Intro

TL;DR

• Cure mastitis at home with bedrest, continued breastfeeding (no more than normal), and a variety of at-home therapies (see below).
• Advanced stage mastitis and bacterial mastitis may need treatment from a healthcare provider. (N.B. In all cases, please work with your provider).
• Breastfeeding experts recently adopted the new treatment protocol from Academy of Breastfeeding Medicine; although it diverges from advice I received from healthcare providers and is commonly found online.

Purpose of this article

Written from one mom to another, my intention is to give an easy-to-consume summary of all mastitis treatment advice I received from healthcare professionals (especially what worked for me) with an additional review of expert guidance available on the web.

What is mastitis?

If you’re reading this likely you already know what it is (and if that’s due to personal experience, I’m sorry!). But in case not, mastitis is an unfortunate condition where the breastfeeding mother has a painful, inflamed breast and flu-like symptoms (fever, body aches, chills). It’s not the flu and it’s not contagious.

My Mastitis Experience

Onset

I have had mastitis three times, with two infants.

The first time I had mastitis I didn’t know what it was. I was acutely aware of feeling cold while my husband in the same room didn’t. I put on sweater and socks and I buried myself under many blankets. Still shivering, I asked my husband to watch the baby while I went for a very long, very hot, shower. This caused me to become lightheaded, dehydrated, and a bit delirious (I don’t recommend it!). Fortunately I had my 6-week OB check-in already on the calendar and she was able to diagnose the issue.

In subsequent bouts of mastitis, I could identify it earlier. I knew I needed to stop and rest when I felt very cold with body aches. For me, so far, it’s really only happened in the first few months of my babies’ lives and usually coupled with oversupply and maybe over-extending myself physically the day before. (I mention over-extending myself physically only because, in reflection, I wonder if I caused my own over-supply issues this way. i.e. I could have unintentionally reduced the number of feedings).

Treatment Advice I Received from Medical Professionals

Summarized here is the advice I personally received in face-to-face meetings with three different healthcare professionals.

Advice from my OB

In 2021 I visited my Ob-Gyn for mastitis relief. She gave me the following treatment advice:

• rest
• keep breastfeeding
• deep massage the breast to get the clog out
• try breastfeeding over the baby, breast dangling, to let gravity help get the clog out
• warm compress on the breast, hot showers
• ibuprofen, if needed
• antibiotics

At the time I really resisted the antibiotics but she had a very strong recommendation. She had known someone in the past who lost a breast from mastitis. I don’t know whether that’s still common practice, how long it went untreated, or if it would have been likely in my case, but the pressure worked and I took the antibiotics. I did recover from mastitis but it took a few days. I remember I did everything mentioned above, including rigorous massage to get the clog out.

Advice from my midwife

In 2023 I visited my midwife for mastitis relief. She gave me the following treatment advice:

• rest
• keep breastfeeding
• deep massage the breast to get the clog out
• warm compress on the breast, hot showers
• Hot castor oil pack 3x/day
• Phytolacca 30c (Amazon)
• Vitamin C 4000-5000mg/day
• Probiotics
• Echinacea (but discontinue if baby shows sensitivity)
• Expect it to subside within 24hrs, no antibiotics needed!

Both of these protocols worked for me, although I vastly preferred this second treatment plan from my midwife. With this protocol I was able to avoid antibiotics and I felt better within 24 hours. I followed this protocol twice in 2023 to the same success.

However, because I’m an imperfect human, I didn’t follow it exactly. Here’s a better account of what I did:

• Immediate & serious bedrest. It was me and the babe in my bed for 24 hours. My gracious husband brought me food.
• Kept breastfeeding a normal amount on both sides. While breastfeeding the affected side, I did massage downward, toward the nipple, thinking I needed to unclog the breast.
• Hot shower with massaging the breast
• Hot caster oil packs 2-3x
• Hot water pack 2-3x
• Phytolacca (Amazon) – I only took about 3 pills in total, spread out over one day
• Vitamin C – 2000mg

Advice from my lactation consultant

Later in 2023 I also visited a lactation consultant and asked for a mastitis protocol in case it happens again. She provided:

