Mastitis: Okay to express instead of nurse?

I was just diagnosed with mastitis in my right breast. It is extremely hard, tender and sore. My doctor prescribed antibiotics and recommended I keep nursing. My baby refuses to nurse on the affected breast because he cannot latch on properly due to the extreme hardness. I have been pumping the affected breast after he nurses on the other. Is it okay to express milk from the affected breast until it heals?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Your doctor was right. It is very important to continue nursing your baby when you mastitis. Frequent emptying of your breasts will help in your healing. It also helps to preserve your milk supply. To resolve your engorgement it is important to begin frequent nursing or gentle expressing of your milk (if your baby refuses to nurse).

It can sometimes be difficult to persuade a baby to nurse on the side affected by mastitis. This may not only be due to the engorgement you're experiencing, but also because your milk's sodium content rises when mastitis is present. (This occurs only in the affected breast.) Babies are usually not too happy with salty tasting breastmilk! Your milk will return to its normally sweet taste once your infection is resolved and you are no longer experiencing engorgement.

It is very important to your milk supply (in the affected breast) to get the engorgement down immediately. Express your milk every hour and a half. While severe engorgement is present, express for no longer than 10 minutes at a time. Use the lowest (intermittent) pressure setting when beginning to express your milk. You don't want to take the chance of damaging your delicate breast tissue. Depending on the pump you are using, you might be able to express you milk from the affected side while your baby nurses at the other breast. You may find this to be much more effective in removing milk from that breast.

Prior to expressing your milk, use warm moist compresses or a saline soak (soaking breast in basin of warm water with one-half to one teaspoon salt per cup of water) for around 10 minutes. Combined with a gentle breast massage, your milk should begin to start flowing. You also might want to try hand-expressing for a few minutes before using a pump. Some women are able to let-down more easily with hand-expression.

For comfort, apply an ice pack to your affected breast for about 15 minutes in between feeds. (A package of frozen peas works well.) This should help to reduce the swelling, as well as the pain. Speak with your Health Care Provider about using ibuprofen if needed for pain relief. The American Academy of Pediatrics considers ibuprofen to be compatible with breastfeeding. Best wishes for a prompt resolution to your mastitis! Don't forget to get lots of rest while healing, and to help prevent a recurrence.

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