Episode 192 - Mel’s Mastitis Protocol
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. In each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:24] Hello, and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I've been a midwife for 18 years, providing full continuity of care for women through their pregnancy, birth, and postpartum all the way to six weeks. So I felt really equipped to talk about today's topic because many midwives don't get to work with women who are experiencing mastitis. Sometimes this can come on in the first few days we're in hospital, but it's not very common that's what happens.
[0:58] So I've had 18 years of working with women in the first six weeks postpartum, and I've had to nurture them through numerous, countless bouts of mastitis. And something that some of you might not know is that I actually also have qualifications as a naturopath. So I understand and incorporate natural therapies and nutrition into my care of women as a midwife so I've studied homeopathy herbal medicine supplements nutrition a range of other alternative therapies and I know many of you might be going oh my gosh we thought Mel was evidence-based how could she be using natural therapies and I've had emails and messages from people saying, how dare you? I trust you. Why do you support things like homeopathy and herbal medicine? There's no research. I want to ask you if you've actually done the research or if this is just your
[1:53] general opinion, because obviously I went to university and studied naturopathy for three years. And I do feel like there's quite a bit of evidence behind a lot of the things that I'll be.
[2:07] So today, I want to share with you my mastitis protocol, and it comes with some really clear warnings and recommendations, and I'll explain why in a minute. But first, in the interest of keeping this podcast completely free to you, the listener, this episode is sponsored by my dear friend and birth prep extraordinaire, Poppy Child from Pop That Mama. She's a doula and hypnobirth practitioner, and her online hypnobirthing course, which is called The Birth Box, has already helped thousands of women get ready for labor. And you know me, if you've been listening to the podcast long enough, I am so picky about what I will endorse on this podcast, but I do get behind the work of Poppy and what she's doing with the birth box. What I love about the birth box is that it is practical. It teaches you tools not only for the birth, but for pregnancy and for your life with children.
[3:04] In the birth box, you will learn tools to manage pain, how to stay steady when labor gets strong, and how to advocate for yourself in medical settings. So it's all about giving you knowledge, confidence, mindset, and tools that will help you on the big day. There's a little cherry on top in there as well. It's called the Oxytocin Bubble, which is a full album of soundtracks to guide you through labor, help you stay in the zone. The birth box is rated five stars across the board. And with my code, Melanie, you'll get 25% off the birth box.
[3:36] The link is in the show notes. Okay. As I said, this episode comes with some clear warnings. So I am qualified as a naturopath. I don't work as a naturopath anymore, but I do incorporate that knowledge into my care of my midwifery clients. I'm also a nurse and a midwife, and I have 22 years of clinical experience in the health field. So I have the capacity for clinical reasoning and management skills that allow me to quickly assess and manage situations like mastitis. So today I'm going to share with you the mastitis protocol that I developed very early in my career. It was actually based more so on my naturopathic training, what I knew about the body, what I knew about the physiology of mastitis or the pathology of mastitis. It's really, it's not a physiological thing. It's a pathological thing for women who are breastfeeding.
[4:33] So this was not specifically based on my midwifery training. We got a little bit of training about how to help women work through mastitis, but it was very medically focused and there was medications and it wasn't, I didn't find it very holistic. So fortunately, I have additional skills in natural medicine. And so that's what I've incorporated into my mastitis protocol. They don't really teach midwives what I will be telling you about today. And in fact although I've been using this protocol with 100% success rate as a midwife for the women who've contacted me for my clients who've contacted me and said Mel I think I'm getting mastitis I go rightio I'm sending you my mastitis protocol if you do this I'm almost certain that you will not need to go and seek extra assistance for things like antibiotics or abscess development or anything like this. And I need to tell you that in my experience, obviously I have some clinical reasoning and I know my clients and I ask some specific questions so I can determine if it truly is mastitis and not just something like engorged breasts or their milk coming in, which can also feel very tender and lumpy. But every time I give women this protocol.
[5:50] It works usually within 24 hours sometimes 48 hours but I do need to tell you that many of the items and actions that are in my protocol are currently against the advice given by some lactation consultants, GPs, other midwives and the current recommendations that are going around for the management of mastitis come from the Academy of Breastfeeding Medicine. They have a clinical protocol number six and of course it's in the resource folder for all of you to look at so you can have a look what the academy of breastfeeding medicine recommends in their clinical protocol number 36 it's called the mastitis spectrum and it was revised in 2022 some of what i do and what i still recommend is against their updated protocol which came out three years ago and for that reason I just need you to know that this might be a very unpopular protocol because it does include some things that they no longer recommend.
