Lactation, breast feeding & mastitis

In keeping with the theme of Women's health blogs mixed in with Pilates blogs, I'm going to share some informational points I feel are important to know when it comes to the topic of lactation and the breast feeding.

Broken into 3 points of interest let's talk about the breast and lactation, mastitis and management options. 

Image courtesy of Google Images, retrieved June 8th 2015

Image courtesy of Google Images, retrieved June 8th 2015

Lactation & the breast

  • Lactation is the most important part of the post partum period (the period after giving birth) and will often be prioritised over musculoskeletal pains and other health complaints. 
  • A well functioning lactation systems protects the mother against health issues relating to cardiovascular health, mental health, and bone density.
  • 30% of the mother's metabolic energy goes towards breast feeding, which is a reason why breast feeding mothers can experience a gradual weight loss after pregnancy.
  • Lactation is vital to the babies health as maternal breast milk acts as a exterogestate placenta (placenta outside of pregnancy) and provides vital nutrients to help protect and develop the babies immature neurological system. 
  • Exercise does not pose any risk to breast feeding and visa versa. 
  • Once lactation is established it will continue throughout the women's life until the supply of milk has ceased. 
  • In the breast, blood drains medially (towards the sternum) and superiorly (towards the collar bone), while the lymphatic system drains towards the arm pit. 
  • Milk ducts in the breast are not linear, instead they are like the roots of a tree with 9 ducts and 9 lobes opening onto the nipple. 
  • The ducts act very differently when lactating compared to not i.e. the ducts dilate between 50-150% during milk production. There if obstruction or blockage occurs, the tissue is vulnerable to pressure overload. 

Mastitis

Image courtesy of Google Images, retrieved June 8th 2015

Image courtesy of Google Images, retrieved June 8th 2015

Image courtesy of Google Images, retrieved June 8th 2015

Image courtesy of Google Images, retrieved June 8th 2015

  • Mastitis is inflammation of the breast with or without infection.
  • Up to 30% of women will experience mastitis in the first 12 weeks post partum.
  • Inflammatory reactions in the lactation system are often very big because of this system is so importance to human survival. 
  • It can be difficult to tell the difference between inflammation and infection:
    • Inflammation has signs of redness, fever, pain and loss of function. 
    • Fever can be present in both infective and inflammatory mastitis.
    • However, just because a fever is present doesn't mean that antibiotics are required. 
  • Most symptoms should resolve within 3 days of onset.
  • Reoccurrence is very high and the primary risk factor is a previous episode of mastitis. 
  • The severity of symptoms is not a reliable predictor of the outcome and each case should be treated with equal seriousness.
  • Some symptoms you may take note of to help measure the severity of mastitis are: 
    • Bothersomeness
    • Erythema (redness)
    • Breast size
    • Breast tissue tension
    • Local breast temperature

Management options

  • The breast tissue and ducts are much softer when compared to muscles and other tissue and very vulnerable to abscess and bleeding if handled vigorously. 
  • Ducts need to be able to relax, expand, and move so consideration of bra type and clothing tightness is very important. 
  • The number 1 supported treatment in the literature is horizontal bed rest.
  • Breast expression is more effective in reducing blockage than manual therapy. 
  • Breast feeding is not the reason mothers feel fatigue. Fatigue is caused but the 30% increase in pro-inflammatory hormones which are produced to protect the mother's body. 
  • But in the case that you're needing additional help then Physiotherapy can be helpful. 
  • Physical Therapy treatment options which aim to reduce inflammation include: advice, ice therapy, manual therapy (massage), electrotherapy (vibrator, therapeutic ultrasound, and TENS).
    • There is no solid evidence and consensus in the literature about the dosage and efficacy of therapeutic ultrasound. In saying this, as a Physiotherapist it is my preferred treatment option. I aim for 1MHz and turn the intensity up to a warm tolerable sensation…. being mindful that temperature sensation might be reduced so test on the unaffected side of different area of skin. 
    • There is also no evidence for the prescription of antibiotics - no high quality randomised controlled trials. 

Like most aspects of motherhood, every person is going to experience a differnt journey and this is because our bodies are so unique. Hopefully what you've taken away from this blog is that breast feeding is a natural and very important aspect of motherhood, that breast feeding placing big demands on the mother but also protects her again diseases, and that mastitis should be addressed as a serious condition and that there are many ways to approach treatment. I'd advice you discuss this with your doctor, midwife and other treating health professionals such as a lactation nurse so that you can understand all the options available and make the best informed decision for you. 

Sian