Lactating woman
Document Number
Version
Ratified By and Date
Name of Approving Body(s) and
Dates
PP-024
1
Medicines Management Group 21 August
2014, SEOG 21January 2015
SACE South 11 September 2012
SACE North 8 October 2012
Medicines Management Group April 2014,
21 August 2014, SEOG 21 January 2015
UNICEF lead breastfeeding South
Health Visitor/BFI keyworker
Consultant Microbiologist
Medicines Management Group
Medical Director
January 2015
January 2017
Health Visitors and Breastfeeding
Specialists working within the Trust
Type of
Change
Reformat
Changed from
a protocol to
pathway
Date
01/04/14
01/04/14
Description of Change
Reformatted into new Organisation
template
Previous protocol had PGDs for
Health Visitors. These have been
removed. This is now a pathway to
give guidance to manage mastitis.
Document Title
Document Status
Date of
Publication
Key Points
DOCUMENT SUMMARY
Pathway for the management of mastitis in the
Lactating woman
New
Revision
Original: June 2012
Revision: April 2014 Jan 2015
YES
It is important to encourage and support the mother to breastfeed from the affected
breast to aid recovery
If symptoms are not resolving or become more severe within approximately 12 -24
hours medical treatment with antibiotics is recommended to help prevent further
deterioration and possible abscess formation. However, it is very important that the
mother is advised to continue with the management of mastitis. Effective milk
removal is an essential part of treatment.
Available Support
Health visitors
Contents
Page
1.
Introduction
2.
Purpose
3.
Explanation of Terms
4.
5.
Scope
5.1 Causes
5.2 Symptoms
5.3 Predisposing factors
5.4 Management
5.5 Other information
5.6 Support
9
9
9
9
12
12
6.
13
7.
13
8.
14
9.
15
10.
15
11.
Policy Review
16
12.
Appendices
Appendix 1 Health Visitor Role
Appendix 2 Monitoring Compliance
Appendix 3 Appendix 3 Equality Analysis
Introduction
Mastitis is an inflammatory condition of the breast which may or may
not be accompanied by infection. The inefficient removal of milk due to
poor positioning and attachment of the infant at the breast is a
significant contributing factor of mastitis. However, it has been reported
that health professionals regard mastitis purely as an infection and are
often not equipped to help such women deal with the contributing
factors, and may also advise Mothers to stop breastfeeding. It is
consequently imperative for health professionals to understand the
aetiology, prevention and treatment of mastitis. This will then enable
mothers to continue to successfully breastfeed and thus facilitate
achieving of the Department of Health (DH) targets.
2.
Purpose
The main aim of this pathway is to standardise practice
The pathway is a statement of intent and it:
Supports the values of the Staffordshire and Stoke on Trent
Partnership NHS Trust in relation to breastfeeding and infant
feeding.
Outlines staff actions necessary to help mothers recognise the
causes, prevention and early treatment of mastitis.
The pathway outlines the responsibility of the Trust to provide training
in mastitis management, by way of the 3 day breastfeeding
management course, to enable health visitors that have contact with
lactating mums to provide full and competent support.
The Objectives of this pathway is:
To ensure standards are clearly identified
To ensure that trained practitioners provide appropriate treatment
for women with mastitis
Promoting and supporting sustainable breastfeeding is an essential
part of an integrated programme of child health promotion and
parenting support as set out in the Healthy Child Programme (DH,
DCSF 2009) and Every Child Matters (2003).
The pathway is written in conjunction with the requirements necessary
for the Trust to achieve full UNICEF UK Baby Friendly Accreditation.
UNICEF UK Baby Friendly accreditation is a structured programme
3.
Explanation of Terms
For the purpose of this document, the following terms apply:
Term
Mastitis
4.
Explanation
an inflammatory condition of the breast which may or may not
be accompanied by infection
5.1
Scope
5.1.
Causes:
Non-infective mastitis is due to immunological responses to milk .
substances forced into the capillaries and connective tissue from the
alveoli by high pressure. This causes inflammation and pain.
