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Prejudices about mastitis.
Lilia Kazakova, pediatrician, breastfeeding consultant. 1. Very often, nursing mothers call mastitis lactostasis. What does lactostasis look like? Painful tuberosity and often - redness of the skin over the hill. The occurrence of such tuberosity or compaction is associated with blockage of one of the ducts, presumably a fatty droplet and disturbance of the outflow of milk from the gland lobe. Sometimes lactostasis is accompanied by fever, chills. The main cause of lactostasis is poor drainage of the entire breast or part of it. Poor drainage is most often due to the fact that the baby is feeding in the same position. For example, in the standard sitting position, the axillary lobe is the largest and with tortuous ducts emptied the worst (the areas closest to the child’s lower jaw are best emptied - in this case the lower center, and the upper side - the worst). The simplest action for the prevention of milk stagnation in the axillary lobes is to sometimes put the child “under the arm” —the mother, for example, sits (you can lie down), the child lies on the pillow with the head at the chest, and the ass and legs are behind the mother’s back , the baby is lying on the side, at hand. Very often, in the event of 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 lactostasis from above “in the center” is typical for those cases when the mother holds the breast with “scissors” during nursing - the nipple between the index and middle finger, the index finger is pressed into the breast. (Thus, the breast cannot be either maintained or given, but in most maternity hospitals this is the way to give the breast. At one of the preparation courses for childbirth, literally the following is advised: “Hold the breast like a cigarette.”). The chest must be supported with the whole hand - the thumb from above, the rest under the breast. In the overwhelming majority of cases, the breast does not need to support all the feeding. Very often there are recommendations to constantly wear a bra so that it supports the chest higher and then it would be filled evenly from the top and bottom, even offer to sleep in the bra. All this is called the prevention of lactostasis. But by nature, the female breast is designed so that it accumulates more milk in the lower lobes, and from any position the lower lobes of the gland are best emptied. So why do we need to achieve a uniform accumulation of milk in all parts of the gland? It is likely that there, at the top, it would be more convenient for lactostasis to form ... If a bra is worn, it should be free, it is convenient when the breast is “full of holes”, milk is leaking and you need to use pads ... Lactostasis practically does not occur when properly organized portions of milk to feed, and the mother knows how to feed the baby from various positions. Lactostasis is a mysterious thing, sometimes it occurs from scratch and, with the active sucking of the child of the affected breast, it takes 1-2 days without special measures. (And my mother begins to say that the cabbage leaf helped her. If a mother comes across who does not understand what is happening to her, and when she begins to develop lactostasis, she stops putting her baby on her sore chest and stops touching her at all no cabbage leaf helps. Then a catastrophe usually happens.) If lactostasis has begun to ripen in the breast, a child should be applied to it as often as possible. Sometimes it is necessary to express the breast BEFORE feeding and attach the child who wants to suck actively to the system in which one lactostasis remains ... Sometimes it is necessary to massage the segment with lactostasis and express it (contact your local specialists ...) The severity of the situation does not depend on the degree of pain breasts, and from the ability of women to decant with a similar pain. That pain does not allow the mother to carry out effective pumping. 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 area because it seems to them that something might burst there. Something may burst if massaging and decanting is carried out as follows: put a sisy on a stone and tap it on top with a hammer. 2. Women often call mastitis a physiological phenomenon - the arrival of milk.
The arrival of transitional milk most often occurs 3-4 days after delivery and may be accompanied by swelling of the breast, pain and fever. (In this case, the so-called chest temperature rises: when measuring temperature at three points (for example, under the arm, mouth and groin), the highest temperature will be under the arm, the difference with other points may be a degree or more.) The arrival of mature milk usually happens 10-18 days after birth and may also be accompanied by swelling of the breast, pain, fever. In this situation, it is necessary to continue to feed the baby on demand, as well as to attach on demand of the mother. If the mother has pain, “stone chest” - then she can move the breast to a feeling of relief about a day after the arrival of milk has begun. It is necessary to wait about a day due to the fact that the substance, folding excessive lactation, appears in the filled breast after about a day. If the breast is drained before this time, the same amount of milk will come, and hyperlactation may start with all the troubles that accompany it, the main one being the need for regular pumping. It should be noted that with the joint stay of mother and child, feeding on demand and proper attachment of large problems with the arrival of milk is not observed. In the case of a separate stay of mother and child, engorgement is often found with marked edema, reddening of the entire breast, difficulty in milk outflow. If there are abrasions or cracks in the nipples, such engorgement can result in mastitis. To cope with engorgement, it is necessary to establish pumping for 2-3 days, as well as frequent and prolonged sucking of the breast by the child. This is the case when it is extremely important to feed at the request of the mother. But sometimes a child cannot grab a breast well and suck milk because the areola becomes hard. In this case, before feeding, it is necessary to decant the breast so that the baby can successfully capture it and start sucking. 3. Real mastitis is an infected inflammation of the breast tissue. Most often develops on the background of engorgement or lactostasis. If during lactostasis milk is not removed in a timely manner, inflammatory changes in the breast tissue begin, resulting from puffiness and changes in blood circulation in the lobe of the gland with lactostasis. This condition is often referred to as uninfected or serous mastitis. If a woman has abrasions or nipple cracks, a rapid infection of the inflammatory focus occurs. It should be noted that the infection can get there not only from cracks, but also from any other source of chronic infection in a woman’s body (for example: a carious tooth, chronic tonsillitis, pyelonephritis, etc.) With mastitis, the state of health worsens, the overall body temperature rises, part of the chest becomes red and hot, painful when touched. Treatment of mastitis is carried out according to the same principles as the treatment of lactostasis. It is necessary to free the milk from the expression by decanting, massaging and putting on the baby. When mastitis, feeding the baby is not prohibited, but necessary, because no one better than the baby can empty the lobes of the breast. When mastitis is necessary, the appointment of antibiotic therapy. There are a large number of modern antibiotics that are compatible with breastfeeding. If a doctor prescribes antibiotics, you need to tell him about it, 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 that is compatible with breastfeeding. 4. Breast abscess - a condition that develops on the background of mastitis in the absence of treatment. With an abscess, on the site of a former lactostasis, a cavity is formed, filled with purulent contents. An abscess, as a rule, is opened in the milky duct and its treatment consists in regular expression of the diseased breast and in the course of antibacterial therapy. With an abscess, while pus is released from the milky duct, it is recommended to continue feeding the child only from a healthy breast. In preparing the material used the book “Counseling on breastfeeding”, the author Zh.V. Tsaregradskaya.
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Prejudices about mastitis.
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