How is milk produced?
Problems with breastfeeding
An initial swelling of the mammary gland usually occurs in the first few days after birth. The reason for this is presumably a disruption in the formation process for mature breast milk, also known as galactogenesis II. A lack of early, too short (time-limited) and infrequent application as well as early additional feeding are known as further factors, the avoidance of which is an important prophylaxis for problems with initial breast swelling. Also, mothers with breast implants are prone to this problem.
If the milk vesicles (alveoli) are not emptied, this can lead to a congestion in the breast tissue, which can lead to edematous swelling of the nipple or the entire breast. The areola is flat, the breast is red and there is no milk flow. Occasionally, a fever occurs for a short time.
This can be remedied by cooling with cool packs (only place on the skin with a mat!), Quark toppings (keeping the areola free) or white cabbage toppings. With a careful lymph massage in the direction of the lymphatic drainage (reverse pressure softening method), the swelling can be reduced, especially in the area of the areola. This is important because otherwise the baby will find it difficult to suckle at the breast. The massages should only be carried out according to instructions from an experienced person, otherwise damage can be caused, for example, by applying too much pressure! Regular emptying of the breast by the baby, if possible, is essential in order to achieve further milk production and the swelling of the breast tissue.
Milk congestion can occur during the entire period of breastfeeding, but especially in the first three weeks.
The causes are known:
- A lack of milk ejection reflex, for example due to stress or sleep deprivation
- A mechanical hindrance when emptying, mostly due to impact or pressure on individual milk ducts or blockage of the milk ducts. A nursing bra that is too tight, a constricting backpack or a constricting sling is sufficient for this.
- Sometimes the breast is not emptied completely due to the wrong technique or too infrequent / too short a time when it is applied.
- Extremely rare: excessive milk production.
The milk congestion leads to painful swelling and reddening of the breast, in one or more areas, which is occasionally associated with a fever (milk fever).
Avoiding the actual disease is also the most important measure in the case of milk congestion. Correct application technique, breastfeeding as required and learning relaxation techniques lead to a demonstrable reduction in the frequency of milk congestion.
The aim of the treatment is to empty the breast as often and completely as possible. After applying moist heat, the child is placed, preferably with the chin in the area of the congested area. If this is not possible, the milk is pumped out 5 or 10 minutes after the milk ejection reflex has been triggered, e.g. by a massage according to Plata-Rueda. If necessary, the milk can drain from the stagnant area by opening the blocked milk duct on the nipple with the aid of a sterile cannula or by gently wiping it out. This should only be done by a person who is experienced in doing this, as applying too much pressure poses the risk of damage to the breast tissue with subsequent abscess formation! A pain reliever, possibly with an anti-inflammatory effect, is usually given beforehand. Cooling during breaks can be just as helpful as using homeopathic and herbal remedies, as well as acupuncture.
Infectious inflammation of the mammary gland
98% of the time this disease occurs in the first three months after birth, especially in the second to third week.
Most of the inflammation is caused by the bacterial pathogen Staphylococcus aureus, which occurs through the smallest injuries to the nipples. The bacterium is usually transmitted from the throat or nose of other people through poor hand hygiene. The mother is less likely to be the transmitter of her germs, as she transmits her specific antibodies to the child before birth to protect the nest. This can also be explained by the immune-strengthening property of breast milk.
In rare cases, fungal infections on the nipples provide a breeding ground for inflammation.
Symptoms include painful, red and overheated areas of the chest, fever, and fatigue.
Therapy includes bed rest, sufficient fluid intake for the mother and supportive measures such as a milk congestion in order to completely empty the breast. It is important to know that changing the amount of fluid the mother drinks does not affect the amount of milk produced. Restricting fluid intake in the imagination of reducing the amount of milk and thus breast swelling is wrong.
In addition, (anti-inflammatory) pain relievers and antibiotics, which are mainly effective against staphylococci, are usually given for at least 7 to 10 days.
In very rare cases, e.g. with acute bilateral inflammation, a short break from breastfeeding while pumping and disposing of the breast milk can be considered. Complete and abrupt weaning, on the other hand, increases the risk of congestion. The germs are usually already transferred to the baby when the diagnosis is made and are usually not critical.
Abscess of the chest
About 4 to 11% of women with mastitis develop an abscess. Most often these are superficial and found near the nipple. Occasionally, deeper lying areas are affected, which can be diagnosed quite easily with ultrasound.
The therapy of choice is usually emptying the abscess cavity by means of a puncture under local anesthesia, which usually has to be repeated several times. A staphylococcal antibiotic is also given for at least 10 days.
In severe cases, an operation is performed under general anesthesia, during which the abscess cavity is split open and emptied in order to destroy all abscess chambers. This is followed by daily rinsing with sterile saline solution for a short time. An accompanying antibiotic therapy according to the resistance test of the causative germs for the treatment of the surrounding mammary gland tissue is recommended until the signs of inflammation disappear.
If possible, the interventions are carried out in such a way that breastfeeding can continue.
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