Breast Care During Postpartum

In the fall of 2022, the Academy of Breastfeeding Medicine issued an updated protocol for treatment of mastitis and other breastfeeding complications. It changed the previous guidance on how we treat plugged ducts and mastitis, but the new advice hasn’t made it to all corners of the internet yet, so we always like to make sure that you are aware of the updates. This is an excellent article if you’d like to learn more.

Essentially, we now understand these complications derive from inflammation of the breast tissues, and we treat them by reducing inflammation. That means we are going to continue to use ice and ibuprofen, we are going to discontinue the use of heat, and we are cautioning against vigorous massage - the only massage you ever want to do on sensitive breast tissues is very, very gentle. Think about using one finger to massage, not a whole hand. We also no longer believe that it’s particularly helpful to use things like the ‘dangle method’ of feeding baby on the floor with the breast dangling down (using gravity to pull out a plug) or soaking a breast in a warm bowl of epsom salts. 

When it comes to mastitis and antibiotics, under the new guidelines your provider may want to wait 24 hours or more before starting a course of treatment. So our advice is that as soon as you notice mastitis symptoms (fever, red streaking across the breast, other flu-like symptoms) you should call them to let them know what you’re feeling to start the clock. That way, if you do end up needing antibiotics, you can get them as soon as possible. 

Here are a few additional accessories that may be helpful.

• Nipple shields: We’ve talked about these before; they indicate there’s a problem somewhere which needs attention and support from a lactation specialist, but in the meantime, if they help you keep breastfeeding and manage your pain, they can be a useful tool.

• Cold compresses like this or this: Weighted compresses, made with gel or seeds or beans, etc. can be iced down to provide cold therapy to breasts feeling tender or painful due to engorgement, plugged ducts or mastitis. These can often be warmed up or cooled down, but we now ONLY advise using them with cold! We’re trying to treat breast problems as inflammation problems, so cold is helpful, heat is not.

• Silverettes: These type of cups protect injured nipples from rubbing against clothing when they are sore, letting air circulate around the skin.

• Nipple cream or coconut oil - There are many, many of these on the market and really any will do. It does not need to be lanolin, and it doesn’t even need to be a designated ‘nipple cream’. One of the most effective treatments for sore nipples is regular old coconut oil from your kitchen, which has anti-inflammatory and antibacterial properties, and as a food-grade oil is safe for Baby.

• Nursing pads, disposable or reusable: You can place these in your bra to absorb leaking milk.

• Nursing pillow: My Brest Friend is more structured and will mainly be used in the newborn days, and the Boppy is softer and more flexible, and has some other uses beyond just feeding and can be used for feeding beyond just newborn days. There are plenty of other brands as well, these are two of the more common styles.

• Burp cloths, cute for draping on you and Baby and functional for covering changing table/floor/furniture: for those Happy Spitters who are covering themselves, you, and your entire house in spit up.