Ep. 129- NEW Mastitis Protocol (Part 1): For Healthcare Providers

Transcript:

Ep 129 – NEW Mastitis Protocol (Part 1): For Healthcare Providers

This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way. So join us for another episode.

Welcome everybody. I’m very excited for this episode today. It is much needed. I don’t know if you know this, but the Academy of Breastfeeding Medicine, which is kind of like our holy organization that we look up to, for all of the latest and greatest evidence based lactation tidbits, has just replaced one of the biggest, most questioned, most important protocols. 

Yeah. They actually have now retired two protocols in place for this one. So protocols 4 and 20, which are engorgement and mastitis are now gone, and they’re all lumped together with this brand new information that turns everything on its head in protocol 36.

Mm. So today we’re talking about mastitis, engorgement, clogged ducts and poor reviews about what was available before. Yeah. So I don’t know exactly how we are gonna approach this, cuz this episode is basically gonna make our old episodes on clog ducts and mastitis kind of useless. But it’s okay. We’ll, we’ll get through it guys.

So this is a big one, and I think it’s important to talk about kind of the nerdy science stuff, as well as how the actual, like treatment protocols have changed. So we’re gonna do this in two parts. Yeah, part one, we’re gonna be talking directly to healthcare providers and we’re gonna be using the bigger words, talking about biofilms and how, why, and where this is all happening in your breast.

So if you’re a parent who’s lactating, don’t tune out or anything. Know that there’s gonna be an episode more directly targeting what to do about it at home, what this means for you, interventions that the internet tells you to do, that you definitely should stop doing you know, but still listen in.

And also you can send it to your provider. So if you end up with mastitis and you’re not sure if they’re up to date on the latest protocol, you can ask them, Hey, have you listened to the Milk Minute Podcast? And you can send them this episode kindly and gently and respectfully. Yeah, and I’m gonna say listening to these episodes is probably gonna take less time than reading the 20 page protocol.

It’s a big one. And, and I think it’s, I think everybody should listen because this, like, it changes our understanding of what’s happening in your boobs. And you should know that as a boob owner, you know? Yeah. I’m the boss of these boobs and I wanna know what’s happening on the ground level. Okay. But before we get into a fun episode about physiology, we do have some patrons to thank, we have a question, so let’s hit those.

Okay, so today I would love to thank Blair from Indiana, Pennsylvania, and Erin Key. Thank you so much for becoming patrons of the Milk Minute podcast and supporting this project to make sure everybody has access to episodes like this on mastitis. So regular people don’t have to go read a 20 page protocol online.

It’s very confusing. Yeah. Okay. Thank you so much guys. We really appreciate it. We’re gonna take just one minute to talk about one of our sponsors today, and then we’ll be right back.

All right. It’s Maureen here, and I want to tell you that I have finally set up a link so you can instantly book virtual lactation consults with me. Oh, thank the Lord. I know, Heather. It took me a long time to take the leap from in person visits to virtual, but I did it. You’re gonna love it. I love doing virtual consults.

They are the best. It serves more people. I’m so glad you took the plunge. Thank you. And if you guys out there wanna book some time with me, you can go to HighlandBirthSupport.com and then click on my lactation services tab. Is that H I G H L A N D? Yes. Okay. I will see you on Zoom, everybody.

So today I pulled a question from TikTok. We actually get a lot of questions there. This one is from Mimi Capri three, and they ask, Can you actually get rid of an oversupply? I have one breast that produces way more, almost too much, and I want it to be even with the other. Okay, Let me tell you about this.

Number one, yes you can. But I have had a couple of patients recently that are just natural over suppliers that don’t even pump. I kid you not, they just make a lot of milk and so when they do regular feed on one, feed on the other, feed on one feed on the other, they end up with an oversupply and they have to block feed, which means they’ll do the same breast for two feedings in a row and then switch to the other breast for two feedings in a row.

And that’s just what they have to do forever. Yeah, and you know, I, it sounds, when, you know, when you first start thinking about it, you’re like, Wow, it’s gonna change everything. But it’s really no different than if you’re like a one boob feeder or a two boob feeder, right? You’re just kind of like half boob, feeder and you can totally get used to it and totally get in that rhythm. But if you want some more specific recommendations for how to do that, Episode 87 of our podcast is like very specifically about oversupply. And then there’s one, just a couple episodes before more about regulation and changing supply.

And also, let me tell you, I have another patient who only nurses on one breast. The other breast does not produce milk. And the one breast she has is an over supplier. Yeah. And so, and of course there’s pumping involved in that case because she felt uncomfortable. Sure. So she pumped to make herself feel comfortable.