[6:55] For that reason, I suggest that in no circumstance, you do what I recommend. This is something that I offer to my clients and all of them have had positive and quick results. I've never had to go ahead and write a script for antibiotics after a woman has not recovered from mastitis who's been under my care. I check on them regularly. I coach them through bouts of mastitis and all of the things that I recommend is not what's taught to midwives. So under no circumstances are you to take my advice in this regard. So this episode is just me telling you what I do, what I suggest. I always tell my clients this is not the recommendation that is currently recommended to women. Obviously, it's up to them to decide.
[7:46] This episode is just me telling you the management plan of what I offer, what my experience has shown me.
[7:52] It's incorporating my knowledge around natural therapies that I've gained over the last 22 years. And I always tell my clients and I'm telling you now that my advice is definitely not in line with some of the current recommendations.
[8:05] So go ahead and read the Academy of Breastfeeding Medicine Clinical Protocol number 36. Then you'll have the current advice. And if you need to, you can incorporate some of the things that I'm talking about, but I just need you to know this right up front. In the resource folder for this episode, as all the others, you'll find lots of guidance about what the current recommendations are, some of the current research, some of the research around the elements that I have included into my protocol because they're not all against current guidelines, but some of them are. So you get access to that resource folder by joining the podcast mailing list. It's easy to do. You just scroll down the bottom into the show notes and you can join the podcast mailing list at melanethemidwife.com. And then you get sent a link to the collective resource folder for this podcast. What I've also done in there, if you are a woman and you're listening to this or you're a midwife and you think, oh my gosh, I just need some help working out how to help women with mastitis. I've put my entire mastitis protocol, a summary of it, dot points.
[9:12] So it's really clear a full summary of this episode is in that folder, in the resource folder. So you can actually print that off, print off the mastitis protocol. It's completely of my own invention.
[9:26] It's absolutely absurd. You shouldn't use it. And so if you want to see it, you can print it off and then use the printed copy to put big red crosses and big red marks all over it because of how wrong you might think it is. So this episode is not about how to treat mastitis it's about how I have come to treat and manage mastitis I used it for myself I offer it to my clients and they have an opportunity to choose it or to choose something else however when they do choose to go ahead with this protocol they've never had to move to antibiotics after applying this particular protocol as I said some of it is not in line with the evidence or the current not the evidence it's there's a lot in line with the evidence, but it's not in line with the current recommendations.
[10:15] So this protocol, although effective in my clinical practice.
[10:19] Again, as I said, and I'll say it one more time, goes against current mastitis management guidelines. But here you go, the mastitis protocol that Mel uses, Mel's Mastitis Protocol. Now, if you are or have repetitive bouts of mastitis, the best care providers to assist you with breastfeeding-related pathology are lactation consultants and experienced midwives. So if you feel like you might have mastitis, contact a midwife or lactation consultant immediately. Immediately some maternal and early childhood nurses have the skill with this but really your experts in this area are midwives or lactation consultants most general practitioners are not trained to assist with the continuation of breastfeeding there are some fantastic ones who specialize in women's health and of course if you've got a GP who's also a lactation consultant and has a special interest in breastfeeding and assisting you with the continuation of breastfeeding, then that's great. But most are not trained to specialize in this area. And often you will go and with very little assessment, they will offer you antibiotics as a treatment without reviewing the bigger picture. But an infection is not the only reason that you would or could get mastitis.
[11:46] So, antibiotics is not warranted in a vast majority of mastitis circumstances. So, just be careful. If the GP is your first port of call, you might find yourself on an unnecessary antibiotic regime and potentially not addressing the root cause of the mastitis. So, midwife or lactation consultant is where it's at. And with mastitis, you want to get treatment sooner rather than later. This thing, it can really suddenly come on and suddenly become concerning and difficult. So my clinical experience is that this protocol, male's mastitis protocol, it creates improvement usually from what I've seen with my own clients and with myself, I've used this for myself, within 24 hours. So with mastitis, if it's not getting worse, it's getting better because it can get worse so fast. If it's not getting worse and you're sort of feeling around the same, it's probably turning a corner and getting better. So the acute pain and the flu-like symptoms and actually the absolute distress that you can feel when you have mastitis, you almost feel like pushing your baby off your breasts because of how tender and difficult it can be to feed. There's a real aversion and emotional reaction to mastitis. Often it's.
