September 17, 2011

Mastitis, by definition, is inflammation of the mammary gland. It can occur in any woman; however, it is most common in first-time lactating mothers. This condition is a result of bacterial invasion of breast tissue. Mastitis rarely occurs in the antepartum period (before birth of the baby). Its incidence includes 1-2% of primiparas (first-time mothers) who are postpartum and lactating. It usually occurs 2-4 weeks after delivery.

The presenting symptoms of mastitis include malaise (general sick feeling), fatigue, chills, muscle aches, or localized breast tenderness. The condition progresses to symptoms like fever of greater than 102°F, tachycardia (rapid heartbeat), and a firm, reddened area of breast tenderness. Mastitis is usually preceded by marked engorgement of the affected breast, and is almost always unilateral (one-sided). The most common area of the breast that is affected is the outer quadrant.

Common causes of mastitis include bacteria from the baby’s mouth, bacteria entering via breast injuries (bruising, fissures, cracks in the nipple), milk stasis (milk pooling in the breast), and bacteria from the hands of the mother or health care provider. The most common organisms associated with mastitis are the bacterial organisms Staphylococcus aureus and betahemolytic streptococci. Concurrent infection with mumps is also found to be a cause of mastitis.

Some contributing factors associated with mastitis are: fatigue, stress, lack of sleep, plugged ducts, engorgement, a decrease in number of feedings, inadequate nutrition, breast trauma, and breast constriction by a tight brassiere. Thus, teaching about preventive measures is the most important treatment. Preventive measures include resting when the infant rests, as well as teaching the importance of maternal nutrition, increased fluid intake, and vitamin supplementation. Lactating women require large caloric requirements as a result of milk production and tissue healing from delivery. Proper hand washing, perhaps with an antibacterial soap, should be encouraged. One of the most important preventive measures to emphasize is good breast-feeding habits. For example, early and frequent feedings with complete emptying of breasts will decrease the likelihood of blocked ducts and milk stasis. Proper positioning of the baby on the breast, along with good latch on, could prevent nipple trauma. Lastly, breast care measures include: cleansing with water only and drying adequately, and wearing a nonconstricting, well-ventilated bra.

Treatment for mastitis includes Tylenol for reduction of fever, inflammation, and pain along with antibiotic therapy with penicillin or a cephalosporin. The mother should be instructed to complete the entire antibiotic prescription, even if symptoms subside quickly. She should be assured that breast-feeding can and should be continued in both breasts. Breast-feeding with an infection will not harm the newborn, nor will the antibiotics used for treatment. Both the use of warm compresses and massaging the affected area may help encourage milk drainage toward the nipple. Supportive care, rest, and decreasing stress will also help hasten recovery. The importance of prompt treatment should be stressed. If left untreated, a more serious complication, such as breast abscess, can occur.

SEE ALSO: Breast-feeding, Lactation

Suggested Reading

Auerbach, K. G., & Riordan, J. (1993). Breastfeeding and human lactation (pp. 382-384). Sudbury, MA: Jones & Bartlett.

Clark, Cunningham, Gant, Gilstrap, Hankins, Leveno, MacDonald. (1997). Williams obstetrics (20th ed., pp. 564-565). Stamford, CT: Appleton & Lange.

Smith, A. BA, IBCLC. (2001). Breast infections and plugged ducts.

Varney, H. (1997). Varney’s midwifery (3rd ed., pp. 677-678). Sudbury, MA: Jones & Bartlett.


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Category: M