What could go wrong during breastfeeding?

The world is marking the end of this year’s breastfeeding week. The annual event is organised by the World Alliance for Breastfeeding Action (WABA), the World Health Organisation and UNICEF. The guidelines for infant feeding emphasise on initiation of breastfeeding within one hour of birth, exclusive breastfeeding until babies are six months old and continued breastfeeding along with nutritionally adequate and safe complementary foods until age two years old or beyond.

Times have changed

In our traditional setups, a new mum would normally receive enormous support from close relatives including free lessons on breastfeeding. Nowadays, most new mums come home to beautifully decorated nurseries with little or no company at all to guide on matters that seem obvious yet prove difficult for some mothers. It is no surprise that many women often miss the telltale signs when mum and baby do not work in sync during breastfeeding.

Any good breastfeeding baby can make a mother’s breast feel a little tender. While the majority of women enjoy the mother-infant interaction during breastfeeding, some may find themselves battling breastfeeding-related inflammation, otherwise known as mastitis. About one to three per cent of women develop mastitis. Mary Mathenge, a lactation manager at the Aga Khan University Hospital Nairobi describes mastitis as “the inflammation of the breast due to blocked milk ducts and seepage of milk into the surrounding tissues.” The inflammation normally causes breast pain, swelling, soreness and sometimes fever and chills. Although mastitis commonly affects breastfeeding women - lactation mastitis - it also occurs in women who are not breastfeeding, and on rare occasions, men as well. Mastitis can interfere with the mother’s care for her baby, sometimes leading to baby weaning before the appropriate time.

Engorged breast and mastitis

Engorged breasts should not be mistaken for mastitis. “Engorged breasts are usually swollen, hard and painful but the mother does not feel ill,“ says Mary. Engorgement may feel like pockets of hard areas of feeling the whole breast as hard as a rock. Engorgement is addressed by letting the baby breastfeed to empty or expressing the milk for storage. If left unattended, stagnated milk can lead to mastitis. Mastitis on the other hand has to be addressed using antibiotics to wear off. “Almost all drugs the mother takes by mouth will cross into the breast milk,” says Mary. “Breastfeeding mothers should only take medication after consultation with their doctor, who should be made aware she is breastfeeding,” she adds.

Complications

Infected breast tissues can hurt like no period pain ever has. Warning signs that indicate that your mastitis is getting worse include painful, swollen underarm lymph nodes near the affected breast, increased heart rate, fever and a hard, painful lump. Recurrent mastitis often develops from late treatment. If inadequately treated, mastitis can result in a painful collection of pus in the breast, a condition known as breast abscess. An abscess may need surgical drainage to heal. Septicemia, a potentially dangerous condition may occur if a breast abscess is not properly addressed.

Causes        

Clogged milk duct; incomplete emptying during feeding can cause milk to get trapped in the milk ducts, blocking them and possibly causing infection.

Bacteria from the baby’s mouth or skin can gain entry into the breast tissues through cracked nipples or milk duct opening. Clogged milk offers a stagnant breeding ground for the growth and proliferation of such bacteria. This causes breast inflammation. “It causes severe pain, fever and the woman feels ill. Part of the breast is swollen and hard with redness of the overlying skin”, says Mary.

Breast infections mostly occur one to three months after delivery. However, women past menopause or those with a rare form of cancer known as inflammatory carcinoma develop chronic mastitis. Non-lactating women who develop mastitis are most likely to be regular smokers. This is according to research published in the Oxford Academic Journal. Unsanitary nipple piercing may also make one susceptible to breast infection.

Breastfeeding with mastitis

Even though it may feel uncomfortable, breastfeeding with mastitis is safe for the baby.  “It is most important that the baby continues to suckle frequently on the affected breast as this will help the milk to flow”, says Mary. Breastfeeding prevents mastitis from becoming more serious and encourages the let-down reflex. It is unfortunate that some women mistakenly wean their babies after developing mastitis.

Is it time we embraced milk banks?

Exclusive breastfeeding up to six months has been shown to reduce child mortality. When a mother is unable to provide enough milk on her own, the next best substitute is milk donated from other women. Scientists from the Africa Population Health Research Centre in collaboration with PATH and the Ministry of Health established that even though breast milk donation is still a new concept, 80 per cent of survey participants expressed willingness to donate breast milk to a milk bank while 60 per cent said they would feed their babies on donated milk. There are valid fears such as HIV transmission and some cultural beliefs concerning this concept. An effective and safe milk bank would ensure donor screening and that the milk is collected, pasteurised and stored appropriately.