Understanding Mastitis in Breastfeeding

Introduction

During breastfeeding, Mastitis is a common condition faced by women in which their breast tissues are swollen creating hindrance for them to breastfeed their babies effectively. In this assignment, physiology and anatomy of lactation and breast are to be discussed by relating it with the pathophysiology of mastitis. The causes, signs and symptoms of mastitis are to be discussed. Moreover, self-help measures for treatment of mastitis are to be discussed and action plan is to be explained. For those seeking more in-depth analysis, healthcare dissertation help can provide valuable insights into related topics, enhancing the understanding of mastitis and its implications in breastfeeding.

Assessment of Jo and breastfeeding history

The student midwife after visiting Jo for postnatal health assessment mentioned that Jo who has been breastfeeding her baby for past eight days is feeling pain in her left breast since she started feeding her baby. The feeding history regarding baby mentioned by Jo is similar to the suggested guidance for breastfeeding by the NHS. The NHS mentions that babies after birth in the first few weeks are to be breastfed 8-12 times per day or more to ensure they get adequate nutrition for their development and well-being (NHS, 2019). The monitoring of the pulse rate and temperature for Jo indicated that she has an elevated pulse rate and mild fever.

Diagnosis and causes

The clinical course of mastitis includes initially the development of small palpable lump on the breast which is considered to be normal by the mother in the course of breastfeeding. However, with time increased pain is perceived in the lump or inflamed area making the mothers feed pain and discomfort (Brennan et al. 2020). This is evident as in case of Jo it is seen that after eight days of breastfeeding she reported feeling pain in her left breast and not within days of first indication of inflammation on her breast. The signs and symptoms of mastitis include burning sensation or pain in the breast during feeding out of infection which mainly affects one breast at a time, swelling, tenderness, warmth in the breast, wedge-shaped redness or lump in the breast, tried feeling and fever (Tan et al., 2019). In case of Jo, it is seen that she experienced all the symptoms of mastitis that is lump in breast, tenderness, hard and pain in the left breast along with fever indicating she is suffering from the condition.

The causes of mastitis include trapped breast milk which occurs mainly due to incorrect breastfeeding technique where the breasts are unable to be fully empty. This leads the breast milk to be trapped in the small openings making the breast to be inflamed and feel soreness eventually leading to development of infection (Yu et al, 2018). A argued by Pustotina (2016), blocked milk duct leads to development of mastitis in breastfeeding mothers. This is because the clogged milk duct leads to create hindrance in milk flow making it to build-up in the area to make the breast inflamed and develop infection. The presence of bacteria in baby’s mouth or in mother’s skin which enters the breast through crack in the skin of nipple is responsible to cause mastitis. This is because breast milk provides an effective breeding environment for the bacteria making it to grow intensely to pathological proportions and adversely infect the cells in the area to be inflamed (Aktimur et al., 2016). As criticised by Egbe et al. (2016), wearing tight-fitting bras leads to mastitis. This is because it creates pressure on the breast to restrict normal milk flow result the breast milk to be clogged in ducts making them to be inflamed and show signs of mastitis.

Anatomy and physiology of breast

The normal anatomy and physiology of the breast indicate it to be made up of glandular, fatty and connective tissues within which milk-producing cells are present. The breast is present overlying the pectoral muscles of the chest and the amount of fat tissue presence indicates the size of the breast. In normal breast, 15-20 milk-producing sections are present known as lobes and inside each of the lobes, small structures known as lobules are present where production of milk occurs with stimulation of oxytocin hormone (McGuire, 2016). The milk produced in the lobules travels through network of tiny tubes known as ducts which are further connected with larger ducts that are present near the exit area of the breast that is nipple. The nerves present in the breast tissues support sensation and the connective tissues along with ligaments provide shape to the breast (Lopez and Olutoye, 2018).

In case of mastitis breast, the connective and fatty tissues present in the breast remain unaffected. However, inflammation of the lobules where milk is produced occurs that created lump along with redness over the skin in the breast region. The lactiferous ducts that are connected with the nipple responsible to allow flow of milk to the nipple are also inflamed in the mastitis breast. This is because of clogged milk in the ducts out of hindered breastfeeding technique or due to its inflamed condition caused by infection with pathological build-up of bacteria in the ducts (Faguy, 2018). The issues may have been raised in the left breast of Jo who is suffering from mastitis leading her to experience the symptoms of the condition.

In normal breast, during breastfeeding, the milk gets collected in the lumen of the ducts and alveoli which are surrounded by muscle cells. The suckling pattern of the baby leads the muscle cells to contract and put pressure on the lobules to allow milk production and stimulates flow of milk through the ducts in the nipple to be drank by the baby (Biagi et al., 2018). However, it is seen that hindered breastfeeding technique leads to inadequate suckling and contraction of muscles to force smooth milk flow through the ducts. This creates inadequate draining of milk from the duct leading to create elevated intramammary pressure and accumulation of feedback inhibitor which reduces milk production and stimulates mammary involution. In case the breast milk is removed from the ducts, the inhibitor is removed and milk secretion is effectively resumed (Sriraman, 2017). In case of Jo’s breast, similar physiology of restricted milk flow is faced leading her to experience pain and addition symptoms during breastfeeding.

