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[00:00:00] Introduction
Engorgement clogged ducts and mastits are all words that breastfeeding moms are familiar with. They can be scary and overwhelming, particularly at the beginning of your breastfeeding journey. Unfortunately. You still might encounter these things throughout the duration of the time that you are breastfeeding. Particularly when there's significant changes happening in your life. And those changes include things like night weaning and complete weaning, which of course is what we do here at cert to stop toddler.
Other breastfeeding, right. To further complicate things. There has been a fundamental shift in the way that science and leading lactation organizations and experts understand these conditions. So understand things like engorge might clog. Ducts mastitis. This has resulted in the academy of breastfeeding medicine, completely overhauling their mastitis protocol.
So this means that we need to change our approach. Right. It needs to shift. So this big overhaul happened about a little over a year ago.
This is relevant to those who are in their early breastfeeding experiences, but it's really relevant to you who have been breastfeeding for a year or more. You're likely to be supporting friends and family members who might be experiencing and Gorge my cloud docs, Ms. Datas, and you yourself might be experiencing them.
Just due to life and changes or maybe weaning. And it means that if you had your baby. A year ago or more. You might not know these new recommendations and have this kind of new understanding. It also means that those in your life, including your doctor might also not know. These things. So it's really, really important that you know, these things, which is why I'm having this conversation today.
We've had this kind of evolution and this new understanding and a lot of the approaches that we did previously, we now know can actually do more harm than good sometimes.
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[00:01:58] Disclaimer
We just wanted to put a disclaimer out there right now that this podcast is for educational purposes only. And it's not intended to be medical advice or to tell you how to treat or diagnose anything in your body or anyone else's. That being said, there is a link to the updated protocol from the academy of breastfeeding medicine. In the show notes. So you can grab that. You can read it yourself. Ah, you can also bring it to your GP or whoever you might be seeing to. Talk about these conditions with whatever doctor.
You know, it takes time for doctors to catch up on all of the things, right. Particularly a general practitioner who there's. A lot of different, tough fields to be constantly being updated in. Right? So this is really new. They might not know this information. So it can be helpful to bring it so that they can have a look through and yeah, just get up to date on all of that stuff.
[00:02:52] This Big Change
So I've been hinting at this big change talking about it. What is this big change? Well, we used to approach engagement. Conduct mastitis as we separate conditions, but now they're groups together, along with some other conditions into what we call mastitis, spectrum conditions. So we used to believe at my status was caused by milk, stasis or milk that wasn't moving through the breast enough, right. That milk was kind of being stagnant in the breast.
And that this would create. Or that this would create these clogged ducks. This hard kind of chunk of milk, stopping the flow of milk. And that meant that. The milk stasis was the problem, though, if that wasn't moving, then the recommendation became all moved more milk, right? Pump more you know, break up the clogs, that kind of stuff.
But we now understand that all of these conditions. Are caused by inflammation in the breast. And there's even a flow to which these. Conditions happen and they kind of build on each other and I'm going to go through all of that today, but this understanding that. These conditions are caused by inflammation in the breast means that we have to treat the mastitis.
Like inflammation. Not like milk, that's not moving. And when we're treating it like milk, that's not moving. We're actually increasing inflammation and it can make things worse. So I'm going to spend a little bit of time going through each of the. Conditions within the mastitis spectrum conditions.
And going over what they are. And a little bit of how to treat them. I'm not going to go too, too deep into the treatment of each individual thing. However again, you can go to the. ABM protocol and look at all that kind of stuff there. You can reach out and I encourage you to reach out to, you know, an IB CLC.
Or a different lactation specialist in your area. That is trained on these things to get really tailored support for you. But I wanted to find what each of these are because so many of them you might've experienced or you're familiar with, but you might not have connected it to inflammation. And it really creates this fundamental shift.
There will be markers. So whatever podcast player you're listening on, you can go to the chapter markers and you can kind of jump around to the ones that are relevant for you, or kind of skip to the end where I'm going to go over.
