Mastitis Prevention StrategiesMaría Eugenia Flores-Quijano
- Mastitis prevention strategies include general recommendations to protect the women’s immune system and milk microbiota
- Breastfeeding counselling on adequate lactation practices and the correct breastfeeding technique are of crucial importance to promote frequent and effective milk extraction and reduce any risk associated with mastitis
- Counselling must also include information on breast care and mastitis sign recognition in order for women to seek professional help on time when needed
Previous studies have documented risk factors for mastitis, which need to be considered in order to put forward adequate preventive measures. Some of these factors fit into a non-modifiable category, placing women with these characteristics in a high-risk group that needs extra attention and support . However, most of the factors associated with the occurrence of mastitis are modifiable. Some of them may directly alter the microbiota, such as the irrational use of antibiotic therapy associated with Caesarean delivery or recurrent throat infections , unnecessary antifungal medications and nipple ointments , or even the use of not properly sterilized breast pumps that could be the source of pathogenic bacteria . Other factors induce changes in the maternal immunological system that may predispose for mastitis. For instance, in women living in underprivileged communities in Africa, reduced plasma levels of some micronutrients including vitamin A, zinc, and antioxidants, such as vitamin E and selenium, have been associated with subclinical mastitis [4, 5]. Also, psychological stress and fatigue have consistently been associated with this condition .
Additionally to the above-mentioned factors, breastfeeding practices and techniques that women choose, as well as factors that hinder appropriate ones such as milk oversupply, the separation of the mother from the baby, or factors that may hurt the breast or nipple such as the use of a tight bra, the presence of tongue or lip tie in the baby, and the improper use of breast-pumps create conditions or a breastfeeding environment that may cause blocked ducts, engorgement (build-up of milk in the breast), and increase the risk for mastitis . Some inadequate practices that lead to infrequent and incomplete milk removal are : scheduled feedings, purposely short duration of feeding, missed feedings, early introduction of formula milk or food (mixed feeding), and pacifier use. An incorrect breastfeeding technique may not only cause nipple damage, but also prevent optimal milk drainage from the breast. At the same time, it has been hypothesized that nipple cracks and nipple injuries may not only provide a point of entry for microorganisms, but could also be early clinical signs of mastitis .
In terms of mastitis prevention, there are some general recommendations that protect women’s immune system and their milk microbiota, these may include: strategies that improve or maintain an adequate nutrition status; provide guidance on how to cope with stress and fatigue ; promote the rational use of antibiotics during pregnancy, parturition, and postpartum, and limit the unnecessary use of breast ointments during lactation. Additionally, the use of selected probiotics has recently been proposed as a novel preventive intervention especially for the high-risk group of women .
Nevertheless, a crucial intervention to prevent mastitis, even in the more susceptible women, is to promote the best conditions for breastfeeding and provide pertinent coun-selling on important matters such as: (I) adequate breastfeeding practices, (II) the correct technique to comfortably sit or lie and place the baby to the breast, (III) how to take care of the breasts, and (IV) very importantly, information on how to recognize early signs of mastitis, so affected patients get proper treatment if needed.
Adequate practices and correct techniques that may help prevent mastitis
| Initiate breastfeeding very soon after
birth (no longer than 24 hours)
• Exclusive breastfeeding
• Free demand, not scheduled feedings
• Let baby fnish suckling and extracting
milk from one breast before changing
to the other one
• Delay the use of pacifer
• Teach correct and comfortable
positions to sit or lie for breastfeeding
• Head and body are aligned
• Face facing the chest, nose
opposite the nipple
• Whole body facing the mother
Position of the mouth on the breast
• Way in which the woman takes
and presents the breast
• Recommendation: hand forms a “C”
• Stimulate the search refex and to
open mouth widely
• It is not necessary to place a fnger
near the nose
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