[13:11] An emotional experience. But those severe symptoms, the acute symptoms should be subsiding within 24 hours of using this protocol. So once you feel an improvement, and this is the same with all mastitis management, once you feel an improvement, keep doing what you're doing, keep using the remedies and the management strategies until you're completely recovered in order to prevent a relapse.
[13:37] So in the event that your symptoms don't improve by 48 hours, consider that you would need additional assistance to help clear up that mastitis. At least have a professional opinion, discover what the cause is,
[13:52] especially if it's reoccurring, then you haven't addressed the root cause because it keeps coming back. And many of the things in Mel's mastitis protocol can be done at home. And that is always my aim. My aim is that a woman would be able to treat and self-manage her mastitis so that you don't have to leave the house to go to appointments and to see numerous healthcare providers. It's really counterproductive to mastitis recovery. So the things that I'm going to talk about, I would suggest doing the first few things while you've sent somebody else out to the shops to collect the other bits and pieces that you might need in order to aid in your recovery. Make sure they take any of your other children with you. This is not the time for you to be hardcore parenting on your own with a new baby and mastitis. So the only person who should be leaving the house when you have mastitis is the other adults in the house who are there to help you. And that's to collect all the other remedies that you will need in order to recover from mastitis.
[14:55] So the first thing, if you think you have mastitis, is to work out, firstly, do I have mastitis? There are some other things that would cause sudden breast pain and discomfort. And if it's happening in both breasts and there's some symmetry, so both breasts are large and hard and lumpy, that's probably not mastitis. That's more likely to either be your milk coming in around day two, three or four, and it can feel like you have rocks in your breast so they can feel really firm and hard. All this mastitis protocol does not apply to that situation.
[15:33] Mastitis is usually once on one breast and in one area it's localized usually red and hot over the area there can be a lump that you feel it's usually characterized by some kind of inflammation. So.
[15:50] It's important to work out, do I have mastitis or do I have something else? It could also be simply a blocked duct, which is also not mastitis. And again, the management plan for a blocked duct is different to mastitis. So let's have a look. And you need to sort of theorize what could have caused this because that's going to help you with the management. So is it a blockage? in which case you're not managing it necessarily with a mastitis protocol but a blockage can progress on to some kind of infection or inflammation which does feel and can treat as mastitis. The cause could be exhaustion, compaction or impaction. So if you've laid on your breast all night for example and that's resulted in some kind of blockage or inflammation in your breast. It can be as a result of inflammation and certainly the new clinical guidelines, the recommendations that were made by the Academy of Breastfeeding Medicine, that clinical protocol number 36, certainly a lot of that conversation talks about inflammation of the breast as a real possibility as opposed to infection in the breast. So inflammation is one reason. Infection is another reason.
[17:09] Engorgement can be another reason for feeling sore, but that's not mastitis. And it's important that you don't treat engorgement like mastitis. The other cause could be depletion in so many ways. A profound lack of postnatal support can be a cause of mastitis. If your baby has a poor latch or there's feeding issues, this can lead to mastitis. There's also the possibility of a breast abscess. And a breast abscess is a complication from mastitis. So, In no circumstances do what I'm going to suggest to you today is not a solution to a breast abscess. That's a different thing again. So if you feel like you might have an abscess or something more severe than mastitis, it is important that you seek other care. Some of these things, if you're sure it's mastitis, you can go ahead and do
[18:00] some of the things on Mel's mastitis protocol. But however, as I told you at the beginning, a lot of this stuff is not what's recommended in the industry. And so you've got to make some choices around whether or not you want to take my word for it.
[18:13] All right, here we go. Mel's mastitis protocol. Now, this is from the vault. I have not shared this publicly. This is the stuff that I will text message women when they message me immediately. Hey, Mel, think I've got mastitis. Have a conversation with them. And then I go, here's my mastitis protocol. Have a good read. Do it all. and I suspect you'll be better by tomorrow. And when I contact them and ask them, how are you going?
