Mastitis and Engorgement | BreastfeedingHerts

Managing Mastitis & Engorgement

The below information aims to help you manage engorgement and mastitis without the need for antibiotics. However, please seek medical attention if the below suggestion do not lead to quick easing and resolution of your symptoms, or if symptoms persist or worsen.

The information here is written for a generic audience, and all information may not be appropriate for you - please refer to your personalised plan and contact Heidi Hembry IBCLC if further clarification is needed.

Managing Engorgement

Not all engorgement leads to mastitis. Engorgement can be a normal part of your body's response to making more milk. However, engorgement is more likely if baby is not taking enough milk, or if your body is routinely producing more milk than your baby needs. Skilled lactation support should be sought to assess the cause of your engorgement.
Ensure baby is well latched, and feeding well with clear and obvious swallows, with no pain for you.
Gently massage your breasts as baby feeds to encourage good flow and drainage. Massage should be gentle and not cause you pain.
If your breast does not feel softer after a feed, try to rouse and relatch baby to the same breast.
Changing feeding position can be helpful if you have a persistent area of fullness. Babies typically drain the breast best where their tongue and chin are placed. E.g. if you have engorgement on your arm side of your breast, then latching baby in underarm hold may be helpful.
If your breast is not well drained, you may need to express to further soften your breast. This is particularly important to do if your baby is not feeding/settling well or gaining weight well as they will need this milk as a supplemental feed.
If your baby is gaining weight well and you are suffering from oversupply, the avoiding expressing can be a helpful way to leave your breasts fuller for longer, giving appropriate signals to your body to slow down on production.

Managing Mastitis

Mastitis is when engorgement has been left unmanaged and your breasts are now hard, painful hot and with redder/darker patches. It can happen on one or both breasts, and it can come on very suddenly, Most mastitis is not a true infection, and releasing the milk will reduce the above symptoms quickly and usually without the need for antibiotics. Antibiotics may be necessary if the below does not ease your symptoms quickly.

Continue to take your full course of antibiotics if you have been prescribed them and have begun taking them.
If you have yet to take antibiotics, you may find expressing/improved feeding alleviates your fullness, without the need for antibiotics.
Ibuprofen has a strong anti-inflammatory effect and is safe to take whilst breastfeeding. Tag teaming this with paracetamol can be helpful too, being aware to remain within the maximum dosage per 24hrs for both medications and avoiding if you have nay contraindications - please read here for full details: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/drugs-faqs/
Aim to feed or express regularly from the affected breast(s) to reduce current engorgement and then prevent further engorgement. This can take sustained and repeated effort for severe engorgement, and should then become easier.
Use warm flannels before a feed to aid milk removal if your inflammation is mild. Cold compresses can be very effective for severe engorgement as they work to reduce inflammation. You can use an icepack or bag of frozen vegetables wrapped in a tea towel, or purpose made gel packs following manufacturers guidelines.
You can also use gentle tapping with your fingertips over any obvious engorged areas. Some people find that using the smooth side of an electric toothbrush is really helpful, though for others it can seem to exacerbate the problem
Gently stroke any inflamed areas during a feed/express (from the back of the area towards your nipple) to aid good drainage.
Express after a feed if you feel baby hasn’t removed enough milk from your breast.
If your flow slows and you are still full, pause for a few minutes whilst massaging, stroking, tapping and jiggling your breasts to loosen any blockages and begin expressing again. Sometimes two or more expressing sessions in rapid succession are needed to release significant engorgement and blockages.
Use cold compresses after a feed/expressing to further help reduce inflammation.
Aim to feed/express again before engorgement increases too much.