are one of the unlucky few, rest assured that you'll likely develop it only once—though, as in Richardson's case, infections do sometimes recur. In the meantime, here are tips to help you avoid mastitis in the first place and different treatments in case you do have to deal with it.

How Mastitis Happens

Mastitis causes the breast tissue to become inflamed and infected. While it can occur at any time, the condition is most common during breastfeeding, when the ducts are filled with milk—a natural breeding ground for bacteria. But how do bacteria get into the ducts in the first place?

"Nipple trauma is a big culprit," says Pamela Berens, M.D., an associate professor at the University of Texas at Houston and an OB-GYN at the University of Texas Health Science Center. "If a woman isn't latching her baby on properly, a crack or opening in the nipple can result. This lets bacteria—which usually comes from the baby's mouth—get in where they don't belong." Once the bacteria enter the nipple, they can travel up the milk duct and cause an infection in the breast tissue itself.

Clogged ducts are another culprit, and they can be caused by a number of factors. These range from wearing a poorly fitted bra to incomplete emptying of the breast during feedings, according to Richardson. "When the breast cannot drain properly because of an obstructed milk duct, the body's usual infection-fighting strategies don't work and bacteria can take hold," she explains.

Berens, who is also a certified lactation consultant, likens this phenomenon to a bladder infection: Your urine is sterile, but if you're not emptying the bladder, you're more likely to get an infection. The same thing happens with breast milk. "Even though it's bacteriostatic—meaning it doesn't encourage the growth of bacteria—if milk isn't draining well and is sitting in the ducts, bacteria are more likely to breed and grow," she explains.

How to Treat It

See your doctor if you suspect you have mastitis—hall marks include a hard, reddened and painful area, usually in only one breast; blood in the milk; and flulike symptoms such as fever, chills and muscle aches. If you do have an infection, you'll need antibiotics and perhaps pain medication.

In an ideal world, your doctor also will try to root out the cause of the infection. "If you've got a latch problem or you're not draining the breast well, we need to fix it," Berens says. (A lactation consultant can be a huge help here.) "Antibiotics may cure the infection but may not resolve the reason you got it in the first place."

Beyond antibiotics, Richardson recommends "local measures" when treating mastitis. These include nursing on the infected breast first, feeding often, massaging the breast while nursing, taking hot showers or using warm compresses on the breast, and pumping after nursing, if necessary. "All these things help keep the breast empty, which in turn helps the infection clear faster," she says.

Whatever you do, don't stop breastfeeding. The baby won't "catch" the infection, and the remedies used are safe for both of you. Plus, continuing to nurse will help clear the infection more quickly.

Can You Prevent Mastitis?

Absolutely, says M. Jane Heinig, Ph.D., a certified lactation consultant and executive director of the Human Lactation Center at the University of California, Davis. "Anything that compromises your immune system—long-term exhaustion, extreme stress—can contribute to your ability to fight off infection," she says. So rest as much as possible, eat healthfully and drink lots of fluids. Here are some other prevention tips:

Skip the soap. Most soaps are drying, which can be traumatic to breast tissue, says Houston OB-GYN Pamela Berens, M.D. Instead, simply rinse your breasts with lukewarm water (don't use a washcloth) and pat dry. If the skin is dry, follow with an over-the-counter breast cream, such as Earth Mama Angel Baby's Natural Nipple Butter.

Be a quick change artist. Change your breast pads and nursing bras whenever they get wet, and wash them often. Avoid pads with plastic backing—they can keep your nipples damp, which can lead to a yeast infection.

Don't overdo the pumping. Whenever you pump (or breastfeed), your body responds by producing more milk. If you make so much milk that your baby can't drain the breasts completely, you set the stage for infection.

Treat clogged ducts quickly. If you suspect that you have a clogged duct, apply hot compresses to the area several times a day, be sure the breast is drained completely and massage the affected area as your baby nurses.

Make sure your bra fits properly. "Extra-tight bras can occlude milk flow," Heinig says. Berens adds that exercise bras can be particularly problematic because they're so close-fitting, which can impinge the ducts. "Wear it for exactly the time you're exercising, then take it off," she says. Also avoid the urge to lift your bra over your breasts to nurse; doing so can pinch the ducts and set the stage for problems.

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