You mentioned blocked ducts, mastitis and abscess. Are they common and how can we treat them?

They do not need to be common conditions as they result from engorgement, infrequent feeding or poor attachment. They become rare if The Ten Steps are implemented. They all need rapid help.

A blocked duct shows as a tender red lump. This can happen if one part of the breast is not well-drained.

· Try to improve the baby's attachment, perhaps by changing the position when you feed.

· Check that your bra or other clothing is not tight. Bras with flap openings can put pressure on one area of the breast and obstruct the milk flow. If you cannot get another bra, cut the cloth where it presses. If you feel comfortable without the bra, stop wearing it.

· Do not use the 'scissor hold' as that can obstruct the flow.

· If it feels more comfortable support your breast from underneath with your hand.

· Gently massage the affected area while the baby is suckling.

· If possible apply warmth to the breast between feeds.

Mastitis is when the breast is red, swollen and painful. Unlike engorgement it may be in one breast only or just a part of the breast. You may feel ill and have a fever. Mastitis is caused by poor drainage of milk from sections of the breast. Sometimes germs will multiply because of the poor drainage and cause infective mastitis. It is difficult to tell, but if fever and flu-like illness persist it may be infective mastitis. If you can, ask a health professional to give you the following antibiotics and finish the course. See box below. They will not harm the baby.

Show this to a health professional Antibiotic treatment for infective mastitis The commonest bacterium found in breast abcess is Staphylococcus aureus. Therefore it is necessary to treat breast infections with a penicillinase-resistant antibiotic such as either flucloxacillin or erythromycin.
Drug	Dose	Instructions
Flucloxacillin	250 mg orally	Take dose at least 6 hourly 30 minutes before food for 7-10 days
Erythromycin	250-500 mg orally	6 hourly for 7-10 days

The commonly used antibiotic ampicillin is not usually effective.

If you can get paracetamol tablets for the pain, use them. They are safe to use while breastfeeding.

Whether you can get antibiotics or not, it is very important that you keep the milk flowing. The best way to remove the milk is to let your baby suckle.

The germs from infective mastitis will not harm your baby and are destroyed by his digestive enzymes.

It is a risk for both you and your baby to stop feeding. It may be hard to attach a baby to a swollen hard breast, so gently express a little milk first.

Some women do not want to breastfeed when they have mastitis. They need help to keep the milk flowing through gentle hand expression several times a day. The baby can be cup-fed with the milk which is still the best food for the baby. Resume breastfeeding as soon as possible.

An abscess is a hard, painful swelling filled with pus that can result from neglected mastitis. Use the same treatment as for mastitis. You may need a health professional to excise and drain the abscess, but you can still carry on feeding. If it is too painful, continue feeding from the unaffected breast and gently express milk from the affected breast for 2-3 days. Then resume feeding.