• rest
• keep breastfeeding, no more than usual
• do not deep-tissue massage (as you would muscles). Instead do surface-level sweeps (lymphatic massage) (YouTube example)
• breast gymnastics – gently move your breast up-down, left-left, right-right, around, around
• cold compress
• Echinacea Tincture 5ml (1tsp) every 2hr for 24hr
• vitamin C (1000mg 2-3x per day)
• probiotics
• ibuprofen, if needed

Looking to authoritative sources on the web

When thinking about writing this article I noticed the advice from both my OB and midwife differs from the latest guidance from La Leche League (source), who rely on the new protocol from the Academy of Breastfeeding Medicine (source: ABM Protocol). This piqued my interest. I have been cured of mastitis three times now, each time following one of the treatment plans above. However, La Leche League published that many of these treatment protocols are inadvisable!

For ease of comparison, I dropped these into a table. (Note: My lactation consultant was mostly in line with La Leche League so I didn’t create a separate column here).

Treatment	Ob-Gyn visit 2021	Midwife visit 2023	LLL website 2023
Rest	Yes	Yes	Yes
Keep breastfeeding normal amount	Yes	Yes	Yes
Deep massage the breast to get the clog out	Yes	Yes	NO
Breastfeed over the baby, breast dangling, to let gravity help get the clog out	Yes	No mention	NO
Warm compress on the breast, hot showers	Yes	Yes	NO
Hot castor oil pack 3x/day	No mention	Yes	NO
Antibiotics	Yes, immediate	Not now	Not now
Phytolacca	No mention	Yes	No mention
Vitamin C	No mention	Yes	No mention
Probiotics	No mention	Yes	Yes
Echinacea	No mention	Yes	No mention
Ice or cold pack on the breast	No mention	No mention	Yes
Lymphatic massage for drainage (light touch)	No mention	No mention	Yes
Ibuprofen, acetaminophen/paracetamol	Yes	No mention	Yes
Lecithin supplement	No mention	No mention	Yes
Therapeutic ultrasound (TUS)	No mention	No mention	Yes
Incision and drainage	Mentioned as a reason to take the antibiotics	No mention	Yes for abscess

Analysis

The differences in advice begs several important questions.

What would I do if I got mastitis tomorrow?

I have been healed now three times using older protocols. And the last two times were fast recoveries. I’m having difficulty wrapping my head around using cold instead of heat just given the success I had the last time.

I hypothesize that 1. my body primarily needed rest to heal itself, and 2. my baby and breasts needed that time in bed to firm a regular milk production rhythm. Given all of the advice and experience above, I would likely do this for myself next time:

• Most important:
  • serious bedrest
  • keep breastfeeding a normal amount on both sides (using baby cues)
• Try:
  • lymphatic massage, breast gymnastics
  • Phytolacca
  • Vitamin C
  • probiotics
  • Cold packs on the hard part of the breast

Why are some treatments absent from the official protocol?

I noticed these were neither supported or refuted in the ABM protocol:

• Phytolacca
• Vitamin C
• Echinacea

Phytolacca looks particularly promising since it has anti-inflammatory properties (source). The latest protocol from ABM points to inflammation as causing mastitis (source).

If you look at the Amazon comments for Phytolacca, others do use it for mastitis but it is noticeably absent from “expert” protocols on the web.

Why is it that a patient with mastitis can get such divergent advice from healthcare professionals?

To be fair, the La Leche League states clearly on the site¹ that this guidance is quite new.

“Since much of the information in the most recent ABM mastitis protocol is new, you may find it helpful to share it with your healthcare provider: ABM Protocol #36.pdf“

https://llli.org/breastfeeding-info/mastitis/

But on what SLA (i.e. on what timeline) do we expect the latest research to make its way to our neighborhood healthcare professionals?

Do you have experience with mastitis?

Any recommendations? Please share in the comments!

Disclaimer: We care deeply about you and your health outcomes but we are in no way responsible for them. We offer this article for information and entertainment, it is not personalized medical advice to you and it is not a substitute for your wellness/medical provider. Please consult your healthcare provider for medical advice.

1. Screenshot of La Leche League website (https://llli.org/breastfeeding-info/mastitis/) from Dec 31, 2023
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