Does this look like the start of mastitis?

[Amy_jellybean]

Hi girls,

My one week old baby is currently on EBM due to damaged nipples.

I am pumping each breast for 15 minutes every 3 hours on advice from a lactation consultant.

About 12 hours ago I noticed a red tinge come up on the side and underneath my left breast. This breast has been causing me major issues, it doesn't matter how much I massage it under the shower it's always sore and lumpy. I'm worried that these red marks are thee start of mastitis. I've just tried pumping and could only get 20ml off the sore breast and 60ml off the good one. Is there anything I can do to help prevent mastitis on the left if that's what it is?

I have another appointment with the lactation consultant on Monday but I'm worries about not being able to get enough out over the weekend and having to give him formula top ups.

[Barb Glare]

Hi,

Yes, this is the start of mastitis. Have a hot shower or put a hot pack on the breast. Take some pain relief (nurofen or panadol). Try to breastfeed your baby on that side (it may hurt a little) It sounds like you’ve been giving EBM for a couple of days now- the nipples should have healed. You need to try to empty that breast as much as possible. And then put an icepack on. If you can’t relieve the symptoms head off to the doctor for some antibiotics. Most mums make a little too much milk for their baby - you have to keep moving that milk. Whenever you feel uncomfortably full feed your baby or express some milk until your breasts are soft and comfortable again. What sort of pump are you using? Not all pumps are created equal. If you are not using one already, a hospital grade pump hired from ABA is a good investment

[Amy_jellybean]

Hi barb,

Thanks for your reply. My nipple is far from healed on that side, I'm having another session of laser at 1pm today and I'm hoping that helps. The problem is it doesn't matter how much I express on that side my breast is always sore I will try the hot pack and see if that helps. My biggest worry is I'm getting bugger all milk out of that breast even if I pump for 20 minutes. I am using a Medela swing pump.

[HotI]

Have you tried hand expressing? This can sometimes be more effective than a pump, and you can focus on where the blockage might be.

[Barb Glare]

Use an icepack and take some nurofen or panadol (nurofen will help with the inflamation) It may be that the nipple is infected and the antibiotics will assist in the nipple healing as well. You might ask the dr for some creme that has a steroid, antibiotic and antifungal. when you breast is full because it is blocked it’s hard to remove the milk - you need to reduce the inflammation. Your milk supply will come back, you really need to get that nipple healed so that you can get the baby on. The ice is more important and useful in this situation than heat

[little_O]

Oh that is a far too familiar sight for me!!

I was the same Amy, I couldn't move the milk either. It's especially hard because you can't get your bubba to feed from that spot either.

For me I found the bath worked a bit better than the shower. I would sit in there, breasts submerged, and massage them out. It hurt like crazy but eventually, once the excess milk came out, long stringy milk would come. This was the bad stuff.

See if you can find a physio that does ultrasound for mastitis. My hospital out me onto someone and that worked good for episodes 3-5 for me.

Another thing I found great to have on hand is something called Poke Root which I got from a naturopath. They use it in the states, and it is the only thing that cleared it up for me. You have to be SUPER careful with the doses, but I didn't have an issue and it amazing!

I also second the nurofen. It made the difference of being able to get out of bed to dd or not when I had it

[Amy_jellybean]

Thanks barb I'll give it a go and go see the doc today. In the mean time I'm not getting enough milk out to feed him, should I give him a formula top up until I can get the antibiotics?

[little_O]

Oh and I ended up having to use bepanthen for my nipples to heal. My ob recommended and it worked the best for me.
I second the I ice too.

You'd be surprised how little milk they need Amy. My dd survived through 5 bouts of mastitis soley on breast milk. I just fed her more regularly, which helps you too! I would recommend to just keep expressing an keep feeding and it will get through.

Are both nipples damanged? Can you feed from one directly? That will help keep the milk up.


Some mums recommended skin on skin contact for me too and that kept my milk going strong.

[Amy_jellybean]

Both are pretty bad but one more than the other. I have an appointment to have more laser treatment done today and hopefully I can get him back on the better breast out of the two. He is already feeding every 2.5hrs but I'll try every two.

[little_O]

Does the place that does laser know anyone for ultrasound? It's a non image one and helps break up the blockages.

[Amy_jellybean]

I'm not sure I'll ask them today, they are a massive clinic im pretty sure they would do it.

[Taurean]

Hi hon. So sorry you're having such a rough time. I had a very tricky start to BF with both my girls and between the two of them suffered from nearly EVERY possible breast feeding issue imaginable so hopefully I can share some good advice.

