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122. Engorgement + New Mastitis Protocol for 2022

The latest and most up-to-date protocol for clogged ducts, engorgement, mastitis and abscesses from the Academy of Breastfeeding Medicine. Learn how to take care of your breasts, so they can take care of you (and your baby!)

ABM Mastitis Protocol

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*This podcast is not "medical advice". Please consult with your Healthcare Provider about your specific situation.


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Read the full transcript here: 

Welcome to the Breezy Babies podcast, where we talk about all things boobs, babies, and breastfeeding. This is Episode 122 engorgement and Mastitis. I'm breath the IBCLC and I made Breezy Babies with you in mind to help ease your transition into parenthood. Becoming a parent changes your life every way imaginable. Bumps in the road are going to come up as you move into your new role, but my goal is to help smooth out those bumps and help you become the most confident parent you can be. With good education and support, I know you can meet your breastfeeding and parenting goals. Let's do this together. Hey there. What's up? How's it going? Thank you for listening in today to this podcast episode. I love being able to talk to you, hang out with you. Even though I cannot see you, I still love seeing all the downloads that this podcast gets every single week. I am excited to bring you some of the latest and greatest information today. If you didn't already know, there is a brand spanking new mastitis protocol that is out in the world. I mean, it's been out for weeks, maybe even a month or two, but if you're not in the lactation world, you may not have even known that this is out in the world. So if you didn't, that's okay. I'm going to break it down for you today. I'm going to tell you the main points, the really important parts, and then if you want to actually go and read through the protocol yourself, then you can do that. I will link it in the show notes, but I want to start off by reading you a review, a Breezy Baby's review. Now, last week I read a review that was all about Lex, and this week I'm going to do the same. Lex is an IBCLC who is on my Breezy Babies team. She does telehealth and in home visits. Love having her on my team, and she's just been on fire lately. She's getting all these awesome Google reviews and I am going to share it with you and just talk about how amazing she is. So this review was left by Jenna Favero, I think is how her last name is pronounced. I would guess this is what she said in her Google review. She said, Alexis was kind and patient as we worked on improving my baby's latch. She completed a thorough evaluation and provided helpful insights catered to our needs. She was quick to respond to my messages as well. I'm so glad we gave her a call. So good, right? The cool thing about having multiple IBCLCs on our team is that you can meet with one or all of us, especially if you're approved for free consult through your insurance. You could set up a prenatal with Lex visit after your baby comes with me, and it's all in the same group, and that's totally fine to do if you haven't already checked to see if your insurance covers free consults, just click the link in the shut notes or go to If you click on Telehealth or in-home Visits, the link for Lactation network is right there. It's worth checking. Why not? Why not just check to see if your insurance covers free consults? Because if you get a yes, you are totally covered for at least six six consultations with us here at Breezy Babies. If you're selfpaying, no problem. We accept that as well. Even HSA and FSA payments. Meaning healthcare spending account or flex spending account. We accept those as well. And we always give an automatic 30% discount for our self pay clients. So here we go into the meat of what we're talking about today. I have to start by telling you that this podcast is not medical advice. Of course, it never is. I can only give you advice if you are my client and you have signed a consent form saying that I am allowed to give you medical advice. So I am not your IBCLC, unless you have hired me to do so. But I just want to share this information. It's from this document, this study that's been released, well, it's pulling from studies. It's a new protocol is a better way to refer to it, instead of a study that was released by the Academy of Breastfeeding Medicine. So this was just revised in 2022. So pretty hot off the press. This updates, you know, every few years or so. So some of these things may change over time, but at the time of this recording, this is the latest and greatest protocol for mastitis. Now, again, I will link this in the show notes if you want to go through and read it yourself. But I will break down all the basics in this podcast episode if you'd rather just listen to the main points that I'm going to share with you today. So, now that you know that this is not medical advice, let's jump in to top three tips. Now, I really am focusing this today on mastitis, of course, because that's what this document is about. But a lot of these tips will also apply to Engorgement because that's kind of how it starts. We'll talk about all of that today, but really specifically, this will be talking about mastitis. So let's just get into it. OK? Tip number one when it comes to managing mastitis is avoid antibiotics at all costs. Really think about your breast microbiome. Okay? So let's just talk about this