The broad. General ways of treating all of these conditions, not really going to the specifics, but those are things. These are things that are going to help with the prevention and treatment of all of these things,
[00:05:17] Engorgement
so starting with that. We're going to start at the very beginning. Like I said, these things can kind of build on each other and increase and get worse, you know, down the line. So the very first one. Is engorgement. engorgement. Is when your breasts are full of it can be milk, but it's not always milk. There's more things going on. There's inflammation. There's other fluids as well in the breast.
That can be creating this swollen you know, Even hot and red rest, typically engorgement happens bilaterally, or it happens in both breasts at the same time. And it's physiologically normal for engagement to happen in the first week to two weeks of breastfeeding. So typically it starts around day three or five, you know, when your milk comes in, I'm using quotes right. When you're transitioning from.
Colostrum to mature milk. And for most of you listening, you've experienced this. So you're, you're aware. And it can be delayed as long as like two to nine or 10 days, but typically it. Just, you know, resolves on its own over time. And it's managed by responsively right on demand, responsively, feeding.
Your child based on their hunger cues. And there may be things like support for the inflammation of the breasts, but it's generally unlikely to progress into mastitis or need further treatment if it's managed. Well and appropriately. And if the cause is known like it, we know that this is because of lack to Genesis two or because your milk is transitioning.
Typically that's all that that is. Again, please reach out to a breastfeeding specialist. If you're struggling to cope with engagement or maybe, you know, you're helping your sister who just had her baby or a friend. If they're struggling to cope with that. And , there might be some things that are making it worse. And you need to know about those things early the earlier you understand it the better, because then you can set yourself up for long term success before things start to snowball. Right?
[00:07:10] Clogged ducts/Ductal Narrowing
So the next condition would be ductile narrowing. So this is what we have always called formerly called clogged ducks. So we used to think that ducks in your breasts just got clogged by this kind of big chunk of milk but new understanding is that.
Ducks in your breasts are microscopic and there's literally so many of them inside of your breasts that we can't count them.
It's not physiologically possible for one of these ducks to quote clog what's actually happening is that one or more of these ducks have become inflamed. And that inflammation is causing the kind of little tube, right where the milk flows through to narrow. So you might notice a sore spot on your breast.
Or even like a small little bump from the swelling. If you have a ductile ductile narrowing, or a clock ducky won't have a fever or any other kind of symptoms, it's possible that this feels better while you're breastfeeding. And a lot of times people think, oh, that's because I've cleared the clog, but it's actually because you're temporarily decreasing the amount of milk in that area. And it's like taking some pressure off of that inflammation.
A lot of times the. Traditional or mainstream way of managing a clogged duct is to remove more milk. Right? You have to clear that clog, get it out of there. You have to kind of massage and break up that clock. Actually we understand now that it's not a clock inflammation and so too much massaging can lead to more inflammation and removing too much milk again.
Creates more milk production. So even though it's temporarily feeling better for a moment, it's actually increasing your milk production and that increase in production is going to put more pressure on this inflammation and potentially make things worse. The best way to support ductile narrowing is to continue to breastfeed to your little one's cues.
And of course at the end, like I said, I'm going to go over more kind of general treatment ideas. So pay attention for that. But yeah, cloud ducks aren't really clogged ducks. They're actually. Breasts ducks that are narrowing because of inflammation.
[00:09:16] Inflammatory Mastitis
So then the next step kind of, as we're talking about this spectrum of conditions would be inflammatory myositis. So this is when that ductal narrowing.
Or that swelling in the milk duct. Continues and worsens and it begins to involve more tissue around that milk down. So this typically results in increased pain and redness and swelling. And you might even have fevers and chills and rapid heart rate. This is not an infection. It's just inflammation. It's not an infection. So antibiotics, aren't going to be a good treatment for this. Right. Cause there's not any bacteria or anything that is.
Causing this inflammation, the inflammation is just happening. Itself. And we'll again with the treatment, we'll get into some of the lies that that can happen.. So that's inflammatory mastitis. When you know, it's increased in pain and redness and swelling, and you might have. What we call, you know, systemic symptoms or symptoms that are happening in the whole system, the whole body, like fevers and chills.
Then we move on to bacterial
[00:10:18] Bacterial Mastitis
on mastitis. So this is what most people think of when they think of mastitis. What's happened here is we've had that ductal narrowing it's progressed to inflammatory mastitis, and now there's a bacterial infections as well. So this is like cellulitis in the breast. It's hot. It's red. It's painful.
