mastitis.

Mastitis is a bitch. Excuse my French (although I think my husband being French gives me a get-out-of-jail-free card), but this is an infection you really really do not want to get. I was chatting with a fellow new mom a while ago about a recent mastitis scare and at the mere mention of the word she said the exact phrase I had said to my doctor a few months prior as I was being hospitalized for my second infection. She asked me to rate my pain on a scale of 1 to 10.

"Oh my god it hurts worse than childbirth!"

Unfortunately for a lot of women this is not an exaggeration. And unfortunately the infection is not completely understood, by doctors and lactation specialists alike. There are certain risk factors, there are certain things you can do to try to avoid infection or to try to rid yourself of the infection at the very first signs, but some people are just more prone to it. You can do everything by the books, follow all the rules and tips and still end up with a nasty case. For those cases, I'm sorry but this information won't be much help. Sometimes you just need a good dose of antibiotics or a stay in the hospital. 

Hopefully it won't come to that for you. After my second infection I vowed to learn everything I could about mastitis, what it is, who gets it and how to best prevent it. I have since had two scares, and following these suggestions (one or all or some combination) has helped me prevent full-blown mastitis requiring antibiotics both times. Hopefully this information can help you prevent it, too.

What is it?

In the simplest of terms, mastitis is an inflammation of the breast.

What causes it?

It is usually caused either by a blockage of milk flow or some kind of infection (most commonly Staphylococcus, or a Staph infection). In the case of infection, it was probably introduced to the breast from baby's mouth through a cracked or damaged nipple and you will probably need antibiotics. This sounds scary but is common; babies pick up a lot of things in hospitals. It probably isn't harming baby, but once it enters your breast it can do serious damage.

Blocked flow can be caused by a whole host of factors, namely:

• failing to completely drain the breast at each feeding (especially once the fatty hind-milk starts flowing), 
• feeding problems (such as a weak suck, a tongue tie, improper latch-on technique, or always using the same position to breastfeed which might only drain one part of the breast),
• restrictions (such as a too-tight bra or top, especially underwire bras; sleeping in a restrictive position or with baby laying on top of you; too-tight straps such as on a really long drive or flight or consistently wearing a baby carrier or diaper bag in the same position)
• damage (from injury, massaging too hard or previous infection/inflammation)

Who is at risk?
Theoretically everyone is at risk, even non-lactating women and sometimes even men (this is very very rare). We're going to focus on the lactation-related kind here. In this case, certain factors can increase your risk, such as:

•  the first few weeks of breastfeeding (most cases occur within the first three months, although it can occur any time during breastfeeding)
• engorgement or oversupply
• changes to breastfeeding schedules (such as going back to work, or increased supply after a tongue tie release, etc)
• being a mother of multiples,
• past history of mastitis,
• a hospital stay (for mom or baby, due to increased exposure to infections),
• too much stress or fatigue

What are the symptoms?
At the very first signs, there is a chance you can avoid a full-blown infection with some home remedies. The signs to look out for are:

• a tender area of the breast that starts to form a lump, 
• it may start out a little painful to the touch but the pain will usually quickly increase and become constant,
• it may be swollen and/or red,
• it may feel hot to the touch,
• it may be painful to breastfeed,
• you may start to feel feverish

Once the infection has progressed to include these symptoms, call your primary care physician immediately (if it is after hours, GO TO THE ER!!! The infection can worsen very quickly and can cause serious and irreversible damage to your breast!):

• fever over 101° F
• chills
• nausea or vomiting
• flu-like aching
• red streaking on the breast towards the nipple

What can I do at home to prevent it?
At the very very first signs of infection:

• Increase your fluid intake to at least a gallon and a half per day, focusing on clear liquids such as herbal teas, 100% fruit juices and Emergen-C or something similar.
• Take your vitamins & herbal supplements, but especially vitamin C, zinc and echinacea. 
• If you have access to herbal tinctures, take immunity boosting ones.
• Homeopathic Phytolacca Decandra 30c - dissolve five pellets under the tongue every two hours from the very first signs of infection until absolutely every symptom is gone.
• Eat as much raw garlic as you can handle.
• Remove as much stress as possible - ask friends & family to take care of food and chores and other children until you are better.
• If possible, bed rest in a dark room with nothing but you & baby. Sleep topless and nurse as often as baby will take the breast. 
• Nurse, nurse, nurse & pump, pump, pump! You are trying to unblock a blockage, and that can only be done by stimulating the milk ejection reflex. 
• Use heat to help with let down before nursing or pumping. Apply a wet hot compress, as hot as you can stand, and insulate with a dry towel to keep the heat in as long as possible. Soaking the affected breast in a hot bath works, too. (Some women find steeping either rosemary, dandelion or fenugreek seed and using the resulting infusion in their compress or as a soak.) Hot showers are very helpful, too, especially when combined with massage.
• Massage your breast continuously before and during nursing or pumping, stroking in the direction of the nipple and making sure to massage all areas of the breast (not just the infected and sore part, although you definitely should concentrate there).
• Use cool compresses as needed between nursing or pumping sessions for the pain.
• Make a warm castor oil compress to draw out the infection. Soak a piece of wool or felt in warmed castor oil and apply directly to the affected area. Cover with something cotton and keep it there for a half an hour to an hour. Wash off the castor oil residue when finished. Do this up to three times a day.
• Take Ibuprofen to help with pain and inflammation. 

If this doesn't help in 24-48 hours (you will know if it hasn't worked and is getting dangerous, call your doctor or go to the ER!!! I am not exaggerating about going to the ER! If mastitis isn't treated in the early stages it can progress incredibly quickly. If the infection festers too long it can require lengthy hospital stays and may necessitate draining the breast. This is as awful as it sounds. It is literally sticking a needle into your boob and draining out the infection. With no anesthetic! Ouch and yuck!

Hopefully thanks to a few home tricks it won't ever come to that!

Happy nursing!