now. It's really common. I see this happen all the time. I hear it from my clients. I see it on mommy Facebook groups. People will have these first signs of mastitis. Maybe they're seeing a little bit of redness, a little bit of soreness. They're starting to not feel well. They'll feel 100% right. And everyone jumps in to say, oh my gosh, you need to get on antibiotics right away. And you're going to learn today that that actually might always not be 100% necessary. And if you followed along with me on my journey a little bit, you already know how passionate I am about gut health after having my own very serious problems with SIBO. You can go back a few episodes to learn more about that. If you don't know what SIBO is, that's okay, I didn't either. And I'm a nurse. But it basically is just extreme gut dysbiosis. Meaning that all the good and bad bacteria in my gut was completely thrown out of whack. And not long before I got diagnosed with SIBO, I had a dose of antibiotics. Antibiotics are beautiful. They're great. They are made to kill off bad bacteria. But guess what? They also kill off all your good bacteria too, which is not ideal. Sure, antibiotics might be great in some situations, but we really want to avoid them when possible. So I don't recommend jumping straight to antibiotics at the very first time. Maybe it's not even mastitis. Maybe we just assume or perceive it to be mastitis and we start antibiotics and then we killed off all that good gut bacteria for maybe no reason at all. So in this protocol, they kind of talk through the steps of mastitis. So they talk about how it starts with your milk ducts narrowing. That's really how it starts. Milk ducts narrow, then all those little alveoli get congested, think traffic jam in your breath, narrowing, congestion, and that is made worse when you have too much milk going on. From there, inflammatory mastitis can start. And then after that, bacterial mastitis may follow. They're not saying it will follow, they're saying it may follow. Now of course, bacterial mastitis is where antibiotics may come in hand, may come handy if it gets to that point. OK, so let's break this down. Let's start with hyperlactation. You may be wondering, what does that mean? That means too much milk. And you also might be wondering with some of these words that I'm saying, you also are going to hear the word dysbiosis. And what that basically means is that the good bacteria and the bad bacteria are out of whack. And yes, you have a microbiome just in your breast alone. The presence of bacteria, that is your microbiome. We talk a lot about microbiome of the gut, but again, your breast has its own microbiome. And when that's out of whack, you can get to mastitis. So hyper, lactation or too much milk or dysbiosis then leads to doctoral narrowing, which then can progress to inflammatory mastitis, then bacterial mastitis, which sometimes can also turn into an abscess. So that's what we're really going to be looking at today. Now, there are some off ramps besides that basic progression that I just described to you, but we're just going to focus on the ones that I've mentioned today. If you want to dive deeper into some other off ramps, then you can go check out the link in my bio to check out the full protocol yourself. But let's just focus on those for now. So again, bacterial mastitis, when it leads to that, then you may need antibiotics at that level. But those beginning phases of ductile narrowing and inflammation, you don't need antibiotics at that point. So of course what I'm going to tell you now and what I want to teach you is how you can avoid this progression and not get to the point of bacterial mastitis, right? It's kind of like a progression. So let's zoom in even more. Let's look really closely at ductal narrowing. This is what we commonly refer to as a plug duct. But from this protocol they talk about how ducts are actually innumerable and interlacing. That's what they talk about in this protocol. So that means that it's actually impossible for one duck to get a clog in it or a plug. You want to think of it more as a congested breast tissue. Okay? That's a more accurate way to think about it instead of one clogged duct. So they suggest that if you do have some ductile narrowing, which you may perceive as a plugged duct, that you are going to still want to continue breastfeeding. That's really important. You want to continue to keep the milk moving and you may want to consider taking an anti-inflammatory. That would be fine at this point. Let's say that we move on to inflammatory mastitis. Now what we're talking about is redness swelling, pain. At this point you may also have a fever. You could have chills, you could have tachycardia, which is your heart is beating really fast. They talk about in this protocol, they say it should be emphasized that systemic inflammatory response syndrome may occur in the absence of infection. Okay, so what does that mean? That means it's still not time to take antibiotics. Okay, so I just said redness selling pain, maybe a fever may be chilled, maybe your heart is beating fast. According to this protocol, it's still not time to take antibiotics. This is the point, if you're listening, this is the point where everyone jumps on the mommy Facebook groups and they say, oh my gosh, you need to go get antibiotics right away. Now what I am instead recommending according to this protocol is that instead of jumping straight to antibiotics, you may want to consider giving it 24 hours. Now during those 24 hours you're not just going about