[18:44] They universally tell me, oh my gosh, so much better. So here we go, Mel's protocol.
[18:52] So as soon as you feel the sudden tiredness and crash of mastitis, because this is what it can feel like, is one minute you're fine, the next minute you want to close your eyes, fall asleep, and you think, oh my gosh, I just suddenly being overcome by tiredness. You should immediately think oh no am I crashing from mastitis do a full check of your boobs and your symptoms because getting mastitis it can be come on suddenly but you got to get onto the management strategy straight away to prevent it becoming any worse so once you feel that sudden tiredness and crash of mastitis that's your cue that your full-time job is to try and get better as quickly as possible. Stop everything else.
[19:42] Mastitis moves fast and the sooner you start managing it, the slower it will progress into a serious situation and the less likely it is to progress onto other complications of mastitis. So the very first step in Mel's mastitis protocol is to plan to rest and sleep. And because one possible trigger of mastitis is that you did too much on that day or in the days following up, and you're profoundly exhausted. This is your body saying it was too much and it can't cope. And so mastitis comes. But before you lay down to rest, here's what you need to do. But don't just go straight to bed. There's a few things you need to do to prepare for your full-time job as a person recovering from mastitis.
[20:33] So firstly, before you go down to rest and sleep, tell the rest of your family that you are ill and you must spend the next 24 to 48 hours engaging in full-time personal care. So you need to arrange alternative care providers for your older children, potentially that's your partner if they're supportive and helpful, or call in other help because you and your baby will be spending all of your time recovering from massitis. So that's point number two. Point number one is rest and sleep. Point number two is you have to tell the rest of your family that that is your plan and make arrangements, you know, delegate the care of the other things in the house and the other children in the house to someone else. Next, before you go ahead and rest and sleep, make sure that you hydrate.
[21:17] Hydrate adequately with water or zero sugar electrolyte drinks and the zero sugar is important. So make sure that those electrolyte drinks are not high in artificial colors and flavors and sugars so something that's as clean as possible so keep sipping as much as possible just slow regular consistent sips because you need to stay hydrated in order to recover from mastitis have fluids next to your bed so before you go to sleep set all that up a hydration station to make sure that you're adequately hydrated and you don't need to leave the bed in order to keep getting fluids that's number three so we did rest and sleep prepare the rest of your family that you're about to shut down hydrate and make sure that you've got a plan for that your hydration station is all set up next before you do anything else remove any restrictive clothing this is point four remove all restrictive clothing including bras and feeding singlets so you've got to let your boobs go free and loose under your shirt and then when you lay down you know if you've got mastitis, you won't want to put any pressure on that sore breast, but try and avoid compressing your breasts while you're sleeping.
[22:34] Number five is avoid eating sugar and sweet or processed foods with white flour products within them. The thing about these types of foods is that your body requires energy to process sweet foods and processed foods. It actually needs to give your digestive system and your body resources from itself in order to digest and use that food. It's depleting. It depletes your body. It doesn't add anything. Not only that, but sugar can multiply the breeding of infections and bacterias. It depletes your immune system. It makes you less capable of dealing with what's going on right now with mastitis. So no sugar, nothing sweet. It depletes your nutrient supply, contributes to the bacterial growth. And if you really, really must go back to it afterwards, please do. But avoid it while you're covering from mass status.
[23:37] Now the next thing and here's where people will start to get bothered and say Mel I can't believe you believe in homeopathy there's no evidence to support it I've put a whole bunch of research papers in the resource folder if you want to have a look then what you're going to do is you're going to go to the resource folder and you're going to say hey Mel all of these studies seem to be animal studies and yes some of them are because guess what guess where there's big money there's big money in keeping large stocks of animals like cows lactating cows dairy milk cows there is a stack of money invested into keeping them healthy free of mastitis which is a really big problem and free of infections so guess where a lot of the testing on homeopathy for mastitis is it's in on large farms by farmers who are caring for lactating cows, I'm not saying that that's what you are, but.
