Author: Pinky McKay
Mastitis can hit suddenly and hard: one minute you feel just fine and the next you feel shattered and aching all over with chills and a fever. Sometimes flu-like symptoms come on even before you get a fever or notice breast tenderness. Mastitis can affect you emotionally too – it is common to feel ‘just awful’ and teary.
As a mum of multiples, you will be spending so much time breastfeeding or expressing as well as caring for two or more babies (and possibly also a toddler or two) that there isn’t time for ‘Mummy sick leave’. So, let’s look at how you can spot the early signs that mastitis with twins or triplets is rearing its ugly head and head it off before you crash – and how to prevent it in the first place.
Early warning signs of mastitis
Feeling ‘fluey’ any time when you are breastfeeding is a warning sign that you could be coming down with mastitis, an inflammation of the breast that may or may not also be infected.
Another sign that mastitis may be rearing its ugly head is an intensely painful breast. Your whole breast may feel tender and ‘tight’ and be swollen, red and hot or you may present with a red, sore, lumpy patch on one area of your breast only. A sore, lumpy breast may also be caused by a blocked duct or, in the early days of breastfeeding can be due to engorgement (full breasts).
A blocked duct or mastitis without infection will start to feel better with simple measures such as ‘warmth, rest and emptying the breast’ (remember this mantra to ward off the evil Mastitis) but if you feel increasingly unwell, you will need to seek medical treatment – the sooner the better!
Preventing mastitis with twins and triplets
Often the causes behind mastitis can be attributed to lifestyle stresses such as overdoing things and becoming exhausted or stressed – and what Mama of multiples isn’t ‘overdoing’ things?
Stress and health issues such as low iron (anaemia) can lead to a depressed immune system that makes you more prone to infections (homework – get a health check, including blood tests for iron, thyroid and vitamin D levels).
Having twins or triplets means you will be almost constantly expressing or pumping and whether you tandem feed your babies or they are on different schedules, your breasts will be working overtime to stay full. It can be much harder than with a single baby to make sure your breasts are regularly ‘emptied’ (they are never really ‘empty’), and this can increase the risks of mastitis.
Missing feeds (such as when you go on a long car trip and your babies sleep through a feed or if you express to go out but don’t express while you are away from your littlies) or scheduling feeds too strictly and too far apart can result in poor breast drainage and blocked ducts – and this can lead to mastitis.
Babies who aren’t well-latched, sleepy babies, a baby with tongue tie and using nipple shields can contribute to inadequate milk removal or engorgement. Cracked nipples can also set you up for mastitis as infection can enter the breasts through broken skin, so it is important to seek help from early for nipple soreness. Check with a health professional such as an IBCLC (International Board Certified Lactation Consultant – this is the gold standard in breastfeeding qualifications).
What you can do to prevent mastitis with twins and triplets
- Avoid overly full breasts by emptying your breasts regularly and completely. If you feel tender or full after a feed express a little milk for comfort. If you feel very full between feeds (perhaps if your babies have slept a longer stretch), either express enough for comfort or offer one or both babies a feed – chances are they will nurse enough to relieve your fullness even if they are sleepy.
- Try to breastfeed equally on both sides by alternating which baby goes on each breast. If one has a more effective sucking reflex than the other, you can risk one side being your ‘super boob’ and that can lead to backup and blocked ducts if it isn’t well drained.
- For any lumpiness that signals a potentially blocked duct, massage your breast gently towards the nipple under a warm shower and express for comfort. If it’s not practical to hop in a shower, apply a heat pack or warm face-washer and massage – remember the mantra ‘warmth, massage and empty the breast’. One tip if you have a hard lumpy patch is to massage ‘in front’ of the lump (the side closest to the nipple) to try and clear the blockage, then as baby feeds, massage the rest of the lump towards the nipple.
- Wear loose fitting clothing around your breasts, especially avoid under-wire or tight bras that may compress milk ducts and hinder milk flow, increasing your risks of mastitis. Also take care when you are sleeping that you don’t sleep in a position that may squash your breasts – such as lying on your stomach.
- Take care of yourself is not selfish. You are doing an awesome job! Rest, nourishing foods and relaxing activities that make you feel good will reduce the effects of stress and boost your immune system.
Supplements and Probiotics
You may like to try a probiotic specifically created for breastfeeding mothers such as Qiara which has been shown in clinical trials to have beneficial effects on the breast health of mothers who have recurring mastitis.
Dietary supplements may be helpful. For instance, many mums have found vitamin C and lecithin helpful in preventing recurrent blocked ducts – for more information about lecithin, dosage and potential contra-indications check this link by Kelly Bonyata, (IBCLC).
Treating mastitis with twins and triplets
The good news is that if you start treatment early, you can get on top of mastitis with twins or triplets before you become very ill. ‘Warmth, Massage, Rest and Empty your breast’ is a good mantra to remember and if you suspect mastitis, consult your doctor early.
Mastitis is a medical illness so should be taken seriously –call in help and take sick leave from all duties except feeding your babies.
Pinky McKay
Tips for treating mastitis
- Breastfeed frequently (aim for every two hours) to empty the affected breast. Vary feeding positions to drain all ducts. If one of your babies is a ‘stronger sucker’ feed that one on your affected breast to help drain it. You may find it helpful to ‘dangle feed’ –try breastfeeding while kneeling over baby on all fours so gravity can help breast drainage.
- Before feeding, apply heat to stimulate circulation and mobilise infection fighters in the breast: have a warm shower or apply a warm wet face washer or comfortably hot water in a disposable nappy against your sore breast (this will stay warm longer than a face washer but test carefully that it isn’t too hot) and gently massage the affected area. If you need pain relief, take Panadol or Nurofen half an hour before a feed.
- Loosen your bra so there is no pressure on your breast that may inhibit milk drainage.
- Feed on the sore side first or pop your strongest sucking baby on that side. If your affected breast feels too sore to nurse on, start with the gentlest baby on that side or if you are feeding one baby at a time, start feeding on the least sore side then switch sides when your milk lets down.
- Drink plenty of fluids – fever and infection will increase your need for fluids.
- After breastfeeds, make sure your breast is drained and feels soft. If you need to, hand express for comfort.
- Apply cold compresses (wrapped ice packs, frozen peas or wet a disposable nappy and freeze it) between feeds to relieve pain and reduce inflammation.
- DON’T STOP BREASTFEEDING! Weaning isn’t wise while you are treating mastitis as this will increase the chances of developing an abscess that needs to be surgically drained.
- If you are prescribed antibiotics, be sure to take the full course.
Pinky McKay is Australia’s most recognised and respected Breastfeeding expert.
She’s an IBCLC Lactation Consultant, Best Selling Baby Care Author and creator of Boobie Foods, all natural and organic foods (Boobie Bikkies and Boobie Brekkie) scientifically formulated to nourish breastfeeding mums.
For tips to boost your milk supply, download Pinky’s FREE ebook ‘Making More Mummy Milk, Naturally’.