your life and feeling stressed and doing your normal everyday things. No. You are being proactive during this 24 hours. And we'll talk a little bit later about how you be proactive. So hold that right there. Okay, let's break down. Now. Bacterial mastitis, this is the point when antibiotics or probiotics are needed to resolve and maybe even both. Again, you would want to work with your IBCLC to see what's best and also your own healthcare provider now, bacterial mastitis, it's not contagious. Keep feeding your baby. Please don't stop breastfeeding during this time. This is usually when the redness on your breast has spread and gotten bigger. So, dang it, we got to the point where we need antibiotics to kind of help clear it out. Now let's talk about the very last step that you could get to, and that's an abscess. This is where we don't want to go. This is something that when this happens, it usually requires drainage by your healthcare provider. In this protocol, they say approximately 3% to 11% of women with acute mastitis will develop an abscess. Abscess presents as a progressive in duration and erythema, that's a redness and often a palpable fluid collection. Basically just means, like, you press it and you can feel some fluid stuck there in a well defined area of the breast. Okay. There are also something called galacticils, which are also fluid filled spots, but they aren't painful like an abscess. So that's one of those little off roads that I said that we wouldn't be diving deep into today. So obvious answer here is we don't really want to get past step one. We definitely don't want to get to bacterial mastitis and certainly not things like abscesses, stuff like that. So, first off, a good first step would be to not push yourself into oversupply. Maybe you don't want to pump after every single feed. And yes, I do have a lot of families that I work with who do that, even though they don't really need to. So maybe don't go crazy with your breast pump. Maybe don't go crazy with your hockey. Maybe don't take a million supplements to boost your supply when you're already making enough for your baby with a little to spare. Second, I want you to take care of your microbiome. How do you do that? You eat real food, fruits and vegetables, not processed foods. Not the classic American diet, which is all things white and starchy. You also are going to want to avoid environmental toxins such as coordinated water and mold. You want to take your vitamins and minerals. You want to drink water with electrolytes. You want to get enough sleep, decreased stress, exercise. Also, think about the medications you're taking. Are they being used as a bandaid to cover up symptoms, or are you actually getting to the root cause? Now, I know hearing this list can maybe make you feel overwhelmed. And can I tell you the truth? I'm right there with you again. I'm on this journey myself for healing my gut and taking care of my microbiome. Your gut is connected to everything in the body. Everything? Everything. I've never personally had mastitis, but again, earlier this year, I was diagnosed with SIBO, which is the ultimate gut dysbiosis, which means that my small intestine was so out of whack, like, to the extreme, I'm still in the healing process. And healing your microbiome microbiome takes time. As well. Honestly, I still get frustrated months later. Sometimes I still can get sick easy, sometimes I still feel bloated, have reactions to foods. But you have to remember the bad level I was at because of pregnancy and stress and all that. And I also have to remember how far I've come even though I'm not quite 100% yet. And I'm really trying hard to not get overwhelmed and I'm telling you to do the same. Don't feel overwhelmed, just make small changes, do what you can. The important part is that we don't want to overfill your bucket with non nutrient foods and mineral deficiencies and stress. So start draining the bucket by choosing one thing. Maybe today you reach for the vegetables instead of the goldfish. Check. Nailed it. Now they also say in this protocol that no evidence exists that specific foods cause mastitis. Although dietary choices may reflect the underlying health and microbiome of an individual. The lactating breast is a dynamic gland that responds to internal and external hormonal stimulation. So don't believe for 1 second that everything in your body is not connected to the gut. Now, they also talk about engorgement in this study and how if it's properly managed, it shouldn't lead to mastitis. Engorgement usually starts by about day five after giving birth and it can really peak around day nine or ten after giving birth. But no worries. I'm going to teach you about breast massage which takes us into tip number two. OK? Tip number two is avoid deep tissue massage. In this protocol they say excessive deep tissue massage in the setting of ductile narrowing and inflammatory mastitis may propagate phlegamon formation because deep massage potentiates worsened edema and microvascular injury. I know that was a lot of big words, but basically what they're saying is don't do deep massage. It will cause more swelling and it will cause injury. OK? That kind of breaks it down. They also go on to say that attempts to extrude a plug or milk precipitated precipitate by squeezing or aggressively massaging the breasts are ineffective and result in tissue trauma. So if you feel hard and area you don't want to get in there and really massage and squeeze because it's not going to work number one. And number two, it's going to result in