Before mastitis develops, the woman starts lactating. Often, it occurs in the third or fourth week postpartum. Rarely does it happen in the antenatal period. However, that can happen with autoimmune diseases of the breast, such as lupus mastitis or granulomatous lobular mastitis. The infection of the breasts is usually unilateral and occurs with significant engorgement, making it even more painful. If left untreated, mastitis can lead to a breast abscess. However, it does not raise the chances of breast cancer. To treat it, antibiotics are given.
What Causes Mastitis?
Mastitis usually occurs when bacteria enter through the broken skin because of cracks, abrasions, or fissures in the nipple that allow entrance to the breast. Mostly, the bacterial source is the infants throat and nose; other sources include the mothers hands, birthing personnel, and increased blood supply to the breasts for lactation.
The most common bacterial agent causing mastitis is Staphylococcus aureus (S. aureus). Other possible agents include beta-hemolytic streptococcus, Escherichia coli, and Candida albicans. In some cases, community-acquired S. aureus and nosocomial methicillin-resistant S. aureus can also cause mastitis. To determine the exact causative agent, healthcare providers culture breast milk and treat it accordingly.
The common predisposing factor for mastitis can be milk stasis, which occurs because of inadequate milk drainage from the breast duct. Often, it happens when the mother misses the nursing sessions, delays feeding, and abruptly leads to infant weaning. The ducts may also become blocked because of tight clothing and lack of support for pendulous breasts. Other predisposing factors for mastitis include a history of untreated breast infections or untreated infections and a low-functioning maternal immune system.
Assessment
If you suspect the patient has mastitis, take a complete detailed history from them that includes inquiring about chills, fever, and increased heart rate. With mastitis, the infection is often unilateral, which means it affects one breast.
The localized symptoms of mastitis include pain, redness, swelling, and heat at the infection site. Moreover, the woman may confuse the other symptoms with flu, such as muscle pain, fatigue, continuous fever, and headache. However, on a review, it is revealed that the breastfeeding frequency has changed. As a nurse, you should investigate the following factors:
- The time an infant spends on feeding
- The time between two nursing sessions
- If the infant sleeps on the mother's breast
- The infant keeps sleeping at night and does not have a feeding session
- If the infant drinks juices, formula milk, or water
Ask if the feeding sessions have decreased, which causes the woman to feed the infant less frequently. Moreover, inquire if anyone else in the family has flu symptoms.
Upon physical examination, you may notice that the area of the breast is pink or red with wedge-shaped swelling resulting from the septal distribution of the breast tissue. The upper quadrant of the breast is involved, but mastitis can occur in any part. Mastitis may also cause sore or cracked nipples. Upon palpation, you may feel the infected area is firm, tender, and warm upon touch. During palpation, you may also notice enlarged axillary lymph nodes. Other systemic symptoms, such as fever and tachycardia, are also present.
Pharmacological Treatment
The pharmacological treatment for mastitis includes prescribing antibiotics and over-the-counter pain relievers that are safe for the woman and her nursing baby. If antibiotic therapy has started before the pus formation, the infection often resolves within 48 hours. However, sometimes it may take longer.
Milk culture can help identify the causative agent, and sensitivity helps identify which antibiotic is effective in treating the infection. To relieve pain, discomfort, and fever, you can prescribe acetaminophen or other NSAIDs such as ibuprofen or naproxen. If an abscess is developed because of mastitis, it needs to be drained with needle aspiration or surgically.
The most commonly used antibiotics to treat mastitis are penicillin-resistant penicillins and vancomycin.
Penicillinase-resistant penicillins include dicloxacillin and oxacillin. These broad-spectrum antibiotics fight infection by damaging the bacterial cell wall.
Vancomycin is used only for resistant organisms that are not treated by other antibiotics, such as penicillinase-producing staphylococci. It is effective against gram-positive bacteria and works by interfering with the biosynthesis of the bacterial cell.
