New Mastitis Protocol
A Modern Approach to Clogged Ducts and Mastitis
As a mother who has nursed four of my babies, I have experienced firsthand the challenges of breastfeeding, including severe bouts of mastitis caused by incorrect treatment methods. With my fourth child, I faced a clogged duct early on and, following the advice of a lactation specialist, sought the expertise of a physician specializing in breastfeeding medicine. This provider shared invaluable insights, surpassing all the knowledge I had accumulated over five years of breastfeeding and a nursing degree. This experience has profoundly changed my approach to managing mastitis and clogged ducts, and I am passionate about sharing these modern, evidence-based strategies with others.
Breastfeeding, while a beautiful and natural process, can sometimes be accompanied by painful challenges like mastitis and clogged ducts. Traditionally, the recommended treatments included heat application, vibration massage, and constant nursing. However, recent insights from breastfeeding medicine specialists are shifting the paradigm towards treating these issues more like a sprained ankle—focusing on ice, rest, lymphatic massage, and anti-inflammatory medications. This change reflects a deeper understanding of the underlying mechanisms of mastitis and clogged ducts.
The Traditional Approach: Heat and Constant Nursing
For years, the go-to remedies for mastitis and clogged ducts involved:
Heat Application: Warm compresses were thought to help by dilating the ducts and promoting milk flow.
Vibration and Massage: Gently massaging the affected area was believed to break up the clog.
Constant Nursing: Frequent nursing or pumping was encouraged to keep the milk flowing and clear the blockage.
Wide Spectrum Antibiotics: Although this wipes your gut flora and isn’t targeted to bacteria specific strains, this was the standard for treatment regardless of doing a clean catch sample (similar to a urine sample for a UTI). For clogs that are just beginning to form sometimes antibiotics aren’t necessarily needed right away.
While these methods have helped many, they often lead to more inflammation and discomfort. New research and clinical experiences are showing that these practices might not always be the best approach, particularly when inflammation is a significant factor.
The Modern Approach: Ice, Rest, Lymphatic Massage, and Anti-Inflammatories
The new perspective on treating mastitis and clogged ducts treats these conditions more like a sprain or injury, emphasizing the need to reduce inflammation and support the body's natural healing processes:
Ice Application: Just as you would ice a sprained ankle to reduce swelling, applying cold compresses to the breast can help decrease inflammation and pain.
Rest: Allowing time for the body to heal is crucial. Overstimulation and constant nursing can exacerbate inflammation.
Lymphatic Massage: Gentle, light massage aimed at promoting lymphatic drainage helps the body absorb and remove the leaked milk from the breast tissue, reducing swelling and preventing infection (see image below).
Anti-Inflammatories: Medications like ibuprofen (Advil) are effective in reducing inflammation and pain, aiding in faster recovery.
Probiotics: Did you know that specific probiotics are designed to target particular ailments in the body? Specific strains that have clinical research supporting their use with mastitis include: Limosilactobacillus fermentum (formerly classified as Lactobacillus fermentum) or, preferably, Ligilactobacillus salivarius (formerly classified as Lactobacillus salivarius) strains.
Why the Shift?
The traditional approach can sometimes lead to more inflammation and trauma. Nursing more frequently can increase your prolactin levels, which in turn boosts your milk supply. As your supply increases, your ducts may become overfilled with milk. However, constant massage can cause added inflammation and narrowing of the ducts, making it difficult for the new added milk to flow properly. This can lead to milk escaping into the breast tissue where it doesn't belong (again). Once the milk is trapped in the tissue, more inflammatory markers are drawn to the area, exacerbating the inflammation and causing further damage. It's a cascade of events that can be difficult to halt:
Heat and Massage: While intended to relieve clogs, these can increase blood flow and white blood cell activity, exacerbating inflammation. When a clog progresses to an infection, heat can worsen the situation.
Constant Nursing: Frequent nursing or the use of devices like Haakaa pumps can create suction trauma, potentially leading to further inflammation and tissue damage. It also drives your prolactin levels up, which creates more milk that gets trapped in the already damaged ducts.
Understanding Milk Leaks and Misconceptions
A critical misconception is that milk leaking into breast tissue can be drawn back into the ducts. However, once milk escapes into the tissue, it cannot re-enter the ducts. The body needs to absorb this milk through the lymphatic system. This process requires reduced inflammation to function effectively, which is why the modern approach emphasizes ice, rest, and lymphatic massage as shown in the photo below.
Practical Tips for the Modern Treatment of Mastitis and Clogged Ducts
Apply Cold Compresses: Use ice packs wrapped in a cloth for 15-20 minutes several times a day to reduce swelling.
Take Anti-Inflammatory Medications: Over-the-counter options like ibuprofen can help manage pain and inflammation.
Practice Gentle Lymphatic Massage: Light, sweeping motions towards the armpit can encourage lymphatic drainage, see image below can be done while laying flat on your back 3-4 times a day for 5 minutes at a time.
Rest: Avoid over-stimulation of the breast. Nurse as needed but avoid excessive pumping or nursing to decrease the chance of causing higher milk supply levels.
Probiotics: Make sure they include specific strains, such as Limosilactobacillus fermentum (formerly classified as Lactobacillus fermentum) or, preferably, Ligilactobacillus salivarius (formerly classified as Lactobacillus salivarius) strains. These are two wonderful options to look at:
https://lactationhub.com/breasthealth-pregnancy-breastfeeding-probiotic-with-choline-and-prebiotics/
Sunflower Lecithin has been recommended to combat recurrent plugged ducts. The usual recommended dosage for recurrent plugged ducts is 3600-4800 mg lecithin per day, or 1 capsule (1200 milligram) 3-4 times per day. After a week or two with no blockage, you can reduce the dosage by one capsule. If there is no blockage within another 2 weeks you can reduce it again by one. You may need to continue taking 1-2 capsules per day if stopping the lecithin leads to additional plugged ducts (info on dosage from KellyMom).
Belladonna 30, Phytolacca 30, or Hepar sulph 6: These three homeopathic remedies have helped me tremendously when I feel a clog coming on. Specifics on dosage and the correct remedy based on symptoms can be found here. (info on dosage from Joette Calabrese).
Seek Professional Help: If symptoms persist, and you have a high fever, flu like symptoms, and malaise that isn’t improving, contact your primary care provider. Ask for a clean catch milk sample (similar to how a clean catch urine sample is collected) to show what bacteria is present which may help in proper antibiotic use. If these are recurrent problems consider consulting a physician specializing in breastfeeding medicine for further investigation. I learned a tremendous amount from all of the appointments I had with the specialist.
Conclusion
The treatment of mastitis and clogged ducts is evolving with our understanding of the underlying causes and best practices for healing. Shifting from heat and constant nursing to ice, rest, lymphatic massage, and anti-inflammatories can provide more effective relief and prevent further complications. By adopting this modern approach, breastfeeding mothers can experience a more comfortable and successful breastfeeding journey.
Feel free to review the new mastitis protocol yourself for more details by clicking the link below:
https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf
*Medical Disclaimer: Please note that I am not a medical doctor. The information provided in this blog post is based on personal experiences and general knowledge in breastfeeding management. It is intended for informational purposes only and should not be considered medical advice. Always consult a healthcare professional or lactation consultant for specific medical advice or before making any changes to your breastfeeding routine.