Infective mastitis is less common and is caused by either infection on
the outer skin of the breast or within the glandular tissue. Usually
mastitis occurs unilaterally. If non-infective mastitis is not treated
appropriately then this may develop into infective mastitis and then a
breast abscess may form
5.2
Symptoms:
Local or generalised swelling
Lump or tender area which may feel hot to touch
Breast pain tender lump
Inflammation often wedge shaped
The whole breast(s) ache and may become red.
Slight pyrexia
Flu like symptoms -aching, increased temperature, shivering, feeling
tearful and tired (this feeling can sometimes start very suddenly and
get worse very quickly)
Headache
If initial treatment is prompt, symptoms may resolve in 12 hours or so, if
not, they may progress (below) and become more severe whereby
Medical treatment with antibiotics is recommended to help prevent
further deterioration and possible abscess formation
Feels very ill
Severe pyrexia
Rigours
Mums may not have all the signs (Morbacher and Stock, 2003)
5.3
Predisposing Factors
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
5.4
Management
It is important to encourage and support the mother to breastfeed from
the affected breast to aid recovery
The Role of the Health Visitor/ Breastfeeding Specialist
If signs and symptoms present-review without delay
Undertake breastfeeding assessment and observe position
and attachment help the mother make improvements.
Advise to feed 2-3 hourly, as often and for as long as the infant
is willing including during the night for as long as pain persists.
Discuss pain relief
Identify predisposing factor(s) and give information and provide
support.
Express at end of each feed until lump reduces /redness
subsides
The Health Visitor/ Breastfeeding Specialist should support and
encourage the mother to overcome mastitis by discussing self-help
measures such as: Feeding from the sore side first for good drainage. Leaning over
baby in an upright position may also encourage effective
drainage.
Establish milk flow before putting baby to the breast - run warm
water over the breast prior to feeds
Try different feeding positions - gravity feed or under arm hold
may help
Use massage and heat to soften the breast.
Use a wide toothed comb with rounded teeth to stroke gently
over the red area and towards the nipple to help milk flow.
Checking clothing to prevent continued pressure [a well-fitting
bra is essential].
Relieving symptoms with cooling treatments such as cold
flannels and gel-filled cool packs.
Rest, plenty of fluid and a good diet.
Homely remedies
Avoid sudden changes in feeding practice, for example, longer than
normal gaps between feeds which leave the breasts full for longer.
NOTE: Patient should be advised to attend the GP if either the
following two scenarios present. 1, If bilateral mastitis is present, as it is
advised that a culture of milk from both breasts is taken to establish the
responsible organism. 2, If mastitis is reoccurring it would be
appropriate to test the milk for culture and sensitivity and also to obtain
swabs from the infants nasopharynx and oropharynx to identify the
offending organism.
Other information:
During mastitis the increased sodium levels in the milk resulting from
the inflammatory process, can affect the taste of the milk resulting in
the infant potentially refusing to feed from the affected breast. Also,
there may be a drop in lactose in the milk due to the damaged alveoli
tissue effecting milk synthesis, in the short term (Featherstone 2001)
5.6
Support
Provide the mother with information about breastfeeding support
session details, local and national breastfeeding telephone contact
details.
Provide follow up care and support as the cause needs to be
ascertained and remedied to prevent reoccurrence
6.
7.
7.1
7.2
8.
8.1
8.2
9.
10.
10.1
References
Clinical Practice Guideline. Breastfeeding Challenges Mastitis and
breast abscess. Australian guideline 2009.
Cusack L, Brennan M. Lactational mastitis and breast abscess
diagnosis and management in general practice. Aust Fam Physician.
2011 Dec; 40(12):976-9.
Featherstone, C [2001] Mastitis in Breastfeeding Women: Physiology
or Pathology? Midirs: 12: 2: 235-240.
Foxman, B [2002] New Insights with Regard to risk Factors for
Lactation Mastitis: American Journal Epidemiology: 155: 103-114.
Hale, T [2010] Medications and Mothers Milk 14th Edition: Hale
Publishing: Texas.
Healthy Child Programme (DH, DCSF 2009).
HM Government (2003) Every Child Matters: change for children.
London; HMSO. Available at www.everychildmatters.gov.uk/
Inch, S [2006] Breastfeeding Problems: Prevention and Management:
Community Practitioner: 79: 5: 164-166.