But it's not contagious, so it's safe to continue breastfeeding. You're not going to do any harm there. We used to think. That pathogens could enter in. So like bad bacteria could enter in through the nipple or nipple trauma or by lack of hygiene, like not sanitizing your pump parts. But we understand now.
That that's not really the case. We don't have evidence to suggest to that. Bad hygiene is creating mastitis. What does create this bacterial mastitis is an imbalance in the breast microbiome. So you've probably heard of gut health and, you know, having a healthy gut microbiome, but there's also a breast microbiome.
So inside of that milk ducks, right. That has the inflammation. There's this biofilm is microscopic layer around the inside of that duct. That is full of this diverse little microbiome, right? All of these. Diverse microorganisms living there and in balance with each other. But in a healthy breast, it's really diverse. . We run into problems when one bacteria starts to take over that ductal lining, right. And becomes overrun with a single strand of bacteria or it's out of balance. So there might still be some healthy bacteria there, but there's one that's like predominant.
And with bacterial mastitis that predominant bacteria. Releasing toxins into the body. That's creating all of this pain swelling, and it can create systemic. Symptoms. So that fever, chills, all that kind of stuff.
If you are having. These symptoms. That are lasting more than 24 hours, it's really important that you get medical care. Immediately. As well, if you're trying to treat the local symptoms, maybe are not having the fever and all that stuff, but like the hot redness and everything, and it's, it's not getting better. It's really important again, that you see.
A doctor. Okay.
[00:12:29] Phlegmon
Another piece that is within the mastitis spectrum conditions, phlegmon. So these can happen anywhere in the body that there's inflammation, but. It's these little kind of bits of fluid that concentrate together. In inflamed tissue.
It's important to bring this up because deep massage can cause these to get worse and cause a more of them to be created. And all those little phlegmon increase and get worse and they can become.
[00:12:59] Abscess
an abscess So when you have bacterial mastitis or these white men, they can progress into a larger fluid collection. Right? So it's that these tiny little fluid concentrations, it's this big fluid collection. And this happens in about three to 11% of bacterial mastitis cases.
And when this happens, it needs to be drained. So you might have systemic symptoms, like a fever and that kind of stuff. It might get worse when you have an obsess, it might also stop. And that can happen because your body's walling off the infection. So you have less of these systemic.
Symptoms because those toxins , aren't getting put into your whole body, but it's still a problem and it needs to be drained. So you're definitely need to see a doctor about that year. Likely gonna need an ultrasound. And those kinds of things to get proper treatment for that. So that's an abscess.
[00:13:49] Galactocele
Then we have a galactocele
and this happens when the ductal narrowing, right? So that idea of co clogged up, but it's this ductile narrowing when there's this inflammation. And the milk duct, and it's reducing the flow of the milk because of this inflammation so much that there's a cavity where the milk is pooling, kind of.
You know, on the backend of that. Narrowing. Cause it's reducing the flow through it. And cyst like ball forms there. And it can be anywhere from like one centimeters to over 10 centimeters in diameter. Typically the galactoceles aren't as painful as an abscess and they don't have the systemic symptoms, right. Unless it's infected can become infected,
[00:14:29] Recurrent Mastits
then there's for recurrent mastitis. So there, there isn't really an official criteria for what is classified as a recurrent mastitis.
But if you're getting mastitis. More than once. It's likely that the root issue needs to be addressed. And it can continue to reoccur because the pre. Previous treatment wasn't maybe enough. Maybe you needed more of whatever that treatment was, or it might not have been appropriate. So there could be things that are temporarily reducing the inflammation. So it's causes the symptoms to reduce, but it's not really dealing with that root issue. So it doesn't take very long, maybe two weeks, four weeks.
The symptoms, come back again.
[00:15:09] Subacute Mastitis
Then there is sub acute mastitis. So sub acute mastitis is that biofilm, right? That microscopic layer of organisms inside of the milk duct. And there's an imbalance that happens here. Now, the difference between sub acute mastitis and bacterial mastitis, is that in subacute, mastitis.