And now it was just this, like she’s got one boob that’s like giant and the other boob that produces nothing, which is a little smaller. And she’s like, My goal is to downregulate for comfort, to be able to leave my home without bringing my pump with me or stressing that my pump is not charged. Mm-hmm.

And also I’d like to cosmetically even out my breast a little bit for the remainder of my breastfeeding journey. Yeah. And I was like, all of those goals are legit. I can help you with that. And really the good news is, oversupply usually doesn’t take months and months to resolve. Yeah. If you’re working with a trained professional, you can do it safely and efficiently.

Usually, I would say within a couple of weeks, give or take, depending on the severity of the issue. Yeah, and don’t forget if you guys need help with that or really interpreting any of the large guidelines we talk about here to a personal level, we both offer private consultation. Yeah. The links to book with us are always in the show notes of every single episode.

So you can either click on it and book yourself or send it to a friend. Yeah. And I just before we talk about mastitis, I have to say big win for me because you just talked about pumping. I’m not pumping when I leave the house anymore. Yay. So sorry guys. We’re done with pump review episodes. I still like leave a pump in the car just in case.

But if I’m uncomfortable and I have to pump, I just like dump it in my coffee because Lyra doesn’t drink pumped milk anymore. Why do you think she quit? I don’t know. But you know, Ivan had tried to feed her some the other day and he was like, Whoa, it’s super lipase-y. And I was like, Well that’s weird cuz it really hasn’t been so far.

But we know that can change. Mm-hmm and yeah, it had been sitting in the freezer for a while, but like, not that long. Not like longer than other milk I had fed her, you know? Mm. It’s interesting. That is interesting. I don’t know if she, that she doesn’t like the flavor, but like she kinda weaned herself off bottles.

She doesn’t, doesn’t really want them anymore. She’s gonna lob it up there for you and you just have to take it and smack it out of the park. Honestly, like she just knows what she wants and doesn’t want. Hmm. Sounds like somebody I know. And it’s fine. You know, she’s old enough that she doesn’t need milk when I’m gone.

My body has adjusted mostly to like an kind of haphazard feeding schedule. Like I really don’t feel like I have to pump unless I’ve been gone like eight hours or something. Mm-hmm. Well that’s great. Yeah. That’s good stuff, man. Good for you. Yeah. And we’re still nursing at home, actually. We were down to like twice a day.

Then do you know what happened? What? Everybody got covid. Oh yeah. And she nursed like a fucking newborn and, and oh man, we got better, but who’s still nursing like a newborn when I’m home. Oh, that’s really rough. Any of you guys that are out there with covid and newborns, my heart goes out to ya, because any progress that you made on weaning usually gets completely chewed up, no pun intended.

Yeah, it was pretty wild and like, Griffin got sick first and we like knew, you know, he had a friend over the next day, they were like, Oh no, she’s got Covid. And we’re like, Ugh. We’re in for it. Mm-hmm. and I came home from work and he was asleep on the couch and I was like, No, because he is like a hyper kid.

Yeah. If he is asleep before bedtime, he’s sick. Yeah. Same with Theo. And then the next day he woke up sick, and then the next day Lyra got really sick, but they were each sick for like 12 hours, you know, in the way that kids are. And then totally fine and bouncing off the walls. And then Ivan and I got really sick for a few days.

I hate it. Yeah, I think everyone’s at this point now with Covid where it’s like, now we’re angry. Well, yeah. And now it’s like we had to be out of work for a while because of quarantine protocols and everything. And I can’t just like go to the DHHR website and be like, Oh no, I missed work. And they’re like, Here’s a lot of money like they did in 2020. 

Now they’re like, I’m sorry, we discontinued that program. Yeah, things have changed. They’re like, Covid is now more like a lifestyle virus now, so we’re just not going to support you anymore. Yeah. It’s just your fault if you got it right. Did you wear a mask? Yeah, I’m, anyway, I’m so over it.

It like, basically we’re like just barely recovering from it now, and it was like a month ago. Oh yeah. Yeah. It hits you pretty hard. Yeah. Well anyway, so that’s still happening in the world. Mm-hmm. Well, I guess my update is that I am nervously looking for a bigger office. Ooh. Which I can’t even believe cuz I feel like we just moved into this one.

Yeah. You’ve been here a while. Yeah. Crazy. I guess my, my lease will be a year in November that we’ve been here, but I’m bringing on two more consultants and that’s very exciting. And yeah. So Breastfeeding for Busy Moms is gonna hopefully be getting a bigger office. Maybe we’re buying a building and renovating it.

Maybe I’m gonna be renting. Who the heck knows? Open to the possibilities. I’m open to anything. So this is me putting it out to the universe. If you have a nice, homey, anti-corporate feeling office that you have available for lease pretty soon, holler at me. Yeah, I need 3-4 offices with hopefully two common rooms that I can use for education and postpartum support groups.