Jones, W., Sachs, M [2009] Mastitis and Breastfeeding: The
Breastfeeding Network: BFN: Scotland.
http://www.breastfeedingnetwork.org.uk/pdfs/BFN_Mastitis.pdf
Kvist, l., Wilde Larsson, B., Hall-Lord, M [2008] The Role of Bacteria in
Lactational Mastitis and Some Considerations of the Use of antibiotic
Treatment: International Breastfeeding Journal: 3: 6.
11.
Policy Review
This pathway will be reviewed in two years following ratification or
sooner if the necessity arises.
Appendix 1
The Role of the Health Visitor / Breastfeeding Specialist
Practice
Rationale/Research
Appendix 2
Name of Procedural
Document
Monitoring Officer
Reporting Arrangements
MONITORING COMPLIANCE
Pathway for the management of Mastitis in the Lactating woman.
Timeframe
6-12 monthly
quarterly
ongoing
Nominated
Lead
UNICEF
Leads
Breastfeeding
support group
leads
UNICEF
Leads
Appendix 3
EQUALITY ANALYSIS
Pathway for the management of mastitis in the Lactating woman
STEP 1: What is the background and starting point for this pathway?
1.1 This is a new pathway.
Currently there is no local guidance on how to manage mastitis in the lactating
woman. Mastitis, if left untreated at worst can cause a breast abscess and at
least may lead to a woman being wrongly advised to give up breastfeeding.
1.2 The pathway fits with the organisational objective/values of
Providing high quality and safe services which provide excellent
experience and best possible outcomes
Empowering and supporting the workforce to deliver care in a way
which is consistent with our values
Putting quality first
Be user focussed and responsive
Be respectful and caring of people
1.3 Health Visitors and FNP nurses who have undertaken breastfeeding
management training and who are SSOTP employees are responsible for the
implementation of this Pathway.
STEP 2: What do we want to achieve?
To ensure that all mothers are given timely information/ treatment to
treat and reduce the complications that mastitis may cause.
To ensure that staff who are involved with supporting women with
breast feeding receive essential training to enable them to support
women with mastitis symptoms/diagnosis
Supporting mothers to breastfeed which is key to reducing health
inequalities.
Who is the target audience?
Lactating women, health visiting staff, staff returning to work and who
are breastfeeding.
The aim of this pathway is to ensure a quality standard of care is given
to lactating women with symptoms/signs of mastitis. It will not
discriminate against any of the equality groups
Without the pathway, there is a potential for larger costs to the
Pathway for the management of mastitis in the Lactating woman V1
Page 21
universal support and education to mums wishing to b/f babies and the
inclusive approach enables education and support to be at the pace
and in the format most suitable to the mother.
Actions identified within the pathway will have minimal cost
implications. Mastitis treatment and diagnosis is already part of the
breastfeeding training curriculum. This pathway will support the existing
breastfeeding training which takes place over 3 days.
STEP 6: Have you identified any actions:
The pathway will support existing breastfeeding training and give further guidance
to manage mastitis in the our practice based community.
STEP 7: How will we know that the pathway has been successful?
7.1 The pathway will be reviewed annually or as new information comes to
light.
UNICEF Audits will show that staff can demonstrate the knowledge and
practice advice they give to breastfeeding women in relation to
managing mastitis and that breastfeeding women with mastitis were
given the correct information/support to prevent/manage mastitis.
Anecdotal feedback from mums who say they may have given up
breastfeeding due to mastitis but carried on due to timely treatment and
support.
Monitoring of breastfeeding rates.
Achievement of full UNICEF accreditation which will demonstrate that
at least 80% of clients are receiving the care and support they need to
breastfeed their baby.
7.2 as above and
Via health visitor team leaders, health visitor team meetings and
updates
SSOTP NHS Trust have set up a web page re breastfeeding
information
STEP 8: Executive Summary
The Pathway for the management of mastitis in the Lactating woman
sets out the best practice regarding delivering a minimum standard of
quality care, equally accessible to lactating women with
signs/symptoms of mastitis. This fits well with ensuring fair and quality
care for all.
The equality analysis indicates that the pathway will meet equality and
inclusion criteria; cost implications in terms of resources and training to
meet
the requisite standards will be negligible because mastitis is already
covered
in the UNICEF accredited training curriculum and this pathway will act
as a
supporting practice document