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Thread: Can't recover after mastitis

  1. #1

    Question Can't recover after mastitis

    Hi, I am a SAHM and have EBFed three children. I have tuberous breasts and PCOS, although I am of normal weight. One breast produces very little milk but the other one is a decent producer.

    Two months ago I got mastitis and breast inflammation in the good breast that lasted about two weeks. I EBFed through it and for two weeks after it had cleared up. At that point, my supply still hadn't come back (as indicated by diapers, no let-down, no leaking, unhappy baby). I weighed my son and he was down a pound. A three-month old shouldn't be losing weight, so I started pumping and supplementing with formula.

    I've been pumping 4-6 times a day with a Medela Symphony (in addition to nursing) and supplementing for about six weeks now and the supply in my good breast is still down. It is producing no more than the bad one and together it's not enough. I'm producing about 0.6 oz per hour. With my first child, when I pumped after three hours, I would get 1 oz out of the bad breast and 3 oz out of the good one. Now I'm getting 1 oz out of each. I'm taking the galactalogues that have worked for me in the past but no galactologue is going to double my production.

    I'm wondering what happened to my good breast. Was it damaged by the mastitis? Did clogged ducts cause pressure involution in some parts of it? Will my supply ever come back? Will it come back with another child? I remember the inflammation migrated around my breast. As soon as one area of tenderness cleared up, another one would pop up, and like I said, this went on for two weeks. What happened?

    I'm getting used to my new life of bottle washing, pumping, remembering to bring the formula, etc, and dealing with the shame of formula feeding in my social circle, but I would really like to know what happened. It would help me deal better with grieving the loss of my ability to EBF.
    Last edited by @llli*jhart; June 24th, 2017 at 08:43 PM.

  2. #2
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    Default Re: Can't recover after mastitis

    Hi jhart, I am so sorry you are having this concern. Why do us women tend to feel shame over things we have no control over? Your friends surely understand that your baby needs nourishment and you are a wonderful mom for making sure your baby is nourished in a difficult and emotional situation. If they are shaming you, then perhaps you need a wider social circle. I suspect that most if not all of them may feel frustrated and unhappy FOR you because they know you would prefer to exclusively nurse your child, but are hopefully not judging of you.

    I am not sure if you can ever know exactly what happened to your "good breast," however, I think you may be able to get some answers if you read the book Making More Milk (if you have not already) and also I would suggest consulting with a board certified lactation consultant, if possible one who specializes in or is very experienced in low milk production. If you have already done so and not gotten the help or info you seek maybe you can see another. But here are some thoughts.

    When a mom gets mastitis, many times it indicates something was already not going quite right on the milk removal front. In other words the mastitis may not have been the origin of the problem that eventually caused low milk production, but instead a symptom of that problem.

    Mastitis itself is "just" an infection (albeit one that makes you feel like you have been hit by a truck) and is not likely to permanently damage a breast, anymore than a sinus infection permanently damages the sinuses. Extremes of unrelieved engorgement might cause breast injury ( I have heard, it is very very rare) so I guess it is possible an extremely large and intractable plug might as well. Also, if a mom is a little overly determined to get the plug out, SHE might damage (severely bruise, inflame) her breast,(I did this once) but most likely not permanently.

    But I doubt there is actually any permanent breast injury, and if there is not, then yes, the possibility exists for your body to begin producing more milk given the right stimulation. Also again if there is no injury, producing adequately for any subsequent children is not only possible but likely. Also PCOS is something that is still quite a puzzle when it comes to production, as many moms with PCOS have no issues with production at all.

    I remember the inflammation migrated around my breast. As soon as one area of tenderness cleared up, another one would pop up, and like I said, this went on for two weeks. What happened?
    Why did your mastitis last so long? That is a medical question. Perhaps the anti biotic you were given did not work well for you, and that is something that is important to know about your health.

    Also have you considered a pharmaceutical galactagogue? These actually can improve milk production very significantly in some moms, but of course they are not for everyone. Also they can be hard to get.

    Something a busy mom who has many kids AND is pumping might neglect is her own health. In particular, good hydration is vital for normal milk production.
    Last edited by @llli*maddieb; June 24th, 2017 at 10:14 PM.

  3. #3

    Default Re: Can't recover after mastitis

    Hi Maddie, thanks so much for this response! I did see an LLLL a month ago and am seeing an IBCLC today.

    Regarding social circles, I guess I mean more the people who haven't heard my story but would see me with the bottle. I can't say to everyone I meet, "Let me tell you about my tuberous breasts and mastitis!" you know? I'm trying not to stress about it.

    Regarding the mastitis, I've gotten it once with each of my kids and never taken antibiotics. I take the baby to bed for three days and that's that. What happened this time is I broke my ankle, and had a day or two where I didn't eat. The mastitis started a few days after that. It cleared after three days as usual but the inflammation continued and migrated around my breast as I said. I massaged whatever area was inflamed in order to promote blood flow. It did hurt when I was massaging, but I didn't think I was doing damage. Aside from the duration of the inflammation, nothing seemed unusual at the time.