[24:34] They've had such promising results that some of the research shows that just by dosing the cows with homeopathy, instead of antibiotics, reduced mastitis amongst the herd for the farmers by 50%, which is a massive cost saving for them. And the homeopathic remedies, one of the papers said it costs 7 cents per cow to treat, which is super important to farmers because they need to know if I've got to treat a thousand cows, how much is it going to cost me? Now, one of the homeopathic remedies that is synonymous with the treatment of mastitis, as I trained as a homeopath, but also now as a midwife, I've been able to kind of test how this thing works on real life women. There are not just animal studies in that resource folder, by the way. There's some other studies on actual people.
[25:31] But phytolacca homeopathic phytolacca pills not a cream these are pills that you would put under your tongue the plant is poke root but it's homeopathic phytolacca p-h-y-t-o-l-a-c-c-a but you'll see this in the protocol if you go to the podcast mailing list you'll get that protocol which is in the resource folder you can find it at a lot of your local health food stores or if You've got a homeopath and you're by, you're going to say, hey, got some mastitis, need some Phytolacca, homeopathic Phytolacca. Start dosing approximately every two to four hours until you feel the change in your symptoms. However, if there's no change within 48 hours, I would stop this remedy. There are other options, other homeopathic options. Phytolacca is the one that I have found works most effectively as part of this protocol. And the benefit is, is that there's no known side effects. They haven't seen any circumstances under which you have a reaction to homeopathic phytolacca. So it's quite okay to self-dose with this, but if it doesn't work, you don't just keep taking it. It might be a sign that it's not the right remedy for you.
[26:47] Okay, that's what I'll say about homeopathy. If I've lost your respect, that's fine. Don't use the protocol. You don't have to. It's just something that I've used that works. If you don't believe me, that's fine. Okay, next. And again, there's heaps of research on this. And again, that's in the resource folder. And this is something that is recommended in the current guidelines is probiotic supplements. Honestly, get whatever you can afford. Something is better than nothing. But there are some brands that are specifically studied for their impact on mastitis. And one of those brands is Kiara, but I do agree that they can be on the more expensive side. So I just think buy the probiotic supplement that suits your budget. Kiara has tested their own products for the treatment of mastitis, but whether or not that's within your capacity is another thing. And can I just suggest here, when you take your probiotic supplements, because I'm going to be offering some other supplementation that you can use as part of this mastitis protocol, take the probiotics separately at a different time.
[28:02] From the garlic supplements so garlic is antibacterial and probiotics are bacteria so I just suggest that people take garlic and antibacterial things away from their probiotic so that's the next thing probiotic so let me give you a very super quick summary of what we've just spoke about so far rest and sleep tell the rest of your family so that you are free to look after yourself, hydrate, remove restrictive clothing, avoid sweet and processed foods, homeopathic phytolacca tablets, a probiotic supplement. And the next is these next three things are all things are going to boost your immune system and reduce inflammation. So these three nutrients are all about that. So if it is an infective process, if there's an infection, these are the things that are going to boost your immune system. So vitamin C, and I usually suggest around 3,000 milligrams.
[29:04] Zinc supplements, usually the practitioner brands are your better brands, something like Biosuticals, which you'll get behind the counter at a chemist or health food store where you can ask for it.
[29:17] And then the next one is a garlic supplement. So the garlic supplement is antibacterial, among other things, but also immune enhancing. And as I said, the practitioner strength brands are the best. And then just take them as recommended on the package. But once the severe symptoms have stopped, I would discontinue taking the garlic because that can be quite a, I guess, a harsh tablet to take and can be a little bit irritating to your baby if you take garlic for the long haul. But definitely continue with the vitamin C and the zinc until you are 100% recovered. Zinc is best taken on an empty stomach and the garlic and vitamin C take it with food.
[30:01] Now, because the garlic supplement is sort of a shorter term supplement, if you don't want to go out to the shops and buy garlic supplements, garlic tablets, you may already have some sitting around great go for those if not you can as an alternative chop up a garlic clove and mix that in with manuka honey which is also quite health enhancing and just take that in a teaspoon and down the hatch you don't have to chew it or anything just swallow it like a pill follow it make sure you have food and water with vitamin c and garlic so that they're all in your belly with the food. That can be a helpful garlic supplement alternative. Do that a few times a day for a good solid dose.
[30:48] And my next suggestion with the garlic is don't purchase odorless garlic tablets. Some of the goodies and benefits of garlic are in the odor, fortunately or unfortunately. But you've sent your family away. Nobody wants to be near you anyway. So if you smell like garlic, it doesn't matter.
