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How to Handle Mastitis when Breastfeeding

Thursday, January 23rd, 2014

Mastitis is, simply put, an inflammation of the breast. It can occur without apparent cause, but it often occurs during breastfeeding. In fact, about ten percent of breastfeeding women experience mastitis. Mastitis can be particularly problematic in women who wish to continue breastfeeding, because it is often painful and women suffering from mastitis are very likely to wean their infants during this time.

Mastitis is caused by infection by bacteria that enter the breast through the nipple; the cracked and sore nipples common in breastfeeding women make perfect pathways for the bacteria to get in through. Most commonly occurring during the first six months of breastfeeding, it can add to the already-considerable burden of caring for an infant and increase the mother’s fatigue and stress. It often leads to the cessation of breastfeeding, but breastfeeding with mastitis is safe, and it is usually cleared up easily with medication.

Symptoms and Treatment of Mastitis

Usually the first thing a woman with mastitis notices is a painful area in one of her breasts. The area may also be warm and red. She may also experience body aches, chills, and fever. Swollen and painful lymph nodes, flu-like symptoms, and a faster than normal heart rate are signs that the infection is getting worse.

Mastitis is usually easily diagnosed by observation of the symptoms; specific tests are not typically needed. If you have symptoms of mastitis, don’t hesitate to see your doctor; an antibiotic will usually cure it relatively quickly. It is safe to breastfeed while taking antibiotics, so feel free to continue to do so, unless your doctor directs you otherwise. During treatment, help your body heal and yourself feel better by resting more, drinking plenty of fluids, and using warm or cold compresses on the painful area. You can also take acetaminophen or ibuprofen for pain. If you think you have mastitis, get medical attention promptly; delaying treatment can lead to complications which can be harder to treat.

Breastfeeding (or Not) with Mastitis

If you are determined to continue breastfeeding, you can do so safely with mastitis. Make sure to empty the affected breast completely each time you breastfeed in order to prevent a dwindling milk supply. If it is too painful to breastfeed much on the affected side, use a breast pump to completely empty the breast on a regular basis.

However, for some women, mastitis presents either too difficult a situation in which to continue to breastfeed, or a good opportunity for weaning for those who were planning it soon anyway. Caring for an infant is extremely challenging, and formula presents a perfectly nutritious and healthy option for feeding your baby. I know that most women feel like they “should” breastfeed, but in fact, millions of completely healthy and well-adjusted people were never breastfed.

Don’t worry about “bonding,” either. Feeding your baby should be a time to interact closely with him or her, but it’s the physical contact and the attention that matter, not whether the milk being fed is coming from a breast or from a bottle.

For more information on this topic and others, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Know the Facts When Making the Decision to Breastfeed

Thursday, April 25th, 2013

There is not a doctor out there who will deny there are some definite benefits to breastfeeding. Both mother and baby experience these benefits, which range from helping mom to lose some of her baby weight to helping your infant gain greater immunity to childhood diseases. But when my patients ask me whether or not they should breastfeed after they give birth, the last thing I want to do is bully them, or use scare tactics to pressure them into breastfeeding if they don’t think that it is the best option for them.

Perhaps it’s just me, but I think these decisions are best left to the mother. It is not my job as a doctor to make those decisions for you. However, it is my job to make sure that you have the facts, and all the facts, before you decide either way. A lot of women might not know just how many benefits there are to breastfeeding, but on the contrary, a lot of women may have heard information that is just plain false. For example, plenty of people trying to push breastfeeding on young mothers will tell them that mother’s milk can prevent obesity later in life, but studies show that this is not the case at all.

Why is this important to me? Because I don’t think that any woman should be shamed for making the decision not to breastfeed if she doesn’t think that option is right for her. And there are plenty of women who have good reasons not to, whether they produce low amounts of milk, they need to return to work or take care of the rest of the family, or the process is just too painful for them. This is an important choice to make—possibly the most important choice that new parents will make in the first months of their child’s life. I want people to be informed about every option that they have, and will always encourage those who are uncertain about that choice to know everything they can, and to get their information from a source that isn’t trying to push some sort of an agenda. Let’s face it—parenthood is hard. You need information to make the right decisions. And there is absolutely nothing wrong with formula feeding. Unlike the milk from breastfeeding, which is deficient in Vitamin D and iron, formula feeding has enhanced those vital nutrients and there is also a quantitative check on just how much your baby is receiving in milk.  There are NO randomized clinical studies or trials (Level I) that have compared exclusive breastfeeding with formula feeding.  Therefore, the recommendations made are not based on evidence-based medicine.  Breastfeeding sounds good, so it must be good and sound.  With breastfeeding, that may not be the case.  Each mother has to decide what is best for her family, her baby and her self.  A panel of “experts” cannot recommend a course of action based on what “sounds” good without definitive outcomes of the two modes of management.  This has not been done when it comes to comparing breastfeeding to formula feeding.  Only observational studies exist and they are not the appropriate study design upon which to make decisions about such an important aspect of infant nutrition. The goal is to give your child the nutrition that he or she needs in order to grow.

