Mastitis & Physical Therapy
By Caryn McAllister, DPT and founder of a CT healthcare company in NYC.
Planning to nurse? Health experts agree that breastfeeding is the healthiest option for both mom and baby. Most healthcare experts recommend nursing for the first 6 months of the baby’s life, and then continuing to have breast milk in the baby’s diet for one year. But what happens if breastfeeding doesn’t go as smoothly as you planned? For instance, what if you develop mastitis?
Mastitis is a condition that affects 20-25% of women in western countries and usually affects women 2-3 weeks postpartum. It includes a hot, tender, swollen breast area, pain, fever, and flu-like symptoms. Caryn McAllister, DPT, suffered with mastitis after giving birth to her first child, and stated that although she didn’t need any medications when giving birth, mastitis hurt her so much that she required medication for it. The most agonizing aspect to this diagnosis, she laments, is that she had to travel 45 minutes to go to the nearest women’s health clinic for treatment, leaving heer 3-week old infant at home. According to Caryn, “This is absurd- No new mom, especially when sick, should have to leave her newborn to care for this commonly occurring infection. There should be easier and better ways to provide care.”
What is the recommended treatment of mastitis? Continuous Pulsed ultrasound and massage are effective treatments and have been shown to help in as little as one session.
Results according to a 2015 study by the Journal of Women’s Health Physical Therapy state, “Statistically significant decreases were noted in pain and difficulty breast-feeding, whereas confidence in ability to manage breast-feeding independently demonstrated a statistically significant increase.” (Cooper, Barbara B. PT, MS).
Patient education is a key priority, as many who suffer from this do not know why or what to do. It’s our job as healthcare professionals to assist in teaching this from a research basis so that more women can understand this common issue.
One critical way to effectively help is teaching people positioning with breastfeeding – essentially altering pressure applied by the baby’s mouth onto the breast. Perhaps the latch is such that the top lip is stronger than the bottom. Grip can also be a factor, so sometimes holding the baby differently makes a huge difference too.
And massaging the whole breast, not just the section the clogged duct is in helps. Often mastitis can return and can even switch sides, so Moms need to hydrate a lot, take care of themselves and get sleep. Pain is reset with sleep, so this helps tremendously.
Try to keep calm because pain increases anxiety which can mess with milk production and flow and the stress hormones can be passed on through breast milk. So staying calm is the best strategy as well.
Although medications fix the infection, they don’t get rid of the clog. Thus, mastitis recurrence is quite common, and happens to 20-35% of the women who develop it. However, physical therapy can help by providing ultrasounds and massages to get rid of the clog in the milk duct, as well as educate new moms on range of motion in the shoulder and posture and positioning with nursing to ensure that it doesn’t come back.
New moms are already under so much duress, so by making treatment easier, as well as educating them on ways to reduce mastitis from happening again, they can be more attentive to their own child. And their own health! It is essential to note that if your patients are having issues with breastfeeding, that they know they are not failing as a mother. Many women experience this, and raising awareness about it is one way to decrease the stigma. If breastfeeding does not work for them, it does not mean they won’t be an amazing mother! Learning as much as possible ahead of time to arm yourself with information that can help to set up successful breast care throughout those early stages of motherhood. And having therapists with experience and knowledge makes all the difference.
Kvist, L.J. Re-examination of old truths: replication of a study to measure the incidence of lactational mastitis in breastfeeding women. Int Breastfeed J 8, 2 (2013) doi:10.1186/1746-4358-8-2
Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K: Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 155: 103-114. 10.1093/aje/155.2.103.
Kinlay JR, O’Connell DL, Kinlay S: Incidence of mastitis in breastfeeding women during the six months after delivery: a prospective cohort study. Med J Aust.,169: 310-312.
Cooper, Barbara B. PT, MS1,2; Kowalsky, Donald PT, EdD3 Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women, Journal of Women’s Health Physical Therapy: September/December 2015 – Volume 39 – Issue 3 – p 115-126 doi: 10.1097/JWH.0000000000000037
Written by Caryn McAllister, DPT and founder of a CT healthcare company in NYC