[31:06] Okay, that's my next suggestion. That is for the boosting of your immune system. And your immune system will be the thing that needs to fight any kind of infective mastitis. The other thing I will say here is it doesn't matter what the cause of the mastitis is, it's absolutely completely safe and actually recommended that you continue
[31:27] to feed your baby as usual. So even if you think that the mastitis is caused by an infection, you don't have to stop feeding your baby as a result.
[31:38] All right, the next thing that happens when you have mastitis is you might feel like you have a really rough flu, and part of that could be a fever. The thing with fever, and this is something that we were, again, I was taught as a naturopath, is that a fever is a natural response from your body. It's an immune response from your body to try and fight whatever bug is in there. Your body's super clever. Your immune system knows what the fastest way is to kill a pathogen, and some of them need to be responded to with a fever. And so if you have a fever, the suggestion would be is to just let the fever run. Have the fever without taking medication to stop it. The reason people stop fevers is that you feel absolutely rubbish when you've got a fever, but hopefully you'll be lying down and sleeping to allow yourself to get through that and the other and other people worry about when your fever gets too high so of course anything more people say that a fever is 37.5 degrees or more and I'd say anything that's over 38 38.5 it is okay if you feel like you need to to treat that with a medication, to bring down the fever.
[33:00] Of course, this is not popular advice. This is the kind of thing in my protocol that I would absolutely not recommend that you do, but we have to know that a fever is your body's way of burning off an infection. It's your immune system trying to help you get better. So if you can leave the fever to run, that could help with a more speedy recovery because you're not dampening down some of the capacity of your body to help fight off whatever's causing the mastitis.
[33:32] Okay, are you feeling already that there's a lot involved in this mastitis protocol? That's why I said it's your full-time job for the next 24 to 48 hours to apply all these things and I can almost guarantee you just from my experience that in 24 hours from doing this protocol, you will start to feel much better and that's just a sign that things are starting to improve. Once you do start to feel better, don't get right back into life and stop all your supplements and keep going. You've got to completely fully recover and then re-emerge into real life when you're 100% better because you don't want to risk reoccurring bouts of mastitis because you haven't properly recovered from the previous bout. Now, if the mastitis is caused by a blockage, it's important to relieve the lump so that the breast can drain. Now, this is where the advice again becomes controversial because the current recommendation is do not empty the breast. However, I'm going to suggest a few little things which does involve emptying the breast, but just hold on a minute, hear me out.
[34:48] Firstly, if you feel a very clear lump that you feel is the absolute root and cause of your mastitis and the breast isn't draining as a result of that lump, it can be helpful to clear the blockage and the lump so that whatever is happening doesn't progress on to a more severe form of mastitis. So identify where the lump is. here again is where the advice a little bit deviates because the advice is ice but in this circumstance where you're trying to relieve a lump and I'm holding my left breast as I speak if you're watching the video you can see it if you're listening I'm holding my left breast, so identify where the lump is.
[35:34] Apply a heat pack as hot as you can tolerate. So it doesn't have to burn your skin, but make it as hot as you can tolerate over the lump for 10 to 15 minutes. If it's inflammatory mastitis, obviously heat can make inflammation worse, but this is just a temporary process that we're going to go through to relieve a lump. So while the heat pack is on, get a comb, a very gentle tooth comb,
[36:04] and gently comb over the lump. Now I'm brushing my left breast. Gently comb over the lump in the direction towards the nipple. So gentle is the important part here because breast tissue is delicate. And if you are too rough and you do deep massage on the lump, you can make inflammation, bruising worse, and sometimes it doesn't do anything. So you could actually exaggerate the problem. So this is just a gentle combing of the breast tissue towards the nipple.
[36:38] And gently comb while the heat is on. I know you can't do it directly over both, but this is also the combing trick can be done. Because after this, I'm going to suggest something else. While you're feeding your baby or draining your breast, you can continue with this little combing action. And something that I have done, if you want to comb with the heat for my own mastitis circumstances, for the times that happened to me, I sat in the bath with the hot jet stream of water directly over the lump and combed gently while the hot jet stream of water was on my breast. And that was something that I did to relieve a blockage back in the day when I fed my babes. But gently combing while the heat is on. And the alternative is like a hot jet stream in the shower or bath and have that blasting on the lump while you do that gentle combing. So this heat application, it's only done in preparation to either feed your baby, and if you're going to feed your baby off the affected side, or in preparation to empty your breast. Now, this emptying of the breast is where there's a bit of controversy, but I'll talk about that.