The bacteria that is. Over running. This little tiny microbiome. Doesn't produce the same toxins that the bacteria does in bacteria at mastitis. So this means you're having the inflammation. There is this imbalance, right? And this biofilm is getting thicker and thicker and it's causing less milk to be able to move through.
But you don't have the same systemic issues, right? Like you're not having that fever and chills and all that kind of stuff. And it can last for a long time because the local symptoms too are generally milder. Right. You don't have this big, hard ball or anything like that in your breast. You might feel.
Breast pain. It's particularly this, burning needle kind of breastfeeding is typically associated with subacute mastitis. Subacute status often has a milk blebs or nipple blebs .
[00:16:16] Milk/Nipple Blebs
So what happens here is when that ductal inflammatory cells, right?
There. Propagating they're increasing and spreading and they actually spread outside of the docked, right. Like to the nipple and they're kind of coming over and we have this film. That comes out of the hole, essentially in the nipple. So you get this little white ball. On the nipple, this little it's called the black.
And in the past, even I have recommended to use a hot washcloth and kind of like massage that to try and kind of scrape it and loosen it or two. To use like a saline soak. But you actually don't want to do those things. Don't scrape it. Don't soak it. Don't try to open it. Something that can help. However, is taking something like sunflower or soy lecithin, which can reduce the inflammation and it can also help your, the milk to flow a little easier through there. And. Something like a topical steroid cream can be helpful in Healing that milk blood as well.
[00:17:10] General Treatment For Mastits Spectrum Conditions
Okay. So we've gone through all of the different conditions. I want to take a moment and go through some of the more general recommendations for all types of mastitis. So this means any of the conditions that I've talked about in Gorge mint.
Claude ducks, milk blabs, bacterial mastitis, subacute, mastitis, inflammatory mastitis, all of those things. All of these recommendations are really important during weaning as well. Right? Because if you're intentionally trying to reduce your milk production, that can cause engorgement, right. And Gorge mint can lead to clogged. Ducks can lead to inflammatory. Mastitis can lead to bacterial mastitis. So it's really important that you're paying attention to all of these things.
So we have studies that show that. Most cases of inflammatory mastitis will completely resolve on their own without the use of antibiotics. And remember that from the outside inflammatory mastitis can present like material best status. Right. You can still get those systemic issues and all that kind of stuff, but there's no actual infection.
It's important to remember as well that most often redness pain and swelling in the breast is due to inflammation and not a bacterial infection.
So remember to continue to feed your baby on demand. If you are in that phase of on-demand feeding, right. And if you are in a position where you've started to cut back and you're noticing and Gordmans clogged ducks, It's okay to allow your little one to breastfeed. And you want to be able to remove the milk.
For comfort, but you don't want to go to the point of quote, like going till empty, right? Which is what we often think when we think of mastitis, because the idea of previously was that this milk stasis or milk not moving was what was causing it. So then you had to move more milk, but that's not the case here. Okay. So don't increase or begin pumping when you have an MSC or mastitis spectrum condition.
Continue to feed at a pace that feels good for you and your little one hand express. If you need to take a little pressure off. But don't go overboard.
And really, really important is to avoid these deep massages. It can create these microvascular injuries inside of your breasts and it can make inflammation worse, and it can just cause more issues than it helps. Right. So, You don't need to do deep, deep tissue massages on your breast. Avoid salient, soaks, castor oils, or other tropical treatments on your breast. You don't need to go around and sterilize everything, your breast touches, you don't need to wash your nipple for concern of bacteria getting inside of it. You can actually do damage to the tissue on your nipple.
And that hurts. .
focus on decreasing the inflammation and the pain. So things like NSAIDs like ibuprofen.
Can be helpful because it's actually going to help with the pain and the information you can be applying ice regularly. He can make symptoms worse for some people, and it can also make symptoms better for other people. So if it feels good for you, you can use it. We don't have any evidence though that it actually decreases inflammation. It would more be a pain management kind of thing. So if it feels good, you can use it, but it's not something that you have to do.
Another thing that can be helpful is sunflower or soy lecithin. So the ADM recommends five to 10 grams daily. To reduce inflammation. So this helps reduce inflammation in your body and it helps to make the milk flow easier. That things can continue to move in a healthy way.
