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Ice for mastitis? New breastfeeding guidelines change everything we thought we knew

I call it ‘the breastfeeding tax’ for a reason: mastitis (along with thrush and plugged ducts) feels like the price you pay for breastfeeding. And it’s a painful one. Mastitis is an inflammation of breast tissue that, if left untreated, could lead to a bacterial infection. But updated 2022 clinical guidelines from the Academy of Breastfeeding Medicine (ABM) published in May now assert that mastitis should be considered “a spectrum of conditions”, ranging from oversupply (hyperlactation) to inflammation, bacterial infection and abscess.

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 Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022

In the past, mastitis has been regarded as a single pathological entity in the lactating breast. However, scientific evidence now demonstrates that mastitis encompasses a spectrum of conditions resulting from ductal inflammation and stromal edema.

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It's official: I am no longer breastfeeding. I was slowly tapering and introducing formula last week but when I got mastitis again, I decided to just go for it and quit cold turkey (pumping when you have 104 fever is just not an option as far as I'm concerned).

Diet impacts risk of maternal mastitis, say researchers

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Everything New Moms Need to Know About Mastitis

Everything you need to know about mastitis, from causes and prevention to treatments.

Explainer: what is mastitis?

About 10% of breastfeeding mothers get mastitis more than once when breastfeeding the same baby, and 7% will get mastitis again when breastfeeding subsequent children. The more children a woman has, the less likely she is to develop mastitis during breastfeeding. This may be because women become more used to breastfeeding, the more children they have.

How to catch and stop mastitis early

Mastitis symptoms can vary from person to person, but many people with the condition develop a red, painful, or hot area of swelling on one or both breasts. According to the Cleveland Clinic, this swollen area is often “wedge-shaped” and can feel warm or tender to touch.

Mastitis and Sore Breasts

Apply cold or ice packs to the affected area. Be aware that antibiotics may not be recommended right away. This is not an infection when it starts, and antibiotics may encourage resistant strains of bacteria to thrive, and may make you more likely to have recurrent mastitis or an abscess in the future.

Turns out breastfeeding really does hurt – why does no one tell you?

No one says: it hurts. At least not beforehand. Once you tell other mothers it hurts they say, grimly, “yep”. It makes sense that it would hurt, because having a small creature attacking your nipples every 40 minutes would hurt, wouldn’t it? It’s OK though, because, you’re told, they’ll “toughen up”. Tough nipples: just what I always wanted.

What Actually Is Mastitis?

It’s hard to know exactly how often mastitis happens—it's estimated that anywhere between 3 and 20 percent of nursing moms experience it—but women are often warned by their doctors to look out for the signs. Those symptoms typically include a fever, muscle aches and fatigue, and an extremely tender, painful, red, and swollen breast, Dr. Ross says, adding that mastitis usually just affects one breast.

Women Who Have To Delay Pumping Risk Painful Breast Engorgement

And if a woman can't pump, breasts swell and become firm and painful. For Parker, engorgement felt like having two hot, sweaty bowling balls strapped to her chest. That's not unlike my description: like two boulders had been grafted to my chest tissue and magically hooked up to my nerves so that they radiated pain from the inside out. One light touch elicited a scream of pain — definitely more distracting than needing to pee.