Breast Infection - Symptoms & Treatment
Breast Infection of the breast are very rare during pregnancy but, unfortunately, they are more frequent after delivery and during lactation. Breast infection must not be confused with engorgement. The breasts normally become engorged on the 3rd or 4th day after delivery, when it may be associated with a slight rise in temperature but there is no infection present. Breast infection, or acute mastitis, occurs in a localized part of the breast, being the result of infection gaining access to a part of the breast itself Breast infections are usually, but not always, preceded by a crack in the nipple arid it is for this reason that cracked or sore nipples are treated with such respect.
A baby who is sucking normally at the breast will seldom cause a break in the skin of the nipple. This results because the baby has been chewing rather than sucking the nipple. It is of paramount importance, therefore, to make sure that the nipple is always placed well inside the baby's mouth where he cannot 'chew' it.
A cracked nipple is painful and requires expert attention and treatment. Since it causes pain, the mother does not allow the baby to feed satisfactorily, which results in the breast becoming engorged and tender. The milk must be expressed by hand or by a breast pump and the nipple rested until it has completely healed, which usually takes 24-36 hours, after which normal breast-feeding can be resumed. If the crack becomes infected, bacteria gain access to neighboring milk ducts where they grow and flourish and then infect the tissue of the breast itself unless the breast is properly emptied. The first sign that infection has entered the breast is usually a sharp rise in temperature, with a rise in pulse rate and tenderness, frequently in the outer part of the breast. This may be accompanied by a flushing or reddening of the skin over the affected part of the breast, which will be tender to touch and also rather engorged. Treatment with a wide-spectrum antibiotic such as ampicillin may arrest the infection so that the reddening of the skin disappears, the soreness goes and the breast gradually returns to normal, providing it is satisfactorily emptied by manual expression or breast pump.
Sometimes the inflammation does not subside; the temperature continues to rise and an abscess forms in the deeper tissues of the breast. When this happens, breast-feeding is stopped and lactation suppressed. A specimen of milk is collected from the nipple and sent to the laboratory so that the organism concerned can be cultured and tested against various antibiotics. Once an abscess has formed, however, it is unlikely that it will be cured by antibiotics alone. The area of the breast in which it has formed becomes extremely reddened, firm or even hard and very tender. Eventually, when the center of the abscess liquefies, it can be opened and drained under a general anaesthetic. A breast abscess is not only extremely disappointing for the mother (because breast-feeding has to be discontinued) but is also a very painful and demoralizing experience. Inflammation of the breast is much more common following a first pregnancy and is very unusual once a woman has breast-fed one child.
Breast abscesses were once relatively common but are now much less so, because modern antenatal instruction teaches a woman to breast-feed her baby correctly, and because modern treatment with both antibiotics and milk expression is very effective.
Cracked nipples usually develop in the first few days and the midwife is nearly always able to treat the condition so that breast-feeding can be resumed satisfactorily. Inflammation of the breast causing flushing or redness of the skin often happens at about the 10th day. Immediate treatment by antibiotics and satisfactory emptying of the breast usually cures the infection and breast-feeding can be resumed. Inflammation of the breast also tends to occur during the 4th week after delivery, when the mother is usually unaware that a crack has developed in the nipple and the first thing she realizes is that the breast is painful and tender. This should be reported immediately, and if it is treated early, an abscess can be avoided.
Once a woman has had a breast abscess, some obstetricians consider that breast-feeding should not be attempted in a subsequent pregnancy. Every case is considered on its own merits, however, and there are instances where satisfactory breast-feeding has been accomplished after an abscess has been previously operated on and drained.