So you're less likely to continue to progress right. To those next stages. Use antibiotics only for bacterial mastitis. So of course this is a, this is a recommendation from the ABM for clinicians. But it's helpful, even for you as a. A breastfeeding mom to be aware so please get support. Right.
It's where trained clinical support is really, really important. So any Biotics, if it's used for inflammatory mastitis, it could unnecessarily disrupt that microbiome. And create an environment where, , bacterial mastitis might occur in the future, right? Because it's disrupting those healthy bacteria to those things that are keeping the bad quote, bad bacteria in, in check.
And we don't have any evidence that taking antibiotics, prophylactically, or just in case is effective in preventing bacteria. Mercedez. You can get stuck in this recurrent mastitis kind of cycle where you're taking the antibiotics and you have temporary relief. And then it comes back. So what can happen is sometimes the antibiotics or the antifungals are. Reducing the inflammation in your body. And it's just a side effect of the medication, but it's not really treating the actual root cause. So it feels.
Because the inflammation is being reduced. But then if you stop taking it and it comes right. So something that you can take. Alongside or instead of, depending on the situation, of course, this is all within the, you know, Support of your doctor would be probiotics. We don't have a ton of research on using probiotics to treat mastitis yet, but we do have some evidence.
That probiotics can be used to both treat and prevent mastitis, but there's very specific strands. That will keep those unhealthy bacteria in check. And this can be really helpful for like subacute mastitis, where antibiotics aren't necessary. But but we do have that kind of disruption in the breast microbiome. So probiotics can be helpful. So I'm going to put in the show notes, what bacteria is that you want to look for? But that can be a helpful way to. Support yourself working through any of the. Mastitis spectrum conditions. So the last thing that I want to talk about here is stress and mood disorder. So this is something that the ABM the academy of breastfeeding medicine, specifically addresses. But it's really. Important for me, because my perspective is always very holistic when I'm supporting parents. So women with a history of anxiety and depression have higher rates of mastitis. We can see that there's these two important elements involved and we're talking about any of these MSCs.
And that's inflammation and the breast microbiome. Stress has a direct effect on the immune system and can create both the inflammation in your body and can cause an imbalance in that microbiome. So it. Stress has an effect on this immune system, right? And the immune system part of your immune system is those healthy.
Bacteria, those healthy organisms in your breast microbiome, keeping all of those bad bacteria kind of in check. So stress. Anxiety and mood disorders. Need to be managed. In this time. This can be really simple things like getting enough rest to drinking enough water. Having healthy social interactions.
Are all really, really important in the function of your immune system so sometimes it can be stress that actually sets off this trigger and results in. These mastitis spectrum conditions,
so acute stress. So this is stress that happens really quickly. Like running away from danger can be adaptive for the immune system means that it can support your body to be able to fight off infections faster. But I really, really want to stress that acute stress is very quickly like momentary putting in a matter of minutes.
That's the kind of stress that's adaptive, right? So you feel that rush of stress as you're running away from a dog that might bite you, right? If the dog. Does by you, that stress that you felt in your body it makes your immune system work a little harder. And it means that your body's going to more effectively be able to fight off whatever bacteria might've been an introduced into your body and help your body heal that wound.
Chronic stress is stress that lasts for days, weeks, years. And as maladaptive, meaning that it actually makes your body have a harder time fighting off pathogens. Or at least keeping those pathogens in like a healthy balance. Right. Because again, we're not trying to eliminate any of these are all of these bacterias from your body. They just need to be in a healthy balance in your body.
So there was a meta study done. I really liked how the researchers talked about stress in that study. So I'll link to in the show notes, but I want to share a quote from it here. And they're talking about. Chronic stress versus acute stress.
So they say the most chronic stressors were associated with the most global immunosuppression. As they were associated with reliable decreases in almost all functional immune measures examined.
Increasing the stressor duration. So that means the, the length of time that the stressor in your life exists, therefore resulted in a shift from potentially adaptive changes. To potentially detrimental changes. So initially in the cellular immunity and then an immune function more broadly, it is important to recognize that although the effects of chronic stressors may be due to their duration.
