Mastitis is a painful condition for breastfeeding moms. When plugged milk ducts cause inflammation, typically within the first six weeks after giving birth, a woman’s risk of infection rises.1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_,2Pevzner M, Dahan A. Mastitis when breastfeeding: prevention, the importance of proper treatment, and potential complications. J Clin Med. 2020;9(8). 10.3390/jcm9082328 Mastitis is extremely common, affecting about one in four breastfeeding women.3Wilson E, Woodd SL, Benova L. Incidence of and risk factors for lactational mastitis: a systematic review. J Hum Lact. 2020;36(4). https://journals.sagepub.com/doi/full/10.1177/0890334420907898 Most cases dissipate after three months.1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_
Mastitis Risk, Diagnosis, and Symptoms
The most common type of mastitis is lactational, occurring in both infectious (puerperal) and non-infectious (non-puerperal) forms. Ductal narrowing is believed to be the primary cause, leading to stagnant milk that can then become infected.2Pevzner M, Dahan A. Mastitis when breastfeeding: prevention, the importance of proper treatment, and potential complications. J Clin Med. 2020;9(8). 10.3390/jcm9082328 With infectious mastitis, bacteria such as Staphylococcus aureus colonize and enter the breast through breaks in the skin.1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_
Other factors that increase mastitis risk include cracked nipples, inadequate milk drainage, lack of sleep, antifungal nipple creams, and a prior history of mastitis.1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_
Although symptoms are generally recognizable, many factors may delay diagnosis, including postpartum fatigue, emotional stress, and drastic physical changes following pregnancy and birth.4Lawrence RA, Lawrence RM. Chapter 16: Medical complications of the mother. In: Lawrence RA, Lawrence RM, eds. Breastfeeding. 6th ed. Mosby;2005:559–627,5Dagla M, Dagla C, Mrvoljak-Theodoropoulou I, et al. Do maternal stress and depressive symptoms in perinatal period predict the lactation mastitis occurrence? A retrospective longitudinal study in Greek women. Diagnostics (Basel). 2021;11(9):1524. doi:10.3390/diagnostics11091524 Hard, swollen, or knotted breast tissue may be accompanied by fever, chills, swollen lymph nodes, body aches, and other flu-like symptoms.2Pevzner M, Dahan A. Mastitis when breastfeeding: prevention, the importance of proper treatment, and potential complications. J Clin Med. 2020;9(8). 10.3390/jcm9082328 One or both breasts may also become engorged, tender, and warm to the touch.
Since mastitis is a common issue for many new mothers, most OB–GYNs can recognize the symptoms without a physical exam. However, there are times when an in-person visit is necessary to confirm the diagnosis. If left untreated, milk production can stop altogether, and an abscess may develop along with other complications.2Pevzner M, Dahan A. Mastitis when breastfeeding: prevention, the importance of proper treatment, and potential complications. J Clin Med. 2020;9(8). 10.3390/jcm9082328
Breastfeeding Correctly Can Prevent Mastitis
Breastfeeding technique is the key to avoiding infection.1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_,6Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008;78(6):727-731. https://www.aafp.org/pubs/afp/issues/2008/0915/p727.html Lactation consultants will visit new moms at the hospital and often at home to demonstrate proper holding, support, and alignment. They can also help create a proactive breastfeeding plan to reduce mastitis risk and ensure optimal milk production.
Allowing babies to nurse as long and often as they want prevents breasts from becoming too full. Sometimes, it’s necessary to wake a baby to maintain regular milk production.6Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization. Session 2, the physiological basis of breastfeeding. 2009. https://www.ncbi.nlm.nih.gov/books/NBK148970
Conventional Pain Relief and Antibiotics
When infection occurs, doctors typically prescribe antibiotics to destroy the offending bacteria. Staphylococcus aureus is the most common culprit.1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_ Over-the-counter pain relievers can also provide relief.2Pevzner M, Dahan A. Mastitis when breastfeeding: prevention, the importance of proper treatment, and potential complications. J Clin Med. 2020;9(8). 10.3390/jcm9082328
“With non-infectious mastitis, it’s important to make sure it is mastitis and not some other condition,” explains Tori Hudson, ND, founder of A Woman’s Time in Portland, Oregon, and clinical professor of naturopathic medicine. “For example, it is important to rule out other conditions, such as inflammatory breast cancer.”
Natural Treatments and Helpful Herbs
Naturopathic medicine is designed not only to fight infection but also to increase blood flow and lymphatic drainage, create a healthy microbiome, enhance immune function, and reduce inflammation.
A naturopathic approach focuses on enhancing milk supply and preventing issues like breast engorgement and blocked ducts. Gentle massage, wearing looser bras, minimizing skipped feedings, and incorporating natural remedies can make all the difference in mastitis prevention. Holistic strategies support both comfort and health for breastfeeding mothers.
“Naturopathic medicine emphasizes expression massage, warm and cold compresses, and possibly poultices, such as charcoal or cabbage leaves,” says Dr. Hudson. “If it is infectious mastitis and antibiotics are prescribed, probiotic supplements can help support gut and vaginal ecology.”