A kitchenette and a private bathroom. Mm-hmm. So that’s what I need. That’s what I want. Please, universe, give it to me. Thank you so much. Yeah. And if you’re listening out there in the greater Morgantown area and you’re like, Oh my God, I have that, please let us know. Yeah, holler. Oh, and also maybe a little space for recording that isn’t super loud.

Yeah. Not like next to a neighbor with a loud refrigerator. Yeah, it’s fine. It’s all good. It’s okay. Okay. So listen, let’s talk about what we’ve been doing with mastitis. Yeah. And what we’re gonna be doing now. Yeah. So can you recap for us what before we read this, our understanding was pretty basic.

So here’s the basic understanding of what the internet will probably still tell you if you end up down a rabbit hole of Googling, I have a hard spot on my breast question mark? So this is probably what’ll come up and most of it is antiquated at this point, just fyi. 

So it used to be a thing that we thought that you would either be more prone to “plugs,” quote unquote, in your milk. So a plug duct. And then because the plug would create milk stasis, the milk, which is very high in sugar, would mix with some of the bacteria in your breasts, like the natural bacteria, mostly like staph on our skin, right? Or it would like invade through a nipple wound, right?

Or you know, you have nipple wounds and we’re at the hospital and we’re afraid that, you know, if we for example, if we have dirty hands from the hospital and we touch a nipple wound, that that bacteria is going to travel back into the duct and it’s going to create plugs and it’s going to, you know, the infection is gonna get stuck behind the plug and cause the streaking. 

The redness, the malaise, the fever, and it, it gets really bad. So the recommendation from everyone was remove the plug. Right? So we’re massaging aggressively, we’re using hot compresses, we’re doing Epsom salt soaks with haakaa, we’re like grinding on it with electric toothbrushes and, and pumping, pumping, pumping, and pumping.

We’re pumping and we’re pumping and we’re pumping. And we’re staying away from ibuprofen because we don’t wanna mask a fever if it does happen, because that’s the only way we know if it’s turned bacterial or not, you know? So that’s stressful. Yeah. For someone that keeps repeatedly getting plugged ducts.

Well guess what, everybody? Let’s just turn literally all of that absolutely upside down and around. Take what you know about mastitis and throw it out the window. We knew nothing, apparently. So in the past we’ve been like, Okay, mastitis is a breast infection, antibiotics, great. Now recent research is showing us that infection is just like one tiny step along the possible spectrum of mastitis, which we are now defining as inflammation of the mammary gland, whether or not there’s a bacterial infection.

But that is one of the possible outcomes from this inflammation. So we kind of already knew this part. Most of the time we get mastitis because we have an oversupply, or what we term as hyper lactation. However, one of the new pieces of the puzzle that we’re just learning is actually shocking, right? That the bacteria in your body plays a big role and dysbiosis or kind of like not the right balance of natural bacteria plays a huge role in this.

And you know, like when you say that you’re kind of like oh, duh. Cuz that makes a difference everywhere. But of course, who thought to look in the breast biome? I mean, and I think until when, Right? Last year? I would say, I’d venture to say that everyone has probably had a yeast infection in their vagina at some point in time.

And they remember that feeling of wanting to take a round brush and shove it up and down there and scratch. Okay, it’s the worst. And it’s like, oh, the way we explain a yeast infection is we have a dysbiotic right situation where some bacteria gets out of control and the other good bacteria can’t keep the bad bacteria under control.

So take what you know about a yeast infection and then stick it in your milk ducts. Okay. And then use that frame to think about all of these other things we’re gonna talk about today. Yeah. And dysbiosis is multifaceted, and when I say that, I mean we don’t get it, you know, we have just barely scratched the surface of the human microbiome.

And as we did that, we were like, Oh, we just found out all the problems you might have because we don’t even understand what the norm is. Can I just say that? So it, it’s by saying it’s a multifaceted issue, quote. It’s kind of like ABM saying like, we don’t get it but we know it’s a problem. So some of the things that can influence this, and I wanna mention them.

Genetics, other medical conditions, medications you’re on, antibiotics you’ve taken, probiotics you’ve taken, breast pump use, whether or not you had a vaginal or a cesarean birth, all of those are factors in your microbiome. So it’s not like this is your fault because you didn’t take the right probiotics.

No, no, this is very complicated and there’s not like one thing that you did wrong that you are a dysbiotic booby, you know? And also that means that we have some clue how to address this, but we don’t really have all, it’s not like a black and white issue, right? It, it’s not. But we do have a pretty solid algorithm to work from now.

Yeah. So they’ve put together, I, I think it’s pretty easy to understand as a lactation professional, but we’re gonna try to break it down a little bit here. So we’re starting at the top. We gotta find the root of the issue, which is typically hyper lactation or oversupply. So if you’re not sure if you have an oversupply or not, go back to our oversupply episode linked in the show notes and try to figure out if that’s you.