The most chronic stressors were that were associated with changes in identity or social rules. And they use the example of acquiring the role of caregiver. And then they also say, or, or refugee or losing the role of of employee. So losing a job. But I just found it so interesting that when they're talking about chronic stressors and how chronic stress can reduce immune function and does reduce immune function in the most meaningful way.
The first. Example that they give is acquiring the role of a caregiver. Which is what you did when you had a baby, right? And they also quote in that study and I really liked this quote from Robert Sapolsky. Stress-related disease emerges predominantly out of the fact that we so often. Correct.
Activate a physiological symptom that has evolved to respond to acute physical emergencies. But we turn on this system in our body for months on end worrying about mortgages, relationships and promotions. So that's the quote, but I would go on to add to Robert's quote, you know, end babies and weening.
Right. And what, whether or not what your baby is doing is normal and Googling in the middle of the night. All of these other stressors. Right. So it's important. Your body has the stress response for a reason. And it's really important and adaptive in acute situations, but when it's turned on, when the system is turned on for a long time,
It will result in more inflammation in your body and lower immune. Support and function, which results in things like ductal narrowing. Bacterial mastitis, inflammatory mastitis, subacute, mastitis, all of these things, right. So it's really, really, really important. What can you do about the stress?
So I used another quote from another, I believe it's another study, but it might've been not saying I will double check it and link it all. It's all going to be linked in the show notes, but I love this quote, two studies have convincingly demonstrated that people's cardiovascular and neuroendocrine responses to stressful experience.
Are dependent on their appraisals of the situation and the presence of intrusive thoughts about it. This means that one person. Can go through a situation and another person can go through the same situation. But the amount that their bodies react and respond to that stress
is directly proportional to their appraisals of the situation, the way that they assess the situation. And what is your appraisal of the situation? It's your story? This is why I called my business own your parenting story. It's the way you make meaning of it, right? It's really, really important to understand that that it's not necessarily the events that you're going through, the actual stressors themselves. It's the way that your body is reacting to those stressors.
So when you're weaning. The thoughts you have, the way we're approaching it, have a direct impact on your relationship with your child. And the way that we need is going to unfold. That is my entire kind of like philosophy. Well, not my entire philosophy, but that's a large part. Right? I talked about the toddler breastfeeding stress cycle.
I talk about these things in my free workshop, which you can get at the link in my show notes. If you're interested. But also the way the thoughts you're having and the way you approach your relationship and weaning also have a direct impact on your immune system response. And in turn could possibly put you at risk for mastitis spectrum conditions.
So, like I said, this is why I work with people in my program on your breastfeeding story, from a holistic approach and supporting all of these elements, the physical elements sleep, the mental, the thoughts you're having emotional elements. I, you know, understanding the. Developmental stages that your tiles and, and why they're doing what they're doing.
All of those things are really important so that you can.
Alter and change your appraisals on these situations and change your stress response to these situations.
So I don't have a ton of time to go into. All of those things. Right. But I want to suggest. A couple of resources. So like I said, my workshop, but there's also a really great book out there. By sisters, Emily and Amelia, Nagorski called burnout. It's a wonderful. Book for learning and understanding.
How your body is responding to stressors and your environment, and what's happening physiologically to your body and what you can do about it.
Another option could be something like emotional freedom technique, which is tapping. You might've heard of it. EFT tapping. There are some really cool studies out there that show how evidence-based this technique is. Again, the study will be linked in the show notes.
For you because I found it super interesting. It's totally an evidence-based. Therapy that can be very, very effective. I've used it personally. I still use it personally and I really love it. These are all things that I. Support you to look at inside of my group coaching program, too. And if you work with me as a client,
But I wanted to throw some of those things out there now, because talking about stress and then not giving you ways to manage your stress.
Right. Getting enough to drink is important. Getting enough sleep is important, but all those things are going to be hindered when we're not dealing with the kind of mindset piece and the more holistic, big picture pieces too. So that's why I'm presenting all of those things for you today. I have talked a lot today. I feel like I'm losing my voice.
So I'm going to sign off. I hope that you have appreciated and found all this supportive. I would love to hear. If you found this interesting. And if you have any questions or what you took away from it, you can just shoot me a DM on my Instagram. I would love to hear from you.