There are 2 types of mastitis, inflammatory and infectious. Both occur in the ductal system of the breast and are associated with milk stasis. The mammary gland is not designed to store milk, only to transport it. Any mother with milk stasis is at high risk for a plugged duct, engorgement, mastitis or all three. Usually this begins with a ductal obstruction; a small hard, warm tender lump.
If left untreated or unresponsive to treatment it can lead to inflammatory mastitis; i.e., the whole breast will swell, become hard, tender, and hot. If this stage is again untreated or unresponsive to treatment it can lead to infectious mastitis. This is when bacteria take up residence in the obstructed duct and swollen breast. This stage can have systemic effects: fever, chills, malaise, and flu like symptoms. It is very important that if homeopathic treatment/lactation supportive therapies have not helped a women with mastitis at this stage, medical intervention be sought out for treatment as it can be a very dangerous condition. Things that predispose a woman to mastitis would be anything which cause milk stasis. This could be a change in feeding pattern, nursing multiples, baby sleeping through the night, a sick baby not nursing well, etc. Also anything that contributes to a possible bacterial infection can predispose a woman to mastitis. This could be sore nipples, broken down nipples, maternal diabetes, maternal decreased immune system, and I also believe that our frequent use of antibiotics in labor contributes to a disrupted normal flora and possibly an increased risk of yeast problems which in turn causes sore nipples that can easily breakdown, and this often is a sub-clinical symptom that is not diagnosed as a problem with yeast and simply as a latch problem that may or may not be present and often frustrates the nursing dyad and often leads to discontinuation of nursing. This yeast would predispose moms to a secondary mastitis from bacterial infection after the nipples breakdown from the yeast colonization.
All patients with mastitis should be sent for an evaluation of their mastitis.
For both types of mastitis, the prevention/treatment is essentially the same, the only difference being the use of antibiotics in the infectious mastitis with systemic symptoms.
- continue to nurse the baby throughout. Discontinuation of breastfeeding will only worsen the condition. Nursing the baby beginning on the affected breast first to ensure emptying that breast is best. Do not encourage pumping as pumping will increase the milk supply adding to the milk stasis. Only pump if it is too painful to nurse. Massage of the affected area. Change the position of the baby at the breast to encourage emptying of all of the mammary ducts.
- a well balanced diet with micro nutrients has shown to be helpful. Increase fluids.
- decreasing stress and fatigue are also important. It has been shown that a high level of stress and fatigue increase your risk of mastitis.
- warm soaks may also be helpful. Leaning over placing breasts in a tub of warm water with hypericum or calendula tincture or apple cider vinegar (if yeast is suspected)
- I also feel that constitutional homeopathic treatment will strengthen the constitution of the women and decrease her risk for mastitis. This would be best prior to pregnancy since that tends to be a time that a woman’s symptoms can become aggravated or much more apparent.
- lactation consult is essential to evaluate the dyad for problems and correct any problems. This would also give mom a plan to heal, preventing things from getting worse.
Anytime there is a baby refusing to nurse on one breast, that mom should be evaluated right away since this could be a sign of breast cancer.
These could be any symptom that the mom may be feeling including how the baby is reacting to the situation. Some rubrics that I could think of were:
-Chest, pain, stitching, mammae (with a lot of sub rubrics) pg 1211 Synthesis
-Chest, pain, sore, mammae pg 1206 Synthesis
-Chest, pain, sore, nipples pg 1206 Synthesis
-Chest, pain, mammae pg 1189 Synthesis
-Chest, pain, nipples pg 1189 Synthesis
-Chest, inflammation, mammae pg 1176 Synthesis
-Chest, inflammation, mammae, nipples pg 1176 Synthesis
-Chest, cracks of nipples pg 1166 Synthesis
-Chest, discoloration, mammae, redness, streaks pg 1167 Synthesis
-Chest, discoloration, mammae, nipples pg 1167 Synthesis
-Fever, heat in general pg 1661 Synthesis
(and any rubrics related to the fever i.e., when is it worse and when is it better)
-Any mental rubrics that would apply to this mom would be important
-Chest, abscess, mammae pg 1159 Synthesis (abscess is different than mastitis)
-Chest, abscess, nipples pg 1159 Synthesis
I would do a lactation evaluation with this patient as well as a homeopathic evaluation. I would want her description of when it started, description of her pain, what makes her symptoms better or worse, any treatments she has tried and with what success, an evaluation of her latch, evaluation of the baby and whether he is thriving or if he is ill, the babies response to the breasts, is he nursing well on both sides or refusing, does the baby have thrush or is he tongue tied, did the nipples breakdown first or was this an inflammatory mastitis?
The answer to these questions would determine where I might go with my questioning. I might stop to do some teaching about Lansinoh if she had been using that and give her an alternative, since often people slather it on and then the baby can’t latch properly adding to nursing problems especially latch.
Sticking with the homeopathic evaluation, I would want her description of symptoms from the mentals to the NWS, and any detailed description of her pain or sensations……All this would be after her medical and lactation evaluation.
- cracked ulcerated nipples, deep painful cracks
- sore nipples, excessively tender
- swelling of mammae
- violent itching in breasts
- areola reddened
- great sensitivity in the nipple area even when they’re lightly touched or when they come in contact with clothing.
- mind- unusual laughter about things not funny
- mastitis pain is throbbing, redness, streaks radiating from nipple
- breasts feel heavy; are hard, red and hot
- very red inflamed
- high fever
- flushed face
- throbbing H/A
- rapid onset
- pupils dilated
- <3pm-11pm, after midnight, <lying down
- mammae hard and very sensitive
- breast hard painful and of purple hue
- mammary abscess-breast lumpy, stone hard, tender in spots
- when child nurses, pain goes from nipple all over body
- cracks and small ulcers about nipples
- aching, soreness, restlessness
- bloody, watery discharge from breasts
- <left breastfeeding
- generally <cold and cold damp
- aggravation at night
- mammae lax and shrunken, HARD, painful to touch
- stitches in nipples and breast
- wants to press breast hard with hand
- breasts enlarge and become painful before and during menses
- itching of breast
- aggravation from suppression of sexual desires
- mentally closed, flat or hard people, mental dullness or confusion
- breast pain due to any type of motion including deep breathing
- better lying on painful side (decreases movement)
- pain sharp and stitching
- slow onset
- breast hot, painful and stony hard
- abscess of mammae
- hard, hot, painful breast, better from heat
- sharp stitching or splinter like pains in the breast
- patients emit a sour smelling discharge from the breast
- extremely sensitive to cold air or cold applications
- irritable and angry outbursts, critical, impatient, hurried
- chilly and aggravated by cold, intolerant of drafts