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  1. Revised Treatment of Mastitis

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    It may surprise you learn that the treatment of mastitis has changed really quite significantly.  No more heat or electric toothbrushes! (If you know, you know!). 

    The Academy of Breastfeeding Medicine (ABM) Clinical Protocol #36 (2022) differs from the old one (revised March 2014) in several ways. The changes include the fact that plugged ducts are now thought to be narrowing of the ducts and not previously thought blocked ducts and the use of ice and anti-inflammatory treatments are now recommended instead of heat. Oversupply is now thought to be  the first marker on the mastitis spectrum and that probiotics instead of antibiotics may be more helpful in some cases. 

    The new Protocol can be summarised as follows: 

    1. Oversupply is the first marker on mastitis spectrum. Hyperlactation can lead to inflammation resulting in narrowing of milk ducts (previously called blocked ducts) and could lead to inflammatory mastitis. 

    2. Plugged ducts are now thought to be ductal narrowing. 

    3. Therefore ice and other inflammatory treatments should be used instead of heat (cold reduces blood flow and therefore swelling). 

    4. No increased pumping to drain breast is recommended. 

    5. Demand feed/pump as you have been (follow baby’s feeding cues) 

    6. Stop dangle feeding/vibration with electric toothbrush etc because issue is not a blocked duct. 

    7. Consider feeding from unaffected breast first before affected breast to avoid over stimulation. 

    8. Use ice packs instead of heat and NSAIDS such as Ibuprofen. 

    9. Gently massage sweeping up from nipple towards armpit to encourage lympathic drainage instead of deep tissue massage previously advised. 

    10. Antibiotics reserved for bacterial mastitis. Should be avoided if possible as disrupts breast microbiome and therefore increases risk of progression to bacterial mastitis. 

    11. Use probiotics instead of antibiotics to help microbiome. 

    So there we go! Help to spread the word as old news still seems to be circulating.  

     

    Reference:  Mitchell et al, Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022  Breastfeeding Medicine Available at: https://www.bfmed.org/protocol 

     

  2. My Top 10 Breastfeeding Myths

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    One well-meaning person tells us one thing, then we hear something completely different.  Conflicting advice is a common experience of new mothers. We must be careful as to where we are getting our breastfeeding information from. Is it evidence based or is it just what someone heard through the grapevine?  Below are some common myths around breastfeeding that I am hoping will help to alleviate some of the confusion we can often feel when feeding our babies. 

    Myth No. 1 – You won’t make enough breastmilk in the first few days. 

    Colostrum is the milk which nourishes your baby in the early days. Your baby’s tummy is teeny tiny at birth, approximately the size of a small marble and a baby will initially take approximately 5-7 ml at each feed.  Following your baby’s feeding cues (see my previous blog on ‘How often should your baby feed?’ to view feeding cues) and regular feeding is essential in order to establish a really good milk supply.  A baby should feed around 8-12 times in a 24 hour period in order that your breasts are getting the right signals to make more milk.  However, in the early days your body has made sure that your colostrum (first milk) is available. It is made available around mid pregnancy. It can be a struggle to trust our body is making enough for our babies but your midwife will ask you questions about how many wees and poos your baby is having which is a good indicator of milk transfer as well as weighing your baby and making sure that they have not lost more than between 5-7% of their birth weight on the Day 5 weigh-in. 

    Myth No. 2 – Breastfeeding is painful 

    Research tells us that in the first 10-14 days of life breastfeeding may feel painful for around the first minute or so after your baby has attached at the breast but then the pains should subside and the rest of the feed should be comfortable. Should the feed feel uncomfortable throughout you should seek support from your midwife, a qualified breastfeeding counsellor or a Lactation Consultant who can work out why it is uncomfortable. Most commonly the pain would be as a result of poor positioning and attachment.  Other considerations include a tongue tie or even thrush. 

    Myth No. 3 –Breastfeeding is too hard work and time consuming 

    Breastfeeding does take time but so does giving your baby a bottle in the early days. Typically, a baby will become much more efficient at feeding as they get older and their increasing stomach capacity will eventually lead to longer gaps between feeds. A real bonus with breastfeeding is that ultimately it will be time saving as you don’t need to make up bottles or sterilise equipment.  Your breastmilk is available in the right amount and the right temperature whenever your baby needs. 

    Myth No. 4 – Mums who breastfeed don’t get enough milk 

    Research shows that mothers who breastfeed actually get more sleep! This is partly because a hormone is released when you feed that helps you go back to sleep quickly.  Breastmilk contains a hormone called Prolactin which helps to induced sleep.  Breastfeeding mothers release this hormone into their own bloodstream which helps them fall asleep faster and more easily after a feed (both at night and during the day). 

    Myth No. 5 – Baby’s crying is because they are not getting enough milk 

    Crying is a baby’s only way of communication.  People often assume that a baby is being starved if they are constantly crying, however, babies cry for many reasons and we know in the early days they cry – a lot!!  In addition to hunger they may be crying because they are hot, cold, feeling over stimulated, are tired but don’t yet have the ability to fall asleep well by themselves.  Look for signs of a well-fed baby such as periods of contentment after a feed, plenty of wet and dirty nappies and of course growth!  

    Myth No. 6 – The size of your breasts matter 

    Breasts of all sizes can, and do make plenty of milk.  Mothers often worry that their small breasts mean that there won’t be enough milk.  Some babies may need to feed more often than others due to storage capacity within the breast.  Perhaps surprisingly, this does not link to how large or small your breasts are.  Mothers who store less milk in their breasts at each feed will potentially need to feed more often in a 24 hour period than a mother with a larger milk capacity.  However, both babies would be getting a similar amount of milk during a 24 hour period. 

    Myth No. 7 – You should stop feeding when your baby gets teeth 

    It may surprise you to hear that it is not necessary to stop breastfeeding your baby once they start getting teeth. Babies can even be born with teeth, however, as babies latch, their tongues cover the bottom teeth and gums, preventing painful bites. 

    Myth No. 8 – Breastfeeding beyond a year is breastfeeding just for comfort 

    Breastmilk is a live milk. When a baby suckles at a mothers breast a vacuum is created. It is thought that the baby’s saliva is sucked back into the nipple, where receptors in the mother’s mammory gland reads its signals.  So in other words there is an interaction between your baby’s saliva and your breastmilk that makes antibodies against any illness that your baby may have come into contact with.  Amazing! 

    Myth No. 9 – Breastfeeding makes your breasts saggy

    Research has shown that breastfeeding does not affect your breast shape or volume although the ligaments that support your breasts might stretch during pregnancy but it is not related to the fact that you are breastfeeding your baby.  

    Myth No. 10 – You shouldn’t feed your baby to sleep 

    We constantly hear comments such as ‘you are making a rod for your own back’ and you’re spoiling your baby when we allow them to suckle themselves to sleep.  It is very normal for a baby to want to have the comfort of your breast to help them sleep.  They haven’t yet acquired this skill and are often struggling to adapt to their new environment.  Their brains are not yet developed enough to be forming bad habits. Your baby needs you and it is perfectly fine to nurse your newborn to sleep.