Puerperal mastitis is an inflammatory process of infectious origin, which affects the breast during lactation or after its suspension. Despite affecting a significant percentage of nurses (up to 10%), mastitis can be prevented first of all, but also cured without the need to stop breastfeeding.
Causes
Puerperal mastitis is caused by the entry of germs into the milk ducts, small ducts that allow the milk to flow up to the nipple. In addition to their natural dilation due to breastfeeding, the entry of pathogens is favored by poor local hygiene and skin lesions. caused by the newborn during an incorrect attachment to the breast (nipple fissures). Breast engorgement can also favor the onset of mastitis, since breast milk is an excellent breeding ground for bacteria.
The causative agents most commonly implicated in the development of puerperal mastitis are staphylococci, in particular staphylococcus aureus.
Mastitis is more common in first-time mothers, probably due to inexperience in managing the aforementioned risk factors, and in women who stop breastfeeding.
Very rare are puerperal mastitis of hematogenous or lymphatic origin.
Symptoms
For further information: Mastitis Symptoms
The symptomatology of mastitis is very similar to that of breast engorgement. Breast pain and general malaise, both of greater entity, are however accompanied by a significant feverish rise (> 1 ° C), which is instead absent in the simple obstruction flu-like symptoms are also typical of mastitis, while on physical examination a part of the breast appears swollen, red and rather painful on palpation and sucking.
Prevention
To reduce the possibility of infecting the milk ducts, it is essential:
- pay particular attention to breast hygiene during pregnancy.
- The mother should wash her breast before and after each feeding; scrupulous hygiene with water is sufficient, while soaps, ointments, ointments and detergent and antiseptic solutions are generally not recommended. These substances, in fact, could irritate the skin and give the nipple an unpleasant smell and taste. On the market there are special wipes for cleansing breastfeeding breasts, obviously free of surfactants, perfumes or substances that require rinsing. Hands, obviously, will have to be washed carefully before starting breastfeeding, while the same attentions in compliance with basic hygiene rules will also be taken in replacing the linen.
- Attach the baby to the breast correctly, in order to prevent the appearance of fissures and irritation, while stimulating lactation (see dedicated article).
- Prevent breast engorgement (see dedicated article).
Treatment
For further information: Medicines for the treatment of Mastitis
Mastitis is a complication that must be taken seriously, as the affected part of the breast may suppurate (abscess).
Normally, mastitis is not a reason to stop breastfeeding, as the pathogens involved are completely harmless to the baby's health. Rather, even in this case, it is important to breastfeed often (about every two hours). When this is not possible, due to pain or medical advice, it is advisable to empty the breast with the breast pump, feeding the baby to the other breast. As mentioned, in fact, milk is an excellent breeding ground for bacteria. consequently any stagnation would facilitate the propagation of the infectious process.
If necessary, the doctor will prescribe anti-inflammatories and analgesics to alleviate the maternal pain symptoms. When the doctor deems it appropriate, it is necessary to undertake antibiotic therapy; in this sense, all those active ingredients that are secreted in milk (tetracyclines, sulfonamides and metronidazole) should be avoided. The needle aspiration of the area affected by mastitis allows to set up cultural examinations with an antibiogram, in order to use the most effective antibiotic in the fight against the pathogens involved. They promote healing, even bed rest and the use of hot and cold packs. respectively applied on the inflamed part of the breast before and after breastfeeding.
When the inflammatory process associated with mastitis results in an abscess, surgical drainage is required via a small breast incision.