    The more I think about it, the more I think it may be hormonal related to PCOS. I do feel that my estrogen level is back up. I'm going to try low-carbing it. I don't even know who I would go to to get a pharmaceutical galactagogue.

  4. #4
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    Default Re: Can't recover after mastitis

    I can't say to everyone I meet, "Let me tell you about my tuberous breasts and mastitis!" you know? I'm trying not to stress about it.
    Ha ha, yes, I get it.

    Ok you broke your ankle? Goodness. I cannot even imagine! I wonder if the stress of that could also have played a part?

    I only had mastitis with one of my kids, (but three times) the first time I also thought I got through it without antibiotics and then a few days later, wham. Sometimes to recover the body needs more help. If you feel fully recovered no reason to worry about it now, I am just thinking for the future. I get wanting to avoid abs of course.

    The more I think about it, the more I think it may be hormonal related to PCOS. I do feel that my estrogen level is back up. I'm going to try low-carbing it. I don't even know who I would go to to get a pharmaceutical galactagogue.
    Who is treating you for the PCOS? maybe it would help to get tested now to see if the issue is likely to be hormone related. You would need a doctor to prescribe a pharmaceutical galactagogue. I think most moms get them from their ob but any doctor could prescribe. Unfortunately many will not. But it depends on where you live and on your doctor. If you want to learn more about this here is a little info, and you can research more as you like: http://www.breastfeedingonline.com/r....DvHtOaxN.dpbs

  5. #5

    Default Re: Can't recover after mastitis

    Yes, I think the stress from the ankle must have triggered the unusually long mastitis. Also the whole family was recovering from norovirus, so just generally I was feeling off my game. And then about two weeks after the mastitis, my father died unexpectedly. The baby and I went home for the funeral. I didn't take the pump with me but should've because that's when the formula supplementation really took off. It wasn't until I got home again, fully a month after the mastitis, that I was able to start trying to build my supply again. Talking to the IBCLC today, it sounded like it may have just been too long between when my supply first dropped and when I started pumping.

    No one is treating me for PCOS. We've recently moved.

    So my current plan is:

    - low carb diet
    - try to get hold of some domperidone, which the IBCLC suggested
    - continue pumping
    - try this approach for three or so weeks and then reevaluate

  6. #6
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    Default Re: Can't recover after mastitis

    Wow honey this has not been your year. I am so sorry for your loss.

    So, you had a baby, you all got sick, you broke your ankle, your dad dies suddenly...and you moved house...all in the space of a few months? Wow. Well, if anyone looks at you cross-eyed about bottles you have my permission to pour it over their head!

    I think your plan sounds good. I think there are many things that may have caused the decrease, but usually there is really only two main ways to make it increase, and that is frequent and effective milk removal and galactagogues. (And do not forget hydration!) I do not know what a low carb diet does, I suppose that is for the PCOS? I once saw a talk on PCOS at a lactation conference and the person said fish oil (like you take as a supplement) is helpful, but I forget why.

    The thing about upping production with milk removal is to do it as often as you can, meaning, as often as you can that works for you. From what I have read about it, frequency of milk removal is more key in increasing production than is how "empty" the breast is made, but that is important too. That is why moms are told to pump after nursing. But that is just not a convenient time to pump for many moms, or mom does not have time to pump until no more milk is coming etc. So, that is not the only choice. In other words sometimes it is better to pump when most convenient so that you can pump more often, even if those sessions are short. The book Making More Milk has many tips for making pumping more "doable."

    Also be sure your pump is working well and in good condition. Encouraging baby to nurse more often is another thing to try, and if it works it would allow you to do less pumping.

  7. #7

    Default Re: Can't recover after mastitis

    Actually, we moved two years ago, but I don't have anyone here treating my PCOS. I go to midwives for birth/gyn, and their training is not in PCOS.

    The IBCLC said Domperidone. I need to get it from Canada. Obviously it's not the first thing they suggest but I've been doing all the usual suggestions. I joined a Facebook group for women with PCOS who have low supply. They are big into Dom. Also ketosis diets seem to be big. Basically, the keto diet addresses the insulin resistance aspects of PCOS. There is some interplay between insulin and prolactin, so if your insulin is misregulated (as is the case with PCOS), your brain does not release enough prolactin in response to the baby's sucking and emptying of the breast. The keto diet down-regulates your insulin so that your brain can properly release prolactin. The Dom promotes prolactin release. Basically, talking to both the LC and the FB group, it sounds like the PCOS is inhibiting the usual feedback loop in which more emptying leads to more production.

    All this was very interesting to me, and I think I'm going to aim for Dom and the keto diet.

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