Mastitis when breastfeeding: engorged breasts, blocked ducts, relief at home and when to see a doctor in Singapore

Mastitis when breastfeeding is an inflamed, often infected patch of breast: it's red, hot and painful, sometimes with a lump, and you may have a fever, chills and feel washed out. SingHealth says it affects up to 10% of breastfeeding women and is most common in the first three months. Keep feeding or expressing from that side. KKH's lactation team says stopping suddenly makes things worse and raises the risk of an abscess. At home, cold compresses between feeds and a painkiller such as ibuprofen help, and you should see a doctor if the fever and pain are still getting worse after 24 hours, because you may need antibiotics, which can be taken while breastfeeding. Engorgement, when your milk first comes in, feels different, and it's the easiest of these to prevent.

When your milk comes in: engorgement

KKH says milk usually "comes in" on the third or fourth day after delivery. Both breasts can feel full, hard, warm and tender, and a very full breast can be hard for your baby to latch onto. KKH's advice for the first weeks at home:

• Breastfeed on demand every two to three hours, nights too. Babies commonly feed 8 to 12 times a day.
• If your baby can't feed from the breast, express every three hours instead.
• Massage your nipple and areola before each feed to get the milk flowing.
• If your breasts feel hard and painful, put a cold pack or cold cabbage leaves over them once or twice between feeds to bring the swelling down.
• Wear a supportive bra, but not a tight one.

Hand-expressing a little milk before a feed helps your baby latch and drain the breast, says KKH's lactation consultant. Our guide to breastfeeding support has more on latch and positions, and the newborn feeding schedule shows how often babies feed in the first weeks.

Engorgement, a blocked duct or mastitis?

SingHealth says mastitis can start from a blocked milk duct, or from bacteria getting into the breast through cracked or broken skin on the nipple. Sore or cracked nipples make it more likely, and so do a tight bra and always feeding in the same position.

How to ease a blocked duct or mastitis at home

KKH's senior lactation consultant gives these steps on SingHealth's HealthXchange site:

1. Don't stop breastfeeding or expressing. Sudden stopping can make the blockage worse and raises the risk of an abscess.
2. Massage the breast gently before and during a feed to help the milk flow, but skip deep, hard massage because it can bruise the tissue.
3. Hand-express a little milk before latching, so your baby can drain the breast well.
4. Feed on demand, and don't try to "empty" the breast. Pumping to empty can cause oversupply and more swelling. After a feed, express only a little for comfort.
5. Change feeding positions so different parts of the breast drain.
6. For pain and inflammation, take a painkiller such as ibuprofen, and put cold compresses on between feeds or pumping sessions.
7. Drink enough, and take fever medicine if you have a fever.

The same advice suggests sunflower or soy lecithin, 5 to 10 grams a day, to reduce inflammation in the ducts. Check with your doctor or pharmacist first, and tell them you're breastfeeding. KKH also asks breastfeeding mothers to avoid traditional or herbal remedies and to check with a doctor before taking any, because a newborn may be sensitive to them.

When to see a doctor in Singapore

SingHealth says antibiotics and pain relief are the main treatment, and a course of oral antibiotics is usually enough. If it doesn't settle, antibiotics may be given through a drip, and an abscess may need draining. The antibiotics usually used for mastitis, such as cloxacillin, amoxicillin-clavulanic acid, cephalexin and clindamycin, are compatible with breastfeeding, KKH's lactation consultant says. Always tell the doctor you're breastfeeding so they can prescribe a breastfeeding-friendly medicine. SingHealth also notes that mastitis does not raise your risk of breast cancer.

For help with latch, engorgement or a blocked duct before it turns into mastitis:

Preventing it from coming back

SingHealth's advice is to breastfeed often, especially when your breasts feel engorged, make sure your baby latches well and finishes the feed, and avoid tight bras or anything that presses on the breast. An SGH obstetrician adds: feed on demand, watching your baby rather than the clock; get help early for sore or cracked nipples, which usually come from poor positioning; rest, eat properly and accept help at home. KKH's lactation team says mild tenderness in the first few days is normal, but nipple pain that hasn't eased by day three or four, or lasts beyond day five or six, needs a lactation consultant or doctor.

If you're pumping, our guide to pumping and storing breast milk covers how often to pump without building an oversupply, and how to increase breast milk supply explains how supply follows demand. Our milk feeding calculator gives a rough daily volume by your baby's weight.

Frequently asked questions

Can I keep breastfeeding with mastitis?

Yes. KKH's lactation team says you shouldn't stop breastfeeding or expressing with mastitis or a blocked duct, because stopping suddenly makes it worse and raises the risk of an abscess. Your milk is safe for your baby.

What does mastitis feel like?

SingHealth lists breast pain, swelling, redness and warmth, a lump, and fever, chills and tiredness, usually in one area of one breast.

When should I see a doctor for mastitis?

If you feel shivery or feverish with a red, painful breast, KKH says to seek medical attention straight away. See a doctor if the fever and pain are getting worse after 24 hours, since you may need antibiotics.

Do cabbage leaves help engorged breasts?

KKH suggests a cold pack or cold cabbage leaves over the breasts once or twice between feeds when they feel hard and painful, to reduce swelling.

Are antibiotics for mastitis safe while breastfeeding?

The antibiotics usually prescribed for mastitis, such as cloxacillin, amoxicillin-clavulanic acid, cephalexin and clindamycin, are compatible with breastfeeding, says KKH's lactation consultant. Tell your doctor you're breastfeeding.