Manage problem

The management of mastitis can be done through adoption of effective breastfeeding technique along with self-help measures. The healthcare practitioners in case of mastitis recommend that mothers are to breastfeed their babies from the affected breast with 3 hours gap. During feeding on the affected breast, the mothers can hand press the affected breast to avoid pain in the beginning during feeding or suckling by the baby (NHS, 2019a). In order to manage mastitis, the mothers are required to adopt self-help techniques such as heat and cold massage along with hand pressure so that the clogged ducts are opened and pain along with redness in the area is gradually reduced. In heat and cold massage, heat or cold packs are to be applied in the affected area to lower inflammation and control pain (Angelopoulou et al., 2018). The use of a warm and/or wet washcloth 15 minutes before feeding the baby on the breast is effective to increase milk flow in the affected breast (NHS, 2019a). Thus, this technique would act to lower the pain and resolve clogged ducts to ensure management of mastitis breast to normal.

The changing of breastfeeding position with gap of 1 day is effective technique to treat mastitis breast (NHS, 2019a). This is because in the way extensive pressure the affected breast can be avoided allowing its healing efficiency to be increased. The self-help technique for mastitis breast among mothers indicates them to initiate breastfeeding at the first from the unaffected breast if breastfeeding from affected breast is painful. They are then to switch to the affected breast for feeding the baby which could be relaxing (NHS, 2019a). The intake of increased fluids along with wearing loose clothes is recommended for managing mastitis breast. The intake of ibuprofen along with acetaminophen is suggested for mastitis breast to lower inflammation and pain of the breast (Russell et al., 2020). The baby soothers and area near the breast area to be cleaned and sterilised to as to avoid bacterial growth that stimulates mastitis (NHS, 2019a). Jo is required to follow the measures to ensure management of her mastitis breast to lower her pain and swelling to ensure normal breastfeeding to her baby Poppy.

Breast positioning

In order to avoid mastitis breast, effective breastfeeding position is recommended to be followed by the mothers. According to UNICEF, the acronym CHIN is to be followed during positioning the baby for breastfeeding. The CHIN indicates close attachment of the baby with the mother's body, head free, mouth in line with the nipple and nose to nipple (UNICEF, 2020). Jo is required to follow the CHIN acronym when positioning the baby for breastfeeding to avoid clogging of milk ducts and increasing chances of mastitis. The cradle position is the effective and common breastfeeding position in which the baby’s head is supported by the arms of the mother near the breast. The head of the baby is cradled near the elbow and the arms are used to support back and neck of the baby. The baby and the mother are to be connected chest to chest in this position (D'Souza et al., 2019). The side-lying position in breastfeeding includes the mother to lie down by her side with the breast facing the baby. The nipple is to be present in line with the baby’s mouth and the mother is required to support her neck and back with a pillow (Puapornpong et al., 2017). The technique could be adopted by Jo to feed her baby in a relaxed way without having to hold her continuously.

The baby during breastfeeding can be considered to have effectively attached when the baby’s whole body is near the mother and the baby has mouthful of breast (NHS, 2020). The baby’s chin is required to be touching the breast and strong suckling feelings indicate that the baby is closely attached. The other sign of good attachment include mother being able to watch the dark skin in near the nipple and the dark skin of baby’s bottom lip, cheeks of the baby remain round during suckling and the baby finishes the feed to come off the breast in their own time and not frequently. The baby is also found to take rhythmic sucking and swallows in close attachment (NHS, 2020). Jo can understand that the baby is effectively attached by considering the mentioned aspects making her ensure she is breastfeeding effectively. The signs of non-attachment during breastfeeding include suckling by babies to be painful for the mother, short suckling period, restlessness of baby to come off the breast and the cheeks are drawn in (Gibbs et al., 2018). Jo is required to identify the following cues to ensure effective attachment of the baby is done during breastfeeding.

Safe storage of breast milk

The safe storage of breast milk can be done within considered condition that is pumped breast milk can be stored in 77˚F or colder for 4 hours to be fed to the baby. The pumped breast milk can be stored in freezer for 6 months and in normal refrigerator for nearly 4 days in effective condition (medela.co.uk, 2019). This stored milk can be used by Jo to feed her baby during healing of her mastitis breast to resume breastfeeding later after the pain is resolved. The frozen breast milk before its use is to be thawed and not heated directly for use. In this purpose, the frozen breast milk is to be kept in lower temperature than freezer and later to be warmed in running warm water or bowl of warm water (medela.co.uk, 2019). This is because rapid heating of frozen breast milk adversely affects the antibodies present in it. During pressing of the breast for pumping milk to store, the mothers are required to slowly massage the breast and locate the lactiferous sinuses where the milk remain stored to be drawn to the nipples with suckling act of the baby (Rodrigo et al., 2018).

