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Prejudices about mastitis.
Lilia Kazakova, pediatrician, consultant on breastfeeding. 1. Very often, nursing mothers call mastitis lactostasis. What does lactostasis look like? Painful tuberosity and often reddening of the skin above the hillock. The emergence of such tuberosity or denseness is associated with blockage of one of the ducts by a supposedly fatty droplet and a violation of the outflow of milk from the lobe of the gland. Sometimes lactostasis is accompanied by an increase in body temperature, chills. The main cause of lactostasis is poor drainage of the entire breast or part of it. Poor drainage is most often associated with the fact that the child is fed in the same position. For example, in a standard sitting position, the axillary lobe, the largest and with the tortuous ducts, is emptied worse than all others (the areas nearest the lower jaw of the child are best emptied - in this case the lower central ones, and the lateral ones - the worst). The simplest action for preventing milk stagnation in the axillary lobes is sometimes to put the child "under the arm" - the mother, for example, sits (it is possible and lying down), the child rests on the pillow with the head at the chest, and the buttocks and legs - behind the mother , the kid lies on his side, at hand. Very often, when there is stagnation under the arm, it is enough to attach the child several times in a row in this position and he perfectly resolves everything. The location of the lactostasis from the top "in the center" is typical for those cases when the mother during breastfeeding keeps the breast "scissors" - the nipple between the index and middle finger, the index finger is pressed into the chest. (So the breast can not be supported or fed, but in most maternity hospitals it is advised to give the breast.) In some courses on preparation for childbirth, the following is advised literally: "Keep the chest like a cigarette."). Breast should be supported with the whole hand - thumb on top, the rest under the breast. In the vast majority of cases, the breast does not need to support all feeding. Very often there are recommendations to wear a bra constantly so that it supports the breast higher and then it would fill evenly and from above and from below, even sleep is offered in a bra. All this is called lactostasis prophylaxis. But the nature of the female breast is designed so that it has more milk accumulates in the lower lobes, and from any positions it is best to empty the lower lobes of the gland. So why do we need to achieve a uniform accumulation of milk in all lobes of the gland? Probably, it's more convenient for lactostasis to be formed up there ... If the bra is worn, it should be free, it is convenient when siphoning, milk leaks and it is necessary to use gaskets ... Lactostasis practically do not occur with properly organized breastfeeding when there is no accumulation of large portions of milk for feeding, and the mother is able to feed the child from various positions. Lactostasis is a mysterious thing, sometimes it arises from scratch and, with the active suckling of the child, the affected breast passes for 1-2 days without special measures. (And my mother begins to say that it was helped by a cabbage leaf.) If a mother comes in that does not understand at all what is happening to her, and when she develops lactostasis, stops applying the baby to the sick chest and generally stops touching her, no cabbage leaf helps.) Then, if there is lactostasis in the chest, it is usually necessary to apply the baby to her as often as possible. Sometimes it is necessary to express the breast BEFORE feeding and attach an active person who wants to suck the child to a sis in which one lactostasis remains ... Sometimes it is necessary to massage the segment with lactostasis and express it (contact the specialists at the place of residence ...) The severity of the situation depends not on the degree of soreness breast, and the ability of a woman to express with such pain. It is pain that does not allow the mother to efficiently express. Therefore, it is better to resort to the help of a specialist who can cope with this complication in 30 minutes. Most mothers are afraid to decant and massage this site because they think there may be something to burst. Something can burst if you massage and pour as follows: put the sisu on a stone and top with a hammer. 2. Women often call mastitis a physiological phenomenon - the arrival of milk.
The arrival of transitional milk most often occurs on the 3rd-4th day after childbirth and can be accompanied by swelling of the breast, soreness and increased body temperature. (In this case, the so-called chest temperature rises: when measuring the temperature at three points (for example, under the arm, in the mouth and in the groin) the highest temperature will be under the mouse, the difference with other points may be a degree or more. The arrival of mature milk usually happens on the 10-18th day after childbirth and may also be accompanied by swelling of the breast, soreness, and fever. In this situation it is necessary to continue to feed the child on demand, and also to put on the demand of the mother. If a mother has a painful feeling, a "stone chest" - then she can strain her breast to a sense of relief about a day after the milk arrival began. Wait about a day because of the fact that the substance that turns off excess lactation, appears in a full chest about a day later. If you express the breast before this time, the milk will come as much, and the "hyperactivity" with all the troubles accompanying it, the main one of which is the need for regular decantings, can "start". It should be noted that with the joint stay of mother and child, feeding on demand and proper application of large problems with the arrival of milk is not observed. In the case of a separate stay of the mother and the child, there is a frequent occurrence of engorgement with pronounced edema, redness of the entire mammary gland, difficulty in the outflow of milk. In the presence of abrasions or cracks on the nipples, such engorgement can result in mastitis. To cope with nagging, it is necessary to adjust the expression for 2-3 days, as well as frequent and prolonged suckling of the baby's breasts. This is the case when feeding is extremely urgent at the mother's request. But sometimes a child can not grab the breast well and suck milk because the areola becomes hard. In this case, before breast-feeding, it is necessary to express the breast so that the child can successfully capture it and start sucking. 3. Real mastitis is an infected inflammation of the mammary gland tissue. Most often it develops against the background of rattling or lactostasis. If lactostasis does not remove the milk in time, inflammatory changes in the breast tissue that occur on the background of puffiness and changes in blood circulation in the lobe of the gland with lactostasis begin. This condition is often called uninfected or serous mastitis. If a woman has abrasions or cracks in her nipples, she quickly becomes infected with an inflammatory focus. It should be noted that the infection can get there not only from cracks, but also from any other foci of chronic infection in the body of a woman (for example: carious tooth, chronic tonsillitis, pyelonephritis, etc.) Mastitis worsens well-being, body temperature increases, part of the chest becomes red and hot, painful when touched. Treatment of mastitis is carried out on the same principles as lactostasis treatment. It is necessary to free a portion of milk from decanting, massage and applying the baby. When mastitis, the feeding of a child is not prohibited, but it is necessary, since no one is better than a child to empty the breast. With mastitis, antibiotic therapy is necessary. There is a large number of modern antibiotics compatible with breastfeeding. If the doctor prescribes antibiotics, you need to inform him about this, because very often doctors do not consider it necessary to continue breastfeeding on the background of antibiotic therapy and do not bother to choose a treatment compatible with breastfeeding. 4. Abscess of the breast - a condition that develops against the background of mastitis in the absence of treatment. With an abscess, in place of the formerly once lactostasis, a cavity is formed, filled with purulent contents. The abscess, as a rule, is opened in the milky duct and its treatment consists in the regular decantation of the patient's chest and the course of antibacterial therapy. With an abscess, while the puff secretes pus from the milk duct, it is recommended to continue feeding the baby only from a healthy breast. In preparing the material, the book "Advice on Breastfeeding" was used. The Tsaregradskaya.
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Prejudices about mastitis.
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