Okay. Cause especially if you’re repeatedly getting quote unquote plugged ducts. Okay? So, We have hyper lactation, plus or minus the dysbiosis. So you don’t have to have oversupply. But if you’re a person that keeps repeatedly getting hard areas on your breast that are painful mm-hmm, and you’ve been treated and treated and treated with antibiotics, you’re dysbiotic.

Yeah. If you’ve had several courses of antibiotics in a row for plugged ducts, you are dysbiotic period. Absolutely. I mean, you could even be set up for that just from routine antibiotics after your birth. Right. So all of that creates inflammation. Okay. And we have these ducts, everybody has a different amount of ducts in their breast, but when we have inflammation, it makes everything inflamed, which makes things tighter.

And we have ductal narrowing. Yeah, and, and you know, that’s just like it’s caused by swelling. Right by fluid gathering, by poor lymphatic drainage, by an increase in blood flow to the area. Just, it’s a literal, like physical problem where the tissues around the duct swell and then kind of close it off.

And this is one of the groundbreaking parts of this paper is that in the past when we talk about clogged ducts, people are like, Oh, well it’s, you know, maybe it’s just some congealed milk and it’s stuck in there and we just have to get it out. Or, you know, blah, blah, blah. Or, you know, and, and now we’re like, Oh, it’s just inflammation, basically.

There’s a little bit more to it, but that changes what we do. Yeah. Or you know, the old adage of you just make fatty milk and you keep getting clumps of fat stuck in your duct. Right. Which is like, it such a weird thing to say to people cuz they’re like, well it’s kind of your fault, but you can’t do anything about it.

No. You got high cholesterol and fatty milk. Yeah, it’s, that’s why you’re plugging up Becky. A lot of weird things we’ve heard people say to breastfeeding parents. Mm-hmm. I can’t with it. Mm-hmm. So when we have this inflammation and the swelling of the ducts there’s a few things that can happen as a result of that, cuz the body is going to do what it needs to do to remedy the situation.

So in one situation, it’ll completely wall off. Yeah. And create a little galactocele. So imagine it seals it off into like a nice little round mobile, sometimes painful, sometimes painless, lump in a circle. And it’s usually a lot of times near the nipple, right? And it, and a galactocele basically ends up looking in the body like a cyst, but full of milk.

Mm-hmm. Yeah. And you can diagnose that on ultrasound. Yeah. And then sometimes it gets infected. Yeah. And, and so really with mastitis on this new spectrum as we’re calling it, first we have that hyper lactation, dysbiosis, ductal narrowing. And then the next step is usually inflammatory mastitis. And this is most of the cases. 

Where we have the inflammation and actually, you know, that comes with the systemic symptoms without bacterial infection, so we can still have fever and chills and tachycardia. Okay, because that is a systemic inflammatory response. But not a response to the infection. So now we’ve realized that it, since we prescribed antibiotics to everybody who had a fever with mastitis, we have made a big mistake.

Oops. Cause now you’re dysbiotic. Oh, yeah. And, and creating resistant strains of bacteria, . Right. And setting people up for recurrent mastitis. Right. And then do you wanna talk about the phlegmon? Yeah, I, I, I do, I can talk about this. Or is it phlegmon? I have been calling it phlegmon. Phlegmon. That sounds like a guy I knew in college.

I, I just feel like that’s not the way you say this, but I’m gonna roll with it, with all the confidence. Okay. Okay. So sometimes. In this process instead of a galactocele and instead of bacterial mastitis, we get this phlegmon, okay? And that is kind of like a complex ill-defined fluid collection, right?

It can occur anywhere in your body, but that excessive deep tissue massage actually makes this worse. Because it’s part of that, like sequela of edema essentially. And that massage can cause microvascular injury, make more fluid collect. Phlegmon should be suspected if we’ve got a history of mastitis that keeps worsening into those like really firm masses, especially if it doesn’t change with antibiotics.

So again, we have to confirm via ultrasound these can become infected. They can become part of bacterial mastitis, but don’t necessarily have to involve that pathogenic bacteria, but we do know that the next step after phlegmon, if you continue to aggressively massage it, and you don’t treat it, it turns into an abscess.

Yeah. And that is no good. Yeah, now we have something that’s like eating through cell walls and it’s continuing to get bigger and bigger and bigger, and those have to be drained and packed and we definitely have to have antibiotics. But can I say the treatment for those galactoceles has changed.

Say it. Yeah. So I was getting go into more in the next episode, but now they’re saying yes, we probably have to aspirate them, but you need to put a drain in a gravity drain because that repeated aspiration causes more problems. Yeah. Shocker. I know like if you stick a needle into your boob 20 times. Yeah.