Action plan

The NMC Standards of Documentation mentions that nurses and midwives are required to develop accurate and authenticated records of relevant practice (NMC, 2018). This indicates that clarified and accurate instances of health assessment and treatment for Jo are to be recorded effectively by the nurse. The detailed course of delivery of treatment and management for health condition of the patients is to be documented and recapped in each session during the documentation process to ensure correct storage of information as evidence (NMC, 2018). This is because the evidence could be later used for planning care of similar patient to ensure their easier and appropriate care and recovery from the condition like Jo. Jo is to be provided contact number for community care so that during urgency she can contact responsible person to cope with her health issues regarding mastitis breast.

Conclusion

The above discussion informs that Jo is suffering from mastitis breast. The issue can be controlled by following CHIN acronym during breastfeeding along with implementing self-help measures such as heat and cold massage, ibuprofen intake, effective breastfeeding technique, maintain hygiene and others.

References

Aktimur, R., Kıymaz, D., Gümüş, K., Yıldırım, K., Çetinkünar, S. and Özlem, N., 2016. Experience and knowledge level of female health care professionals in Samsun province regarding puerperal mastitis. Turkish Journal of Surgery/Ulusal Cerrahi Dergisi, 32(4), p.261.

Angelopoulou, A., Field, D., Ryan, C.A., Stanton, C., Hill, C. and Ross, R.P., 2018. The microbiology and treatment of human mastitis. Medical microbiology and immunology, 207(2), pp.83-94.

Biagi, E., Aceti, A., Quercia, S., Beghetti, I., Rampelli, S., Turroni, S., Soverini, M., Zambrini, A.V., Faldella, G., Candela, M. and Corvaglia, L., 2018. Microbial community dynamics in mother’s milk and infant’s mouth and gut in moderately preterm infants. Frontiers in microbiology, 9, p.2512.

Brennan, M.E., Morgan, M., Heilat, G.B. and Kanesalingam, K., 2020. Granulomatous lobular mastitis: Clinical update and case study. Australian Journal of General Practice, 49(1/2), p.44.

D'Souza, S., Thomas, T. and Paul, S., 2019. Comparison of Two Breastfeeding Positions on Maternal Comfort and Infant Feeding Behaviors through Video Teaching among Postnatal Mothers. Journal of Health and Allied Sciences NU, 9(03), pp.104-115.

Egbe, T.O., Ngonsai, D.T., Tchounzou, R. and Ngowe, M.N., 2016. Prevalence and risk factors of lactation mastitis in three hospitals in Cameroon: a cross-sectional study. Journal of Advances in Medicine and Medical Research, pp.1-10.

Faguy, K., 2018. Infectious and inflammatory breast disease. Radiologic technology, 89(3), pp.279M-295M.

Gibbs, B.G., Forste, R. and Lybbert, E., 2018. Breastfeeding, parenting, and infant attachment behaviors. Maternal and child health journal, 22(4), pp.579-588.

Lopez, M.E. and Olutoye, O.O., 2018. Breast embryology, anatomy, and physiology. In Endocrine Surgery in Children (pp. 365-376). Springer, Berlin, Heidelberg.

Puapornpong, P., Raungrongmorakot, K., Laosooksathit, W., Hanprasertpong, T. and Ketsuwan, S., 2017. Comparison of breastfeeding outcomes between using the laid-back and side-lying breastfeeding positions in mothers delivering by cesarean section: A randomized controlled trial. Breastfeeding Medicine, 12(4), pp.233-237.

Pustotina, O., 2016. Management of mastitis and breast engorgement in breastfeeding women. The Journal of Maternal-Fetal & Neonatal Medicine, 29(19), pp.3121-3125.

Rodrigo, R., Amir, L.H. and Forster, D.A., 2018. Review of guidelines on expression, storage and transport of breast milk for infants in hospital, to guide formulation of such recommendations in Sri Lanka. BMC pediatrics, 18(1), p.271.

Russell, S.P., Neary, C., Abd Elwahab, S., Powell, J., O'Connell, N., Power, L., Tormey, S., Merrigan, B.A. and Lowery, A.J., 2020. Breast infections–Microbiology and treatment in an era of antibiotic resistance. The Surgeon, 18(1), pp.1-7.

Sriraman, N.K., 2017. The nuts and bolts of breastfeeding: anatomy and physiology of lactation. Current problems in pediatric and adolescent health care, 47(12), pp.305-310.

Tan, Q.T., Tay, S.P., Gudi, M.A., Nadkarni, N.V., Lim, S.H. and Chuwa, E.W.L., 2019. Granulomatous mastitis and factors associated with recurrence: an 11-year single-centre study of 113 patients in Singapore. World journal of surgery, 43(7), pp.1737-1745.

Yu, Z., Sun, S. and Zhang, Y., 2018. High-risk factors for suppurative mastitis in lactating women. Medical science monitor: international medical journal of experimental and clinical research, 24, p.4192.