Mastitis, an inflammation of the breast, can occur from varied causes including infection or obstruction. It is most frequently seen in the first 6 months of breast feeding. Common causes for mastitis include cracked nipples, missed feedings, oversupply of milk, tight fitting clothing, maternal stress/fatigue, and malnutrition. Most often the condition affects one breast and presents as a red, tender lump or area of breast tissue with fever, lumpy or stringy milk, and malaise.1

Mastitis is a significant complication of breastfeeding and can even stop some mothers from breastfeeding. The nipple becomes sore and the breast becomes tender and swollen. Cracking of nipple can lead to infections. Poor breast attachment and inadequate emptying of milk from the breast when feeding may also contribute to mastitis.2

As a preventive measure, it is important to routinely empty the breast every 2 hours. Applying warm compresses before nursing can help mobilize and dissolve the clotted milk. Mothers should avoid tight fitting clothing and should try different feeding positions.1

Correct positioning and latch are key treatment options for cracked, sore and painful nipples. Improvement is often seen by the simple improvement of the infant’s latch.3 There are several different positions that mothers can choose from to breastfeed their babies, including laid back breastfeeding or biological nurturing, cross cradle hold, cradle hold, rugby or football hold and side lying position.4 Mastitis prevention and treatment guideline recommends effective positioning and attachment while breastfeeding as a preventive measure. It is important to prevent nipple trauma through good position and attachment in order to prevent the development of mastitis. The mother should avoid missing feeds and leaving long gaps between feeds. Mothers must also learn and practice gentle massage and hand expression of breast milk as a self help measure.5

Appropriate positioning⁵

1. The baby’s head and body should be in alignment and the neck not twisted
2. The baby’s tummy should be turned towards the mother’s tummy
3. The baby’s head should not be held but the neck and shoulders should be supported so that the baby’s head can tilt backwards
4. The woman may shape her breast to enable a deeper latch
5. The baby must start a breastfeed with the nose opposite the nipple
6. When the mouth is wide open, the baby should be brought to the breast with the chin leading
7. The nipple should point towards the roof of the baby’s mouth
8. The baby’s body should be held close to the mothers’ body.

References

1. Khan T. Common Breastfeeding Problems, Part 3 of 3: Nipple Pain + Infection. Available from: http://www.familydocs.org/f/14.CME_.Spotlight.JAN_.Breastfeeding.pdf.
2. Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014377/
3. Walker M. Are There Any Cures for Sore Nipples? Clinical Lactation 2013;4(3), http://dx.doi.org/10.1891/2158-0782.4.3.106.
4. Positioning and Attachment of Baby to the Breast - Fact sheet for Health Care Professionals. Available from: https://www.breastfeeding.ie/Uploads/Positioning-and-attachment-of-baby-to-the-breast.pdf.
5. Mastitis Prevention and Treatment. Available from: http://nationalwomenshealth.adhb.govt.nz/Portals/0/Documents/Policies/Mastitis%20Prevention%20and%20Treatment_.pdf.