So instead for most of these cases where we have a large abscess or a larger galactocele, we should be putting in a drain. Mm-hmm. That is not a vacuum drain, a gravity drain. Mm-hmm. Not a vacuum drain? No. Hmm. Yeah. Why? I guess there’s so much pressure in the breast anyway. I have it written. It could probably create more inflammation to have a vacuum.

I bet. Yeah. I think that’s it. Okay. Yeah, so that’s really interesting. But that’s like why this physiology is so important, right? Because it informs how we treat the pathology so that we can return to the normal physiology. Yeah, I mean I guess like one of the biggest things about all of this is just that the research is showing us that actual infection is one of the last steps on this mastitis spectrum.

So yeah, but a lot of people get to that. Right? Cause it happens quick. I will say. It can happen quickly, but now that we know that a fever is not actually a positive sign of infection from mastitis, maybe not as fast as we thought. So now we’re looking at waiting about 24 hours to see if those at home treatment stuff works before even thinking about antibiotics.

But if we progress from the narrowing to inflammation to bacterial mastitis, so now we know that that is a part of a dysbiosis, right? Where we have harmful bacteria that’s actually causing a blockage. So your milk ducts are lined with good bacteria and usually they leave enough room for milk to go through. When you have harmful bacteria that is now growing at this like exponential rate, it can create a biofilm that actually blocks that duct off.

And that’s a lot of what happens when we see those milk blebs. And then we have that epithelial cell response that’s like proliferating over the top to try and compensate as part of this inflammatory response. And that like totally covers the nipple. So common organisms that we’re seeing are mostly staph and strep, right?

Staph aureus, staff epidermis, et cetera. And the interesting thing that I’m not totally sure what they’re saying, but I have an idea. This protocol said there is zero evidence of what they say is quote candida mastitis. And I’m like, Are you talking about thrush? They are. They are. Yeah. So this has been very interesting for me because I’m not sure that I can, I’m not, not mentally ready to jump on board clinically from what I’ve seen in practice.

Mm-hmm. So, and you having had an actual serious yeast infection, potentially. Potentially. But antifungal did not work. Right. So they’re saying here that actually when you swab the nipple and you take milk cultures from people that have been diagnosed with thrush, we actually find, and I, I’m pulling this out of the air, but it’s a very small percentage that are actually positive for candida.

It’s mostly staph. It’s mostly staph, which would put it in the bacterial group, which would lump it in with mastitis. But one of the interesting things is that antibiotics and antifungals are often anti-inflammatory. Yep. So sometimes even if we don’t have a bacterial infection or we don’t have a fungal infection, but we’ve prescribed these things, they work to an extent because they reduce inflammation.

So it’s given us like a false sense of success. Well, same thing with respiratory viruses. Yeah. That people take antibiotics for and they’re like, Yeah, but I can breathe finally. And it’s like, Yep, there’s an anti-inflammatory property in antibiotics. It does the same thing. Yeah. And now we have, you know, they’ve come out and said at ABM that there is exactly zero studies that show true causation between nipple trauma and mastitis.

You know, we used to say like, Oh, harmful bacteria is like on your skin, and then it travels up in through the wound. Apparently we have no evidence of that, but since we’ve examined the composition of the human milk microbiome, now we’re seeing that it is a dysbiosis of bacteria that’s already in there versus foreign bacteria.

Well, and I would argue that the majority of people are starting out dysbiotic because of the 40% of people positive for GBS that get treated with antibiotics in labor every four hours. And also the staggering amount of C-sections that we have in this country where you get prophylactic antibiotics in the OR.

Sure. So we’re starting out dysbiotic to begin with, which is why I think I lean more towards, there could be yeast, somewhere. Yeah, and we just don’t know that. We don’t have evidence for it. Thankfully with all this new information, we’re still maintaining that bacterial mastitis is not contagious. It does not pose a risk to the infant, and it does not require an interruption in breastfeeding.

Which we still have doctors telling people, and that is like 30 year old misinformation. Right? I mean, I literally last week had somebody call me and say they were dumping milk because they had mastitis. And I was like, Oh no, here’s what I got the other week. They’re dumping milk because of the mastitis, but they didn’t mind because they had 500 ounces in the freezer.

And you’re like, and I’m like, That’s why we have mastitis. We probably have an oversupply. Exactly. Yeah. So it’s really like when you, if and when this happens to you that you get a hard spot with pain on one side of your breast, or both, please call a lactation professional. Yeah, immediately. Not your doctor, unless they’re a breastfeeding physician.