[37:54] But the idea is to kind of soften the flow of milk through that area so that once the baby feeds and you get a letdown or once you put the pump on and a letdown happens, the flow through that breast is more seamless and hopefully the blockage relieves.
[38:14] It used to be, the recommendation used to be empty, keep the breast empty if you've got mastitis. I'm not saying you should keep your breast empty. I'm suggesting that you effectively empty the breast with mastitis of milk as completely as possible once. One time in this protocol, again, possibly before you go to sleep, is empty the breast of milk. If you can latch your baby to that side and the baby has a really effective feed and then you can feel that your breast is empty that's job done if you can feel that the lump is relieved a little bit and the pain over it is less tender maybe the heat helped maybe the comb helped you can feed and pump whilst also gently combing over that lump then you don't need to do anything else to empty that breast however in my experience and with some clients colleagues and clients of mine they would be having this bout of mastitis they feed the baby they can feel the rest of their breast emptying but this hot burning lumpy area has not drained it's as full and lumpy and as hot as it was before the baby fed so that could be a sign to you that that part that little wedge of your breast is not draining efficiently for some reason. So...
[39:39] You could then attempt only once. Do not repeatedly pump on a breast that has mastitis. It could definitely make things worse and you would increase your milk supply. But draining it the one time is a kind of therapeutic pumping the one time. It shouldn't be a repeated, like I wouldn't do it two or three times in the day. One time while you're trying to recover. and the idea is to start getting milk flow and emptying of that little painful wedge where the mastitis has localized and as I said before continue breastfeeding your baby although this can feel really painful and distressing the worst thing you can do for your mastitis at this time and you know if you're already breastfeeding your baby and things are going well you don't have to stop but it could exacerbate the mastitis if you suddenly stop feeding off it and if you favor pumping over feeding that can also make your mastitis worse. So if you're breastfeeding, continue to feed your baby through your breasts.
[40:45] Could be very uncomfortable and I acknowledge that. I know I've done it myself and I've helped other women work through it. But it is safe for your baby to drink that milk even if it's a result of an infection in your breast. And you can allow the baby to breastfeed anytime on demand. If you are feeding to a schedule while you're recovering from mastitis, I would suggest feeding anytime the baby wakes and is willing to suckle off your breast. Offer the baby a feed at the breast. don't wait to stick to your schedule while you're recovering from mastitis. And early on in my career, actually, some people would suggest positioning the baby with its chin over the sore affected area during a feed, which could lead to some very awkward positioning like babies over a shoulder or in that little weird angled football hold. I don't fixate on that too much, but certainly if you want to try everything, positioning the baby's chin where the lumpy potential mastitis lumpy part is, is something that's been recommended to me in the past by trusted colleagues.
[41:52] Now, once you've done the heat trick, just in order to drain the breast, if you are having a lot of pain in between feeds, you can use an ice pack over the area just to help with symptomatic relief to help manage the discomfort. It. Now, the next thing to do, and this is something that you can actually continue to do, I've had clients who have a history of repeated mastitis and we've used soy or sunflower lecithin granules, it's a tricky word to say.
[42:25] We've used them as prophylactic, like preventative management of mastitis, and they haven't had the reoccurring mastitis that they had in their previous pregnancies. So this is something that you could take daily as a preventative if you have a history of reoccurring mastitis, but certainly something to introduce into your diet while you have mastitis. So, and this is something that's in the new current guidelines is soy or sunflower lecithin granules, and you can buy them at your health food store. About one or two big heap tablespoons the current recommendation is five to ten grams per day so if you have some scales you'll get a visual idea of how much that is but they're these little granules they're fairly tasteless so you can easily add them to food and to your smoothie so maybe on your porridge in the morning or in a smoothie or wherever you want to get it in mix it in with some yogurt and.
