Mastitis Protocol Updates from the ABM

Mastitis can be a challenging experience for breastfeeding moms, but the latest recommendations from the Academy of Breastfeeding Medicine (ABM) offer some fresh perspectives on managing this condition.

Clogged Ducts: A Misnomer?

Traditionally, clogged ducts were thought to be caused by milk "plugs." However, the ABM suggests that these "clogs" are actually due to inflammation. This inflammation narrows the milk ducts, creating an obstruction. It's common to feel lumps due to breast fullness, but these usually resolve after breast emptying.

Managing Symptoms

To manage symptoms, the ABM recommends:

  • Ice and NSAIDs: Applying ice every few hours and taking nonsteroidal anti-inflammatory drugs like ibuprofen can reduce swelling and provide relief.
  • Breastfeeding Strategy: Start feeding from the unaffected breast to avoid increasing milk supply in the inflamed area. Over-pumping the affected side can exacerbate inflammation, so it's best to avoid it.
  • Supplements: Consider sunflower lecithin (5–10g daily) or choline supplements to reduce inflammation and milk stickiness. Sufficient levels of choline may support better milk production and flow, which could theoretically help prevent issues like clogged ducts that can occur when milk isn't being efficiently emptied from the breast. While probiotics show promise, consult your healthcare provider before starting new supplements.

Reducing Engorgement

Engorgement can be a painful aspect of mastitis. Techniques that reduce blood flow and inflammation can ease discomfort such as lymphatic massage.

The goal of lymphatic drainage is to encourage the natural flow of lymph fluid, reduce swelling, and promote healing.

1. Start at the Neck and Collarbone

  • Positioning: Place your fingers just above the collarbone (near the neck area).
  • Action: Using light pressure, move your fingers in a gentle downward motion toward the chest and the underarms. This helps activate the lymphatic drainage system.
  • Why: This area is a key starting point as the lymphatic system drains into the larger lymph nodes near the neck and collarbone, so this helps clear the pathways.

2. Move Toward the Underarm (Axillary Area)

  • Positioning: With your fingers still near the collarbone, slowly move your hand down to the underarm area (armpit).
  • Action: Gently massage or sweep downward toward the underarm area, making small circular motions or light sweeping motions. You can also use a “C” shape with your hand to help guide the fluid downward.
  • Why: The underarm is where the main lymph nodes are located, and this helps encourage fluid to drain from the affected breast into the lymphatic system.

3. Lightly Massage the Affected Breast Area (Away from the Nipple)

  • Positioning: Place your hand on the outer side of the engorged or affected breast, near the outer edges (away from the nipple).
  • Action: Using your fingertips, massage outward and toward the underarm in light circular or sweeping motions. Avoid massaging directly on the nipple.
  • Why: This helps move the milk and lymphatic fluid away from the breast tissue and toward the underarm area where it can be drained.

4. Focus on the Upper Chest and Shoulder Area

  • Positioning: Once you've worked on the outer breast and underarm, move to the upper chest, just below the shoulder.
  • Action: Using gentle pressure, massage the tissue in an upward direction toward the shoulder. Focus on the area near the collarbone and shoulder joint. This continues to promote lymph fluid flow away from the affected breast.
  • Why: The upper chest area is another key area where lymphatic fluid should be drained. The fluid should be directed toward the large lymph nodes near the neck.

5. Massage the Opposite Side (for Symmetry)

  • Positioning: To encourage the flow of fluid away from the affected breast, you can also gently massage the opposite side of the body (i.e., the unaffected breast or area).
  • Action: Use the same techniques to gently encourage lymphatic drainage from the opposite breast, which can help promote balanced lymphatic fluid movement.

6. Finish with Sweeping Movements Toward the Neck

  • Positioning: Move both hands to the sides of your neck.
  • Action: Gently sweep both hands from the top of your shoulders toward the neck and collarbone area.
  • Why: This final movement will encourage the fluid to move upwards and away from the breast tissue toward the main lymphatic drainage areas at the neck and collarbone.

Additional Tips:

  • Use Light Pressure: The key to lymphatic drainage is using light, gentle pressure. Avoid applying too much force or massaging too aggressively, as this can cause discomfort or further congestion.
  • Hydrate: Drink plenty of water to assist with the natural drainage process and support your lymphatic system.
  • Repeat: You may want to perform this massage a few times a day to encourage fluid drainage and alleviate any swelling.

Important Considerations:

  • If engorgement or swelling persists despite lymphatic drainage massage, or if you have symptoms of mastitis (fever, severe pain, redness), you should seek medical advice from a healthcare provider.