Clinical Updates on Mastitis and a Holistic Approach for Treatment
Dec 09, 2024
When I first became a midwife, the clinical guidelines for treating mastitis were very much based upon prescribing antibiotics right away. The big fear (and still what remains a rare risk) was the mastitis could turn into an abscess. There has been a shift to attempt at home measures for a longer period of time before taking antibiotics, as it is also not a completely benign thing to take antibiotics! Risk for severe mastitis and mastitis that needs antibiotics right away should always be personalized, but here are some general guidelines:
- getting at the ROOT CAUSE of mastitis means treating inflammation as well as figuring out why that inflammation happens in the first place (baby started solids or sleeping longer and nursing less or too many galactagogues —> engorgement? Shallow latch or inefficient sucking? Overtired with a muted immune system?
- No more is it recommended to use WARM compresses. Do not take an overly long shower or face your chest to warm water. Use ice packs and cool compresses tp decrease inflammation. Cold green cabbage leaves as sheaths work well too (no this is not midwifery witchcraft, this is evidenced-based!) This is very different than the guidelines that used to exist and I am working on shifting my clinical mindset around this.
- Take choline rather than sunflower lecithin (again, this is against previous recommendations that lecithin could make milk less viscous and flow more freely. But there is concern lecithin may further contribute to inflammation)
- No more vigorous massage of the breasts which may create more injury and inflammation
- A holistic approach includes REST (this is critical, call upon your inner circle to assist with childcare), stress reduction, bone broth, electrolytes and herbal teas for hydration, nutrient-dense soups/stews/protein/healthy fats, varied fermented foods, consider a probiotic with lactobacillus fermentum and salivarius, Phytolacca homeopathy, adaptogenic herbs, Zinc/Vit D/Echinacea/Elderberry for immune boost, and daily sunlight.
- As mentioned earlier, when to start antibiotics should be based upon the overall clinical picture, the person’s history, and their access to medication. Sometimes I will prescribe medication for someone to have on hand in case things worsen dramatically and it is 3AM and there is no open pharmacy. I think psychologically it can also help someone to feel reassured to have it if they need it, even though most of the time with the above measures they do not need antibiotics. I have had mastitis once and it is truly awful. I was able to avoid antibiotics through the holistic approach, but had my symptoms worsened after 24 hrs if it one of the few times I would have gladly accepted antibiotics
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