– Yvonne S. Thornton, M. D., M. P. H.

No Breastfeeding; No Guilt

Thursday, April 19th, 2012

I was raised in an era when children were fed Karo Syrup and evaporated milk, and nobody gave my mother a guilt-trip for doing so.  As with many low-income families, she spent much of her time working to provide for our family and would not have been able to stay home to breastfeed.  Somehow though, we all grew up to be healthy, happy adults.  In fact, two of my sisters are doctors and the other is a lawyer and Ph. D., so I’d say we turned out pretty well.  The American Academy of Pediatrics (AAP) though, would like moms to believe otherwise.

When an organization like the AAP recommends breastfeeding, new moms are likely to trust in their expertise and follow suit, assuming the organization has conducted years of research and found conclusive results in favor of breastfeeding.  Unfortunately, that just isn’t the case.  That hasn’t stopped them from publishing an executive summary of their recommendations though.

In their most recent Executive Summary on Breastfeeding and the Use of Human Milk, the AAP cited, “a variety of government data sets, including the Centers for Disease Control and Prevention (CDC) National Immunization Survey, the NHANES, and Maternity Practices in Infant Nutrition and Care.”  These studies merely show how many people are breastfeeding in developed countries, not whether or not this has been beneficial for the children involved.

In fact, there has so far only been one scientific study performed and this is where all of their data is coming from.  Also, the study itself admits that, “Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”  In other words, they gathered their information from other reports and performed a scientific analysis, but did not do any controlled experiments themselves, so they can’t be certain that the relationship between the health of children and the rate of breastfeeding are actually related.  Even more shocking is the AAP’s blatant disregard for some of the findings in the study.  The AAP Summary reports that, “Adjusted outcomes for intelligence scores and teacher’s ratings are significantly greater in breastfed infants.”  While the study they are citing actually says, “There was no relationship between breastfeeding in term infants and cognitive performance.”  Human breast milk is deficient in iron and Vitamin D; yet, those deficiencies are rarely mentioned when it comes to comparing breastfeeding and formula feeding.  Moreover, the touted immunity conferred to the newborn from breastfeeding has not resulted in better outcomes for breastfed infants.

So why are they so adamant about it?  It turns out; they have spent the past several years urging the Senate to carry out a $15 million campaign to promote breastfeeding at maternity care practices, community-based organizations, and hospitals.  In other words, wherever mothers might be giving birth or receiving pediatric care, their physicians are flooded with propaganda pushing the importance of breastfeeding.  This has led to a lot of pressure on moms who have chosen not to breastfeed, and consequently, a lot of unnecessary guilt.  Mothers have the right to choose the method they feel most comfortable with, and shouldn’t have to feel guilty for that choice.

— Yvonne S. Thornton, M. D., M. P. H.



New Moms: Don’t feel guilty if you’re not breastfeeding

Thursday, January 21st, 2010

If you’re pregnant or have recently had a baby, you’ve probably heard that breastfeeding is one of the best things you can do for your baby. Other mothers will tell you so. Books extol breastfeeding’s virtues. Even the government gives mothers a nudge in this direction.

But what if your schedule doesn’t make breastfeeding a viable option?

Don’t let anyone make you feel like you’re an inadequate parent if you give your baby a bottle instead. There are no randomized clinical trials that prove the virtues of breast milk over formula feeding. And most working mothers simply don’t have the opportunity to breastfeed in our society, at least not exclusively.

When public lactation stations become the norm, and when most workplaces have specifically designated areas for breastfeeding, then it will make sense for more women to consider the breastfeeding-only option.

Until then, in a society where many women are either single parents or are the primary family breadwinners, exclusive breastfeeding must be seen as an unrealistic – and maybe even a chauvinistic — recommendation.

– Yvonne S. Thornton, MD, MPH