What we’re recommending now is that medical professionals should wait 24 hours to see if the at home stuff works. Because seeing them before that really leads to a much higher rate of overuse of antibiotics. Right. And I’ve actually, so a lot of the people that I work with get these symptoms when they’re traveling.

Mm-hmm. Over the holidays, on nights and weekends because your schedule changes. They’re putting off feeds. I mean, your diet changes. Your diet changes. Exactly. Your sleep changes and your immune system is compromised and all of those things contribute to inflammation. Right, Exactly. Maybe you’re eating all those pro-inflammatory foods cuz you’re like out at a steakhouse every night cuz you’re on vacation.

You know when you don’t sleep, we know you have more inflammation so. It’s really the perfect storm when we change anything about our daily schedules especially if you’re already at that baseline dysbiosis or hyper lactation. Now, I think this is really important information for those who get recurrent mastitis and I’m kind of like, need to apologize because we have given incorrect information to people for years.

I mean, we didn’t know it was incorrect, but and I feel like they’re the people we’ve done the greatest disservice to the people who call like once a month with a clogged duct or with mastitis, you know? And it turns out we don’t have any agreed upon definition for recurrent mastitis. But in my opinion, if you get it more than once, it’s recurrent.

I don’t think anybody should be getting it more than once. I don’t think anybody should be getting it at all. Yeah, it’s very weird. Can you imagine if this was a problem that happened in your brain? Yeah. You know, or like even in your uterus? If you know like, oh, you know, once every couple of months I get this crazy huge abscess like cluster of fluid that results in pain and people would be freaking out.

I mean, it does happen to a lot of people, like on their ovaries and stuff like that. Well, I know, but like we can see it and it’s affecting the nutrition of another human being. Oh yeah. Like, that’s crazy. And we kind of blow it off, like, Oh, that’s just part of breastfeeding. No. Yeah, it’s, it’s really tough. But I did wanna mention that despite the fact that this paper didn’t have a lot of great information for those who suffer with recurrent mastitis, it did identify some risk factors that we can then like look out for.

So people who have had really early inflammatory mastitis, so like the first few weeks. People who suffer with hyper lactation, especially if it’s like on and off, it comes and goes dysbiosis. I don’t know how we’d exactly identify that for a lot of people. Well, I think there’s certain risks that put you, you know, for dysbiosis like we had talked about before, like any hospital birth where they’ve touched you at all, basically.

Yeah. As far as like interventions and medication, Right. Antibiotics. Lack of sleep. But yeah, people who have had inadequate treatment before, especially if you like, didn’t take your complete course of antibiotics and basically if you’ve had mastitis, but you never had anyone help you address the cause, right?

You got antibiotics, it was fine, but you still have an oversupply, you still have dysbiosis, whatever. You’re at a risk for that.

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And they remind you when you’re eligible for free replacement parts. Yep. So when you’re tired in your postpartum period and you’re wondering why your pump isn’t working as well, you might get a text that says, Did you know you need replacement parts? And you say, I did not know that. Right. You push a button and boom; they show up at your door.

Thanks, Aeroflow. Thank you so much. Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.

So Maureen, Okay. What people really wanna know is, all right, so a fever isn’t the defining symptom to know that it’s gone bacterial. So, you know, I’ve got fever, I’ve got malaise, I’ve got chills. I’ve got a hard spot that’s painful and maybe even a decrease in milk supply. So I’ve pumped on that side. I usually get four ounces, I get two. 

How do I know if I have moved into the bacterial mastitis space from just the inflammatory space? Yeah. Our guidance on that, there’s not a definitive answer, but if you’ve had those symptoms for 24 hours and they have not improved at all with at home treatment, that’s when we need to introduce antibiotics, and the guidance still is not to culture milk at that point.

We might do it later. I would imagine if we had universal insurance coverage, the guidance would probably be to just culture milk then, but it’s not. It’s just, anyway, that’s frustrating. But essentially that’s it. It’s like if you do everything right, and you know, it’s not bacterial, it should pass within 24 hours.

So that’s good though. I actually like that better, yeah, that it’s like a timeframe because people can usually suffer through anything if there’s an end point. Well, and honestly, so many people end up managing it at home for that long anyway, cuz it’s always a freaking Saturday night. You know, and it’s always that like they’re like, Oh, should I go to the ER? Wait till Monday?

So you don’t have to feel bad now about doing that, cuz that’s actually now part of, you know, how we’re gonna move forward here. One thing I wanted to mention. So you know how we see in our like Facebook group all the time and like people send us pictures when they’ve like quote, like resolved a clog and they have like a little goo and they’re like, Look, there it is.

Mm-hmm, that’s a biofilm. So gross. I mean, it’s actually cool. I think it’s, there’s gotta be milk in it too. Yeah, yeah, of course. Right? Because there was milk up against the biofilm. But the reason that that is like coagulated milk. Yeah. Essentially is bacteria. It’s like when you poop, and you have a long string of mucus in there.