tissue trauma. Okay? So instead we're doing light touch, light touch massage. If you don't know how to do that, work with an IBCLC one on one. You can also check out my instagram where I talk about breast massage, breast gymnastics and some of my highlight bubbles. All right, tip number three is mastitis is not a one size fits all. There is something called subacute mastitis that I just want to touch on for a second. Let's say that you have a long chronic case of Dysbiosis, or not a healthy microbiome in your breasts and over time ducks can narrow and you get this chunky looking milk that's from biofilm. If you're still confused about Dysbiosis, then say let's say this. In this protocol, they say when the mammary microbiome loses bacterial diversity and the number of antiinflammatory organisms declines, an increase in pathogenic bacteria occurs. So we want lots of good bacteria, we want a forest of good bacteria. We don't want just a few here and there. And you can see how when that happens, this pathogenic bacteria occurs. So basically there's this thick biofilm that is narrowing the ducts in your breast. The people who get subacute mastitis, they may have had a recent case of mastitis, but this new one isn't as bad as the original case of mastitis. In this protocol, they say cesarean birth, exclusive pumping, nipple shield use, and other circumstances that alter the milk microbiome may lead to this. You may have this if you are feeling needle like burning breast pain, nipple blubs, recurrent areas of indulation or congestion, and may have unresolved hyper lactation, which, remember, that means too much milk. They also say with subacute clinical mastitis, they say sterile milk culture and sensitivities can be performed. So that means you go to your healthcare provider and they can test your milk to see exactly what's going on. So as you can see, mastitis is a term that we use often, but can use many different things that can be treated very differently. So the take home message here is just because mastitis symptoms are popping up, that doesn't mean, oh, take this antibiotic and you're good to go. No, we want to be massaging, we want to be proactive, we want to be improving our microbiome and not tearing it down with taking an antibiotic. If it's not necessary, also just put the breast pump away if possible and just breastfeed your baby. Now, why do I say put away the breast pump? Well, in this protocol they say mechanical breast pumps stimulate breast milk production. Without physiologically extracting milk as an infant will. Pumping does not provide the opportunity for bacterial exchange between the infant's mouth and mother's breast and may therefore predisposed to Dysbiosis. We don't want that. We don't want it. They go on to say breast pumps can also cause trauma to breast paringa, that's a big word. And the nipple aeriolar complex. If improper franchises are used, suction is too high or the mom is pumping for an excessive duration of time. So basically that's just saying that trauma can happen if you're, especially if you have the wrong franchise, you're using too high of suction or you're pumping for too long. They go on to say milk expression should be limited to when mother is separated from her infant or requires pumping for other medically indicated reasons for herself or for her infant. Women should not be instructed to express and discard their milk, as bacterial mastitis is not a contraindication to breastfeeding. So basically they're saying keep feeding your baby. It's not necessary to wean, it's not necessary to pump and dump just keep doing it. And they say if you do have to use a breast pump, try and do it for as long and as often as your baby normally feeds at the breast. They go on to say in this protocol that a Swedish study noted that most women with inflammatory mastitis had complete resolution of symptoms without the need for antibiotics or other interventions. So cool, right? I love that they go more into talking about things like milk blobs and castor oil and saline. Soaks I'm not going to get into all that today because you may have already noticed that this podcast episode is already plenty long. So if you want to read about that, you can go to the link in the Show Notes and read through it yourself. Make your own decision. And they also go deep into the exact steps to take with bacterial mastitis and abscesses and all that. And again, I'm not going into that today. And truly, if you are dealing with things like that, remember this podcast is not medical advice. You need to work closely with your IBCLC and your healthcare provider to go through this journey together. So there you have it. I hope you're feeling a little bit more confident about engorgement and navigating mastitis. Again, the top tips that we talked about today was number one, avoid antibiotics at all costs. Really think about your breast microbiome. Tip number two was avoid deep tissue massage. And tip number three was mastitis is not a one size fits all. Listen, if you are looking for an IBCLC in your life to help you through, just go to the Show Notes, put your information into Lactation network and maybe you just have free consults with me. That always makes my day. Every time I see that email come through saying hey, so and so has six free consults with breezy babies. Can't wait to work with you. I hope you have an amazing day. And of course I'm going to leave you with you are strong, you are smart, you are beautiful, you're a good friend to all. Bye

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