See if you can see your LC sooner. Does she do home visits? Get her out today if possible. You said his attachment is good but there sounds like there could be an underlying issue if your nipples are that badly damaged. Get your LC to check your DS for a tongue tie. DD2 had a posterior tongue tie which was missed by our Paed (at SJOG Murdoch) but picked up by my LC at around the 3 week mark (I think). DD2's attachment was beautiful but my nipples were annihilated and the tongue tie was the issue. We had it snipped as soon as we could (around 5 weeks) and things improved out of sight from there. It was a hard slog and I exclusively pumped every 3 hours for 5 weeks but we got there. She was exclusively fed breast milk and only weaned a week ago

Barb suggested getting a hospital grade pump and I agree, definitely do that while you're trying to get this sorted. The Symphony is so much more efficient than the Swing. You can hire them from the ABA, many pharmacies around Perth and King Eddies.

Make sure the Medela breast shields you're using are the right size. The standard size that comes with Medela pumps is rarely a good fit. This is how I badly damaged my nipples when BF DD1. It wasn't her attachment, it was the bloody small shields that annihilated them! It took a while before I knew this (my fab LC picked it up) so I changed sizes. Actually, I have three different size breast shields now as my nipples have varied during the BF days. So get this sorted pronto hon. The damaged caused by the small shields with DD1 caused me to get Vasospasm which, in a nut shell, is hell.

Lasinoh actually made my nipple wounds worse so keeping them dry and airing them was better for me. It's not the case for all women but it could be worth discussing it with your LC.

As for the pumping for only 15 minutes, it sounds like you really need to empty the breast. I wonder why your LC suggested a time limit? I pumped until the milk stopped flowing. I had far too much for DD2, but most mums do in the early weeks, so I froze the excess and I constantly rotated (ie pumped to replace a used frozen feed) that amazing stash until she was one. It was one of the benefits of having to pump so much in the early days. Maybe ask your LC again why she thinks you should limit the pumping to 15 minutes.

The only thing I can add at this stage is about his feeds. 60ml is a very normal amount for a baby of his age to take and for you to express. Even the 20mls off one of your sides is a normal amount. Often one breast performs better. A hospital grade pump will extract more milk than the Swing though so once again, maybe hire one for now. Unless your DS isn't gaining weight then avoid the formula top ups, he honestly doesn't sound like he needs extra milk yet. Two hourly feeds sounds like a great idea though.

I hope things improve for you soon. You're doing an amazing job and congrats again!

[Taurean]

Oh, and get some bamboo breast pads. I got dermatitis from disposable ones with DD2. The bamboo ones were bliss, especially with nipple issues. Mine are Pea Pods (same as the MCN brand) and I got them from Babyland in Osborne Park but most of the big baby stores sell them.

[Amy_jellybean]

Hi love

Thanks for the advice. I've got the large avent nipple shields and they have been really good.

The reason my nipples are in such bad shape isn't because of bub. This is following on from another thread where a midwife at the hospital put a breast pimp on for 30 minutes on my scuba night to stimulate milk. She walked away and didn't show DH or I how to turn it off and bu the time she came back they were bruised and welted and a mess. I'm going to try and get him back on the boob this arvo after the laser treatment.

[RockingBaker]

I had mastitis when DS2 was 3 weeks old. I had fevers and bright red welts on my breast so I got antibiotics. I demand fed DS2 as normal making sure I allowed him plenty of time to drain the breast and it cleared up in 3 days. If you have any questions the ABA helpline is excellent. I rang them when my dr didnt confessed she knew nothing about breastfeeding or mastitis beyond prescribing antibiotics.

[sahbear]

How are you feeling Amy? Hope you and Quinn are going ok.

[Taurean]

Hi love

Thanks for the advice. I've got the large avent nipple shields and they have been really good.

The reason my nipples are in such bad shape isn't because of bub. This is following on from another thread where a midwife at the hospital put a breast pimp on for 30 minutes on my scuba night to stimulate milk. She walked away and didn't show DH or I how to turn it off and bu the time she came back they were bruised and welted and a mess. I'm going to try and get him back on the boob this arvo after the laser treatment.

How are you hon? That's awful about your intro to the breast pump in hossi. Ouch!

In my last post I was referring to breast shields, not nipple shields. The breast shields are the main plastic piece that goes over your boob when you pump. If you're using Medela, the shields come in 4 (or 5?) different sizes. I suspect you had the standard ones in hossi which are rarely a good fit hence the severe nipple damage. Get your LC to check your own breast shields when you see her because you probably need a larger size. The incorrect breast shield is not only inefficient but it will continue to damage your nipples. That's how I got Vasospasm and it is awful.

Hope you're seeing some improvement.

[Pholi]

I second Taurean's advice to get the breast shield size checked. I bought the large on my LC's advice, and my nipple ulcers improved moderately, but later tried the XL, and actually that improved things more on the right - my bad side. It's not the size or angle of the flange sop much as the diameter of the tunnel bit that makes a difference. Given that you've had a few days of pumping only, they 'should'; have healed up a fair bit - if not, it may be the pumping (ie, the fit of the kit) that's contributing to your problems.

Hang in there, I know it's really tough. You will get to a time, eventually, that you breast feed your bub painlessly and easily.