It’s not poop mucus, it’s actually the lining of your intestines that is sloughing off. Yeah. Much like the lining of this bacteria that creates this gross biofilm that’s actually really hard to penetrate. Yeah. I mean, and that’s exactly it. Like usually our ducts have a biofilm just in like a tubular fashion.

Right. And milk passes through, but when we have that dysbiosis, that staph and strep that are just happy in your boobies instead go bananas and over proliferate and make these really thick biofilms. And then some people manage to shoot them out into a pump and they’re like, Oh my God, what just came out?

Cleared my clog, all I did was use a vibrator and my husband used his elbow to rolf my side of my boob. And it’s like, no. And then I used the haakaa, I flipped it inside out to get maximum suction and it came right out. And I feel so much better. And I totally get how that feels better. And you’re moving milk, but at that point you’ve contributed to inflammation.

Yeah. Then you’re gonna get another one. Yeah. So it’s, it’s a really tricky thing and it’s gonna be hard to implement this like among the general public because that sort of treatment like seems to work short term. So it’s gonna be hard then to kind of move people to a treatment that maybe takes a little bit longer to work, works more thoroughly, right.

But maybe doesn’t give that immediate relief. Well, and I think the thing is, it feels like something stuck in there. Yes. And I mean, it is, but that’s not the cause of the problem. And if you don’t remove it, your body will absorb it ideally or wall off, like Yeah, totally. We’re hoping for absorption. When it gets walled off is when things get weird.

Yeah. And you know, I’m, I’m really excited to come back next week and just talk about how treatments have changed and like much more detail about what we need to stop doing and what we should do instead. Okay, so Maureen, if we have strep all over us all the time, you know, we’ve got these bacteria that aren’t necessarily great, they’re pathogenic bacteria that just kind of hang out inside of our lumens.

Why when we get dysbiotic does just one section or like one wedge end up inflamed and, you know, in, you know, inflammatory mastitis, but not necessarily bacterial. Why one section and not systemically the entire breast, or even both breasts? Right, I mean, sometimes we do have this kind of classic presentation of mastitis that looks like you have like a slice of pizza on your boob that’s really upset and that is because of the specific kind of bacteria that’s responsible then for the bacterial mastitis.

So, obviously there are many, many, many, many kinds of bacteria present in your body all the time, so some of them produce toxins. Right? When they proliferate to a certain population. When those toxins are present, then we have that like systemic immune response, right? That’s often what your immune system is responding to is then like these toxins kind of circulating through your body.

However, sometimes there are very, these two specific strains that under normal circumstances form the thin biofilms that we just talked about. So there’s this like coagulates, negative staph and this specific kind of strep. They’re not harmful, they’re normal, whatever. They line the epithelium of your mammary ducts and they allow for normal milk flow.

But when there’s dysbiosis, those particular species form those really thick biofilms that cause the quote plugged ducts. Okay? And they just cause that localized inflammation. They don’t produce the toxins that are responsible for the acute bacterial mastitis. Mm, gotcha. Right. So the systemic symptoms in that case are uncommon and the local symptoms are pretty mild.

So I think that would be then all those cases we’ve seen where like, Oh, just a plugged duct. We’ll solve it. Oh yeah. Right. Versus when we have people come in and they’re like shaking and they have a fever and their whole boob is red. That’s just like a different bacteria issue. Got it. Yeah. 

That’s really good to know though. Without, and maybe that’s why we also don’t need to culture as much milk. Exactly. It’s really interesting. And I think that’s most likely the case when people report nipple blebs as well. We don’t have like, obviously great studies cuz like, you know, nipple blebs are pretty short lived for people. Yeah.

But they’re painful and they are a sign of inflammation in the duct. So if you have just a nipple bleb, assume there’s inflammation behind it and do a lot of self-care. Yeah. And I just wanna be clear about the blebs. The reason it looks like skin has grown over your nipple pores is because it has. You know, your epithelial cells are responding to this inflammation and they’re like, Ah, what do we do?

I guess we’ll just cover it up. Thanks. How about a skin blanket? Yeah, so, you know, they’re just trying to fix the problem. They’re not doing a very good job, but we can help and we will tell you how next week. Tune in next week, folks. For all of you recurrent pluggers and mastitis and over suppliers and anyone who’s pregnant.

And you tell your lactation professional that your worst fear is mastitis because you’ve seen some terrifying things on the internet. Sure. I can’t tell you how many prenatals I’ve done where I’m like, Okay, tell me about your number one fear. And they’re like, mastitis and losing my entire boob. And I’m like, Okay, you’re like, reasonable, probably won’t happen, but I get why that’s scary.