According to data from a 2017 randomized controlled trial, cold compresses and cabbage leaves help ease mastitis symptoms, with cold cabbage leaves even more effective in reducing breast pain and stiffness than cold gel packs.7Wong B, Chan Y, Leow M, et al. Application of cabbage leaves compared to gel packs for mothers with breast engorgement: randomized controlled trial. Int J Nurs Stud. 2017;76:92-99. https://doi.org/10.1016/j.ijnurstu.2017.08.014
“A cold compress can help reduce swelling and relieve pain,” notes Dr. Hudson, “while a hot compress helps clear blockage, improve blood circulation, and aid in milk flow.”
Antibiotic Alternatives
Dr. Hudson prescribes a potent course of echinacea as a natural alternative to antibiotics. “If echinacea is used in place of antibiotics,” she says, “there needs to be improvement within 24 hours. Echinacea can also be used with antibiotics.”
Although research on echinacea specifically for mastitis is lacking, the herb’s effectiveness in fighting bacterial infections is well-documented. A 2024 analysis of 30 clinical trials found echinacea significantly reduced respiratory tract infections and lowered the need for antibiotics.8Gancitano G, Mucci N, Stange R, et al. Echinacea reduces antibiotics by preventing respiratory infections: a meta-analysis. Antibiotics. 2024;13(4). https://doi.org/10.3390/antibiotics13040364 Preliminary studies highlight echinacea’s anti-inflammatory properties, suggesting it might also help treat mastitis.9Vieira SF, Goncalves V, Llaguno CP, et al. On the bioactivity of Echinacea purpurea extracts to modulate the production of inflammatory mediators. Int J Mol Sci. 2022;23(21). https://doi.org/10.3390/ijms232113616
Dr. Hudson says naturopathic physicians are typically proactive in teaching proper breastfeeding techniques and positions to help fully drain breasts and avoid clogged ducts.
“It’s also important to [prevent] sore or cracked nipples,” she adds. “Applying probiotic powder to the nipples before breastfeeding [can] reduce the risk of infection.”
Seeking Early Care and Support
A blocked milk duct can often be resolved at home, but the risk of developing mastitis increases without proper care and guidance from a lactation consultant or doctor. Many breastfeeding mothers face significant physical and emotional stress, which can delay them from seeking timely treatment.4Lawrence RA, Lawrence RM. Chapter 16: Medical complications of the mother. In: Lawrence RA, Lawrence RM, eds. Breastfeeding. 6th ed. Mosby;2005:559–627,5Dagla M, Dagla C, Mrvoljak-Theodoropoulou I, et al. Do maternal stress and depressive symptoms in perinatal period predict the lactation mastitis occurrence? A retrospective longitudinal study in Greek women. Diagnostics (Basel). 2021;11(9):1524. doi:10.3390/diagnostics11091524
Some moms may feel isolated or judged, adding stress and anxiety to the mix and, in some cases, leading to postpartum depression. If breastfeeding is causing significant stress or discomfort, there might be a sense of relief when switching to formula. However, transitioning to formula feeding can still stir up mixed emotions due to societal expectations.
Not breastfeeding can also take an emotional toll. From guilt and sadness to feelings of inadequacy, many new moms face societal and self-imposed pressure to breastfeed, which can intensify feelings of failure if things don’t go as planned.
Every mother’s journey is unique, and deciding to formula-feed or breastfeed is personal. Support from family, friends, and healthcare providers is vital to help moms focus on what’s best for them and their babies.
Footnotes
- 1Blackmon MM, Nguyen H, Mukherji P. Acute mastitis. StatPearls. 2023;July 21. https://www.ncbi.nlm.nih.gov/books/NBK557782/?report=reader#_NBK557782_pubdet_
- 2Pevzner M, Dahan A. Mastitis when breastfeeding: prevention, the importance of proper treatment, and potential complications. J Clin Med. 2020;9(8). 10.3390/jcm9082328
- 3Wilson E, Woodd SL, Benova L. Incidence of and risk factors for lactational mastitis: a systematic review. J Hum Lact. 2020;36(4). https://journals.sagepub.com/doi/full/10.1177/0890334420907898
- 4Lawrence RA, Lawrence RM. Chapter 16: Medical complications of the mother. In: Lawrence RA, Lawrence RM, eds. Breastfeeding. 6th ed. Mosby;2005:559–627
- 5Dagla M, Dagla C, Mrvoljak-Theodoropoulou I, et al. Do maternal stress and depressive symptoms in perinatal period predict the lactation mastitis occurrence? A retrospective longitudinal study in Greek women. Diagnostics (Basel). 2021;11(9):1524. doi:10.3390/diagnostics11091524
- 6Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization. Session 2, the physiological basis of breastfeeding. 2009. https://www.ncbi.nlm.nih.gov/books/NBK148970
- 7Wong B, Chan Y, Leow M, et al. Application of cabbage leaves compared to gel packs for mothers with breast engorgement: randomized controlled trial. Int J Nurs Stud. 2017;76:92-99. https://doi.org/10.1016/j.ijnurstu.2017.08.014
- 8Gancitano G, Mucci N, Stange R, et al. Echinacea reduces antibiotics by preventing respiratory infections: a meta-analysis. Antibiotics. 2024;13(4). https://doi.org/10.3390/antibiotics13040364
- 9Vieira SF, Goncalves V, Llaguno CP, et al. On the bioactivity of Echinacea purpurea extracts to modulate the production of inflammatory mediators. Int J Mol Sci. 2022;23(21). https://doi.org/10.3390/ijms232113616