By: K. Karl
Mastitis affects about 20% of nursing mothers. On a rare occasion mastitis can occur while the mother is still pregnant. The routine cures for mastitis does not apply to a pregnant woman. Left alone, mastitis in a pregnant woman can lead to serious complications.
Mastitis is normally caused by a blocked lactation duct. This duct does not completely empty when the baby nurses which causes the mother’s milk to back up. Since the milk is high in sugar, bacteria love it and flourish.
Nursing mothers with mastitis are put on antibiotics. They are told to encourage frequent feedings for the infant in order to keep the lactation duct clear. This situation is impossible for the woman who is still pregnant. It is not recommended to use a breast pump to clear the duct because that type of breast stimulation can cause premature uterine contractions.
The following is a true story of a woman who developed mastitis while she was pregnant. The story includes mastitis treatments while pregnant, nursing, and weaning. The treatments lasted over eight months.
The first sign that Samantha had that there was a problem was eight weeks before her due date. She had a small red lump on one side of her breast. It hurt to touch it. Samantha’s obstetrician recommended a breast doctor since he was unfamiliar with this problem during pregnancy.
The breast doctor was also unfamiliar with this problem but she needed to know what type of bacteria was causing the infection. She aspirated the lump with the smallest needle possible in order to send the fluid to the lab.
Samantha experienced pain relief from the doctor aspirating the fluid. The doctor prescribed a ten day supply of an antibiotic called Penicillin VK. This penicillin was strong enough to kill a wide range of bacteria and still be safe to take while pregnant.
Samantha was pain free for fourteen days. On a Friday afternoon she felt a sharp pain in the same breast that previously had the blocked duct. There was a small red area on both sides of her breast. Samantha did not think anything of it, but if she knew then what she knows now, Samantha would have immediately called the doctor’s office and insist on being seen.
By Monday, the pain was so bad that Samantha could barely move her upper body. When she finally saw the doctor that afternoon, her one comment was “You didn’t sleep at all last night, did you?” That summed up the pain.
Unfortunately, this time Samantha’s problem was more than an infected blocked duct. It was mastitis. Her doctor decided that she needed to drain the pus out of the two infected sections immediately. She numbed the skin and cut one slit on either side of her breast in order to drain the pus.
The doctor drained about two ounces of pus from both sides of Samantha’s breast. Then she packed the area with thin strips of gauze in order to let the rest of the infection wick out.
Samantha was given another two week supply of Penicillin VK and instructed to return every other day to get the packing changed. The packing helped the area heal and each time the doctor repacked with less gauze.
The packing finally came out the day before Samantha was scheduled for her c-section. The hope was that she would be able to nurse her son naturally with no further problems.
Nursing was difficult because now Samantha’s nipple was distorted from all the undermining of the breast tissue. Her very stubborn little boy refused to nurse on that side so she was left with pumping that breast at every feeding.
Within a week of finishing her antibiotics, the mastitis was back. This time she was prescribed Augmentin, a stronger antibiotic that is safe for nursing mothers. Samantha’s breast was repacked with gauze.
The third time that the mastitis returned, Samantha needed a surgical incision and drainage of the area. At that time Samantha’s doctor decided that nursing was going to do more harm than good. In order to put her on stronger antibiotics that would clear the infection, Samantha could no longer nurse her son.
Samantha would repeat this process several times over the course of the next three months. She was put on two courses of Penicillin VK, three rounds of Augmentin, two courses of Keflex, and then finally a combination of Cipro and Flagyl stopped the mastitis from coming back.
Fistulas of the breast developed where the mastitis was. Fistulas are tracts that are formed where there are not supposed to be openings. The incisions would close up, the area would fill with fluid, the tissue would turn red and become painful, and then the incisions would open and drain.
Samantha had to have these fistulas surgically removed so that her breast would finally heal. Her last surgery and course of antibiotics was eight months after she first noticed that little red lump.
Pregnant women should never ignore breast pain, redness, or lumps. If Samantha would have called her doctor on the Friday that she noticed the red area, instead of waiting the weekend, many of her problems could have been avoided. Her treatment probably would have been more antibiotics with no need for any surgical incisions, packing, or drainage.
Nursing would have also been possible with earlier treatment. The breast tissue would not have been destroyed by the infection.
It is very difficult for a nursing mother to handle a mastitis infection. It is even more difficult and dangerous for a pregnant woman who gets this infection. Curing the infection may take months if a pregnant woman waits too long to get treatment.
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