I understand. So we’re talking to all of you out there and also healthcare professionals get ready to change the way we treat all of these symptoms. Yay. Okay. Well before we go, we have an award to give out! And an email. And an email.

Do you have a baby that struggles with excessive gas, fussiness, colic, and general sleep problems? Well, I did, but then I used Evivo probiotics. Evivo is a pediatrician approved probiotic for babies that’s even used in NICU on the gentlest tummies all over the United States. It is an amazing, unique product that contains a specific strain of B. infantis that we need to digest human milk oligosaccharides. 

That’s actually 15% of breast milk that your baby will then be able to utilize whereas if you don’t have the bacteria, there’s so much extra in the gut, which is why American babies poop like 10 times a day more than babies that are colonized with B. infantis. I have personally seen this probiotic help my baby and the babies of many of my clients.

And frankly, if we’re dealing with any of these symptoms, it is the first thing I go to. And the best part is it’s not like any other probiotic that we would take when we’re sick or taking antibiotics where you take it every time you go through antibiotics for the rest of your life. If you give your baby Evivo in the first a hundred days of life, it actually colonizes in their gut and becomes a part of their immune system, which then they can pass to the next generation.

And this is how we make change, y’all. Evivo is amazing because it’s gonna safeguard your baby’s health today and give you peace of mind in the future. Check out Evivo probiotics through the link in our show notes and enter code MILKMINUTE for $10 off.

All right. Today’s award in the alcove goes to Andrea from Seattle. Andrea says, Last weekend, I traveled to my cousin’s wedding WITHOUT MY BABY in all caps. This was the first time in his 17 months of life I’ve gone somewhere without him for an extended period of time. I was worried he and or I would just cry the whole time.

But we both did great. I pumped just enough for comfort and didn’t have any clogged ducts, and when I came back, we celebrated with a two hour nursing session. He’s definitely a little more clingy this week, but my supply has bounced right back and I’m so happy that our nursing relationship didn’t suffer. Aw, that’s so sweet.

Yeah. And also a great testament to all those people who are at a year mark. Yes. Or, or earlier who are like, How can I maintain this? You know, you’ll get there, you’ll get there. You know, this baby’s 17 months old and her supply just went up and down and all around and did whatever they wanted to do. So freedom is within your grasp.

All right. What should we give her? I think that Andrea, you deserve the Valiant Voyager Award. Oh, I love that. Yes. The Valiant Voyager Award and we will put a photo of her on our Instagram story for the day. So please show Andrea from Seattle some love for us. All right. Now before we go, I wanna read an email from one of our listeners cuz they’re so sweet and I love them so much.

Okay, this one says, Hi girls. I’m currently nine weeks pregnant with my first baby and stumbled onto your content via TikTok. A video of Maureen talking about the number of people who choose to breastfeed versus those who are actually successful, and how massive the gap between them is. In that moment I realized that if I was going to successfully breastfeed, I needed to start educating myself.

Hell yes. I’m already on episode six of the Milk Minute Podcast, and I cannot thank you both enough for providing this free resource. My husband is listening as well, and we feel so empowered to know that we will properly be able to advocate for our family in the hospital setting. I wasn’t aware of the anxiety I had until questions and fears started getting replaced with facts, evidence, and positive and effective strategies for attaining the birth we plan and hope for. 

Thank you from the bottom of my heart. Hannah, from Michigan. Oh, Hannah, I love that one so much. Hannah and husband, Hannah’s husband! Snaps for you for listening as well. Thank you so much. I might cry a little bit. I know. Oh my God. They’re empowered at their birth in a hospital setting.

Hell yeah. I’m also like, Oh yeah, that was a good TikTok video. Maureen crushes TikTok. If you guys don’t follow her, I mean us. I’m on there once every 500 videos, but it’s okay. I have other gifts. It’s fine. You don’t have to TikTok. I will not force you to. Okay, good. Cause you’d be sorely disappointed. I would.

I know. I know my battles that I need to pick. This is not one, it’s fine. All right, guys. Well, we hope that that kind of explained our new thinking about mastitis and this new lens that we’re looking through to diagnose it. Please tune in next week for how we’re going to treat it, how the protocols have changed, and what this means for you at home as the boob owner.

Thank you for tuning into another episode of the Milk Minute. How we change this big system that’s not designed for you and me is by educating ourselves and others. If you found value in the episode we produced for you today, please head over to our Patreon and become a V I P patron so you can get early and ad free access to episodes and cool merch that’s exclusive just to you.

And really fun personal videos and anecdotes from Maureen and I any time of day. Okay. Thank you so much guys, and we will see you next week. Toodaloo.

Sources:

Academy of Breastfeeding Medicine Clinical Protocol #36:
The Mastitis Spectrum, Revised 2022