Nursing Considerations
Mastitis mainly occurs when feeding sessions are missed, and the milk does not get emptied from the milk ducts, eventually leading to clogged milk ducts. Tell the mother that to prevent mastitis, the key is not to miss nursing sessions and to feed the baby unrestricted. Moreover, they should observe the baby while nursing for techniques related to latching on, sucking, and placement position. Check if the breasts are empty at the end of the feeding session. Instruct the mother to rotate feeding sites and positions to empty all lobes. If you observe clogged ducts, ask the mother to massage the area before the feeding session and assess if the area is completely emptied.
If the woman has developed mastitis, ask her to take complete bed rest. However, she should not stop her feeding sessions. Tell her to focus on nursing her baby with utmost focus. She may be reluctant because of the infection, but it is safe to do so. Therefore, breastfeeding shouldnt be stopped.
Moreover, she should pump the milk gently if the breast is too sore. Breast emptying is an essential practice in preventing the development of abscesses. Educate her that it is a good idea to massage her breasts before the nursing session when she feels her breasts were not completely emptied in the last session.
Tell the woman that applying heat to the affected area or taking a warm shower followed by a gentle massage using the palm can help promote milk drainage. Encourage the mother to remove her bra during feeding sessions so the pressure doesnt cause the milk ducts to clog.
Let the mother know that not all babies are able to feed from an inflamed breast. This can happen due to engorgement and edema, which make it difficult for the baby to grip the areola. However, pumping milk from the breasts can help alleviate this issue. Furthermore, some infants might not take the milk from the infected site because of the changed taste, as the milk from the infected site is high in sodium, which changes the taste of the milk. Encouragement to breastfeed the child through mastitis is much needed. Make sure to guide and support your patient at every step.
The position of the infant is critical for efficient breast milk drainage. Instruct the woman to turn the infant on their side with the head placed on the womans breast. Moreover, the head should be towards the areola without turning. One or more inches of the areola should be placed in the infants mouth, and the chin and nose should rest lightly on the breast. The infants lips should be flared during the nursing session. As the infant is fed, the mother should pay a keen ear to know if they are easily swallowing and gulping the milk. Encourage the mother to change and try various feeding positions such as cradle, football, cross cradle, and side-lying to ensure the breast ducts are emptied completely.
To start the feeding session, use the breast affected by mastitis. Tell the mother that she has to feed the baby frequently, usually every 2-4 hours, round the clock. To feed frequently, the woman may need to wake the infant during sleep.
To manage the pain and redness of the breasts because of mastitis, ask the woman to use ice packs or warm packs on the breast. Moreover, a supportive and well-fitting bra can also help reduce pain if it does not compress the affected area. To reduce pain, prescribe analgesics to the mother. Encourage her to drink at least 3000 ml of liquid daily and plenty of fluids. Ask the mother to monitor her urine color to check if she is well hydrated. Light yellow-colored urine indicates the person is well hydrated, while dark yellow-colored urine indicates that the person is not well hydrated. The mother should eat whatever she wants but ensure the diet meets all nutritional requirements.
Nurse's home visits can help lower the occurrence and complications of mastitis. Therefore, make sure to check on new or first-time moms to see if they have any difficulty nursing the baby and if they have any complaints, such as mastitis.
The Bottom Line
Mastitis must be treated promptly, as it can lead to abscess development. However, it does not raise the chances of breast cancer. It is a painful condition of the breast that often occurs in breastfeeding women and is accompanied by pain, redness, swelling, and warmth of the affected area.
Mothers experiencing mastitis often feel uncomfortable while nursing their children. As a nurse, you should encourage them to feed their child as much as possible, as it helps to relieve clogged milk ducts. Additionally, applying a warm compress to the affected area can also aid in effective nursing sessions. Advise the woman to stay calm, rest, try different feeding positions, and attend the follow-up visit with their provider.
About the Author:
Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.
Mariya is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
If you want to learn more about CEUfasts Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.