[43:24] And it can be incorporated into your diet daily. And again, it can keep going even after the mastitis is gone if you want to. So that's soy or sunflower lecithin granules. Again, you'll see that on the mastitis protocol. If you sign up to the mailing list, you will get this protocol in the podcast resource folder. Okay, here's my next few things. Those things that I just talked about, if you only do those things, That's my original mastitis protocol. And then I've got a few extra, four little extra points that could be helpful to you. This one, so the current breastfeeding mastitis management strategy that's recommended, they suggest that you can use pain relieving medication and anti-inflammatory medication. And if you have a look in the resource folder with the Academy of Breastfeeding Medicine in their protocol number 36, the clinical protocol, they will tell you which medications you can use for the symptomatic relief of mastitis. However, it does include medications that will also reduce your fever when you take them. One of the other effects is that it will reduce your fever. And there are anti-inflammatory medications that can be used in order to reduce the pain.
[44:51] However your body does use inflammation as a healing strategy as well so if you can avoid the anti-inflammatory medications and again this is in direct opposition to the current medical recommendations if you reduce inflammation you might also slow down healing that's my personal feeling about that but.
[45:13] That's the next thing that I'll say. The other thing is, is if it keeps happening, consider that you haven't properly assessed the root cause of your repeat mastitis. And so you need to seek another care provider. If you're already using one and you keep going back and the mastitis keeps coming and they keep giving you whatever they give you and you're using those recommendations and they're not working, you need to find somebody else to help you find the root cause. It shouldn't be reoccurring mastitis, should not keep reoccurring. The other thing you do is there is some pretty good research about ultrasound therapy, which a physiotherapist can actually do, and they do ultrasound therapy over the area. There are some lactation consultants also who've gathered these tools, the ultrasound tools, that they can use to help with mastitis management. That's something that you can use in the moment. So if you feel like you can leave the house and you have a physiotherapist who you know can do this, that's an option. And the other modality that I really love, again, I have a great acupuncturist who will actually come to my house if I ask her to, then acupuncture can be a really helpful remedy for a range of things, including mastitis. Now, that is Mel's postnatal mastitis protocol. I'll run you through it again very quickly.
[46:41] Mel's Mastitis Protocol. As soon as you feel the sudden tiredness and crash of mastitis, it's rest and sleep as a priority. Your full-time job is to try and get better as quickly as possible. That relies on you telling the rest of your family that you are ill and you need the next 24 to 48 hours in bed. You have to hydrate, reduce all restrictive clothing, free your boobies, avoid eating sugar and processed products because they will slow down the healing and contribute to bacterial growth homeopathic phytolacca pills orally probiotic supplements then you want to take some supplements that are going to boost your immune system and reduce inflammation and that's vitamin c zinc and garlic if you do have a fever the next thing in my protocol is to let the fever run without stopping it with medication. Of course, that comes with some caveats. If your fever is way too high or you're feeling absolutely rubbish, you make a decision on that.
[47:45] Again, I spoke about if the mastitis is caused by a blockage, relieving the lump in the breast can help to reduce the chances of progressing to full-blown severe mastitis. And I spoke about the heat and emptying your breast just the once. Everyone's going to get really upset about me talking about emptying the breast just the once. Listen to the full episode again if you're not sure about emptying the breast.
[48:13] Continue to breastfeed your baby you don't have to stop feeding your baby while you have mastitis ice packs can be a really comfortable place if you need symptomatic relief between feeds add the soy or sunflower lecithin granules to your daily diet and then also avoid any anti-inflammatory medication if you can.
[48:39] So these are all things that you can do at home. The rest is one of the really important things and better still, if you can have great postnatal support and adequate rest, hydration and nutrition in the early weeks of your postpartum, you might actually be able to prevent massitis from happening in the first place. Okay, that is Mel's massitis protocol. If you want that all listed out with a little bit of detail, but as a nice summary page, go to melaniethemidwife.com, sign up to the podcast mailing list, and that's where you'll get access to the resource folder for this podcast. I research every episode as thoroughly as I can. As I said, this one is a little bit of a rogue episode because it's just something that I've built and used over the years and it's always worked.
[49:34] But you'll be able to read it all in the resource folder. Print it off if you want to for those big red crosses through the protocol for all the things that you don't agree with.
[49:46] Okay, that's been this week's episode of the Great Birth Rebellion podcast, and I will see you in the next episode. To get access to the resources for each podcast episode, join the mailing list at MelanieTheMidwife.com and to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at TheGreatBirthRebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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