Puerperal mastitis: Causes, prevention, and management

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Breast infection can be a pathologically based negative influence on breast feeding. There are basically five types of lactational mastitis: subclinical mastitis, acute puerperal mastitis (cellulitis and adenitis), supperative mastitis, mammary infection with uncommon organisms, and virus infection in mammary neoplasms. The first three types are seen most often. Mastitis patients present, along with fever, a rapid pulse, and hot, reddened, tender areas on one or both breasts. Symptoms are most severe in supperative mastitis. In these cases, the developing breast abscess may be clearly identifiable. Nipple trauma and engorgement are thought to be predisposing factors to mastitis. Nipple trauma may lead to fissured nipples, thereby facilitating entry of bacteria into the connective tissue of the breast and development of acute cellulitic mastitis. Engorgement leads to stasis of milk and plugged milk ducts, which may create a setting conclusive to development of acute adenitis. Nurse-midwives should be actively involved in prevention and early detection of mastitis. Prevention may include instruction in hand expression and breast massage; encouragement of early, unrestricted nursing; identification of mothers with increased risk of nipple trauma and engorgement; instruction in signs and symptoms of infection; identification of support and information sources; and scheduling of early postpartum clinic visits. Treatment of mastitis includes rest in bed, increased oral fluids, temperature monitoring, and either continuation of breast feeding or discontinuation with binding of breasts and application of ice packs. Research seems to indicate that continuation is preferable. Treatment with antibiotics, usually antistaphylococcal drugs, is also necessary.