Letter: Mastitis

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HJL,

Mastitis nearly killed me. In a more primitive country, I could have been another maternal death statistic. Mastitis is just one path of infection and death for new mothers. Mastitis cannot be downplayed. Nor can the value of breast feeding “support” be over estimated. While my response to the excellent and informative article by Dr. Goscienski is intensely personal and private, perhaps in the future it may save a baby or mother’s life.

I come from a comfortable family, in the socio-economic sense. It would not be correct to just say we are advocates of breast feeding. Simply, everyone does it; it’s the norm. While growing up, my mother who was born in 1918 always proudly told us she nursed all her babies, and her vastly experienced family– grandmothers, mother, sister, aunts– that surrounded her had helped her.

Never was there a “well, maybe I will, maybe I won’t, we will see how it goes” attitude. I just knew breast feeding was natural, best for the baby, one of the sweetest and dearest parts of mothering, and you do it.

Thankfully, no doctor, prior to my first giving birth ever said to me, “Oh, you have inverted nipples so you won’t be able to nurse a baby.” Since then, throughout my life, several docs have said, “Oh, you were never able to nurse a baby, right?” My response? I said, “Only three babies for a total of 36 months.”

Mastitis is not simply full, hot, and hard breasts. The suffix “-itis” means infection. It’s a life-threatening illness. Had I been without medical support, the outcome could have been direful. One minute I was fine and out grocery shopping with my second child– a 3 month old. On getting into the car, I had that familiar tingly feeling of “I should feed the baby”. I tried, and she refused. Within the 30 minutes that it took to drive home, unload the car, and get inside the house, serious symptoms struck. I spiked a high fever, had chills at the same time, and wandered in and out of delirium. I writhed and thrashed on the bed several hours until my husband came home to take me to the ER. There, I received oral antibiotics and a needle aspiration for culture and was sent home.

As dying people sometimes do, my body gave its big hurrah. Dying people with little urine output may appear to have better kidney function. Dying people may appear to rally right before the end. My body seemed to respond to the antibiotic– no fever, no chills, in my right mind overnight. However, within 18 hours, every symptom returned with a vengeance, and I was the same as the day before, yet much worse.

We went back to the ER where I was admitted. I remained in the hospital on IV antibiotics for five days. This baby daughter had been breastfed exclusively for her short three month life. My husband looked at me before departing that night with our other child and asked, “What do I do?” All I could do was shrug and say, “Go buy some bottles and formula.” I was too sick to care.

What did support look like in this situation? Support was IV antibiotics, clear liquids, a small electrical blanket made of cells with circulating warm water to lay across my chest, a breast pump, and after a couple of days, the directive for my husband to bring the baby to me in the hospital so she could nurse. No one ever suggested I stop breast feeding. I was ready to quit. But that option was not ever brought up. I got well, we went home, and I nursed her until she was a romping 14 months old. Never, ever in 63 years have I been that sick, before or since.

What did support look like for the next child in line? At that point, I was leery of breast feeding an infant since the last experience had nearly killed me. Before delivery, I told the OB that I had no intention of breast feeding this next baby. He was having none of that. He sternly told me that oh yes I was, and it was not up for discussion. I was good at breast feeding, I knew how to do it, and the chances of getting sick like that again were infinitesimal. Sometimes people need to be bossed. The baby came and happily nursed without event or drama until her first birthday.

What did support look like for my first born? My mother came and stayed with us for a month. She was an old pro at how to breast feed a baby. She got up with me at night, and sat with us in the wee hours while I muddled along. She forced liquids on me and simply encouraged me. Giving up was never an option. When my nipples cracked and bled and I moaned, “What do I do?” Her response, “Put that baby back up there. Keep going.” An OB woman acquaintance later joyfully told me about the blood, “More protein!”

The hospital gave me a nipple shield, which saved the situation. After three weeks, my baby had the hang of nursing, so I could retire the shield. The subsequent children took less time to figure it out and pulled strongly enough.

Let me be honest. It hurt in the beginning, it was frustrating, I was scared that I was starving my baby, and again, it hurt. But, all this was short-lived– really only a few days. And I gave my babies the jump start in life they needed.

What did support look like for my daughter when she had a baby? First of all, her intense desire to breastfeed for one full year saw her through and enabled her to succeed. She could have quit at any time. Her mindset was that she could do it, and she made it work. In 2014, there are many excellent items in the marketplace to help mothers of newborns, but in the end it’s mental. I stayed with her for several weeks, got up with her at night, ensured she always had a glass of juice or water at hand, sat with her hour after hour as she pumped her excess, sat with her hour after hour as she nursed, and washed her equipment. When her milk came in, I made hot packs for her breasts. She prevailed and nursed that baby over 12 months.

If there is the least remote chance you will be around childbearing women, which is pretty much teenage girls and up, your stock of supplies must include several nipple shields, nursing pads or fabric to make them, nipple cream, such as Lansinoh HPA Lanolin for Breastfeeding Mothers, breast pump (manual/painful or electric/pleasant but requires electricity) and a thermometer. Encourage, encourage, encourage, be a cheerleader, and reassure the new mom.

Flat or inverted nipples, cracked and bleeding nipples, hard full breasts, engorgement, true mastitis, leaking, heat, and pain can all be a part of the early breast feeding experience. However, just like childbirth which hurts, the pain is transient, and the outcome is oh so worth it. A progressive, knowledgable medical and family environment helps support the new mom.

In conclusion, create a positive culture of breast feeding. Why is this even an option? I don’t know what the numbers are, but except for a teeny, tiny percent of new moms who for whatever reason are truly, physically unable to nurse, the vast, vast huge majority of moms could nurse if they have emotional support, products, and a desire to be successful. Otherwise, the human race would have gone extinct a long time ago.

Oh, by the way, I was in that hippie generation and gave birth “naturally,” sans epidural, spinal, or any of those other aids, but that is another article. – S.A.

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