Mastitis Round 2 and Breast Massage

Four weeks to the day of my first round with mastitis I was struck again! This time in both breasts at the same time. I knew exactly what it was this time when my fever spiked to 103.9. I started massaging my breasts and tried feeding as much as possible. I pumped and added it to my storage in the freezer. I knew I needed to see the doctor though. So we walked up to the hospital again. When the nurse saw me and felt my breast she too knew right away. She told me she would massage the lumps out again for me and called in another prescription. This time was double the pain since I had to have both breasts cleared of lumps. Poor Violet cried and cried. Luckily, they took her to another room so that I could cry too. Finally that release came and my milk again flowed through my nipples. I nursed Violet and let her empty both breasts. While she nursed the midwife told me that a lactation specialist came once a month from the neighboring city of Sendai. Every month she came to give advice and breast massage to nursing mothers. I had never heard of routine breast massage before but decided to give it a go. She told me that it would help keep me from getting clogged ducts. Some women use it to help produce more milk and others use it because they make too much milk. I fell into the ladder category. I have always produced an abundance of milk and the midwife was certain this was what was causing my mastitis problems. So I made an appointment for the first available time slot. The only day that month that she would be in town was the day we were leaving for the US to visit family for Christmas. I knew I had to make time to do this so we adjusted our travel schedule and I went in for my hour 2 hours before our scheduled departure from Ofunato. My hubby packed the car up and got everything ready to go while I was getting my treatment.

First time patients were given a discount and charged only 2,000 yen (roughly $23). I was instructed to bring my own hand towel. The room was much like a classroom and was set up with cushions on a tatami floor with a moveable curtain partition. Behind the curtain the floor was lined with soft mats for lying on. I could hear the LS talking to the current patient and she sounded so joyful and kind. She didn’t speak English but luckily my dear friend, Mutsuko, had come with me to help translate. When it was my turn I was asked to go fill a small basin with warm water and bring it back to the massage area. When I got back there the LS was waiting with a smile on her face. She asked me to lie down on my back and remove my shirt. She then covered me with my hand towel and started to work. She told me that it was going to hurt at first but that it would help me in the long run. So I braced myself for another painful hour. It did hurt quite badly at first but after about 10 minutes the pain turned into more of a slight discomfort. She constantly wet her hands in the warm water and kept my breast warm the entire time. She started working from my armpit area first and then worked her way in to the center. When I was first nursing my breasts sprayed like fire hydrants every time I let down. (Just like my dream during pregnancy!) I often sprayed my daughter in the face by accident and a couple of times my husband was caught in the crossfire. As I started to feel my self let down I began to get nervous that I would spray the LS in the face. When she started to laugh, I knew that was just what had happened. She laughed so hard but in a kind way. She told me “No wonder you keep getting clogs. You have enough milk to feed triplets!” We both laughed and she continued to work on my breasts. The towel that covered me was soon soaked with milk and she repeatedly rinsed it in the warm water and placed it back on my breasts. She gave me tips on feeding like changing the position often and trying upside down (meaning while laying down have my daughter’s feet in my face as she nursed lying down) to get all the ducts cleared out frequently. She also asked me about my diet and what I ate. She told me that rice turns straight into milk. She said to try to stay away from oily meats and fish, fried food and sweets because these things can cause clogged ducts by making the milk too “sticky”. She also asked me about my sleeping position. I told her that I frequently fell asleep while nursing so I usually slept on my side. She told me to try to sleep on my back as often as possible because the pressure on the breast while sleeping on it could cause clogs as well. She was very kind and informative and I was so thankful to be able to receive treatment before my big trip. Knowing that I was going to be traveling to the States for Christmas, before I left she reminded me to watch what I ate while on vacation and to try to eat as healthy and as normally as possible. The massage was so helpful and I could hardly believe how soft my breasts felt when she was finished. She took my hand and said “Here touch your breast now. Doesn’t it feel like mochi now!” And it did! My breast felt like soft fluffy pillows. I couldn’t believe it! I smiled so wide and she gave me a big hug (which is not common in this culture). I started to cry. I felt so relieved and so light. She hugged me and told me what a wonderful thing I was doing for my baby. She encouraged me to keep on going even when it felt hard or painful. She was an amazing, motherly woman. I was so thankful and promised to be back in a month. At the end of my session I was asked to go rinse the towels that had been used in my treatment and also the basin of water. The towels smelled like sweet cantaloupe and the water was milky white. My little angel was sitting there resting sweetly in her Auntie’s arms and woke up just as I was finished. I nursed her there and before we left she rolled from her tummy to her back for the very first time. She was almost 3 months old. I felt so relaxed and so happy. Now if only they offered these breast massages in the US.

Mastitis Round 1

When I had my 6 week postpartum check up I was feeling great! I was producing more than enough milk. I had a large reserve in my freezer and was nursing every 2-3 hours. It was going so nicely. Violet and I walked up the hill to the hospital for my appointment enjoying the nice autumn weather. (It was about a 15 minute walk to the hospital) My Dr. told me that my body was healing nicely and that I could resume my normal activities. I was thrilled. Violet and I walked back home from the hospital and enjoyed a nice nap together. Violet was scheduled for her first well baby check up the next day. That night I started feeling like I was getting a cold. My head started to hurt and I felt weak and feverish. I thought maybe I was just tired. I went to bed early only to wake up 2 hours later with cold chills. I took my temperature and realized I had a fever of 103.9! I woke up my husband terrified that I had the flu and that I was going to give it to our baby. He brought me some tylenol and cool rags to put on my head. I got online to search what to do when breastfeeding while sick. I found that I should continue as the antibodies in the milk would help her fight off whatever I had. I put on a surgical mask just for added protection. Side note: It is common in Japan for people to wear surgical masks when they are sick so as not to infect the people around them. When I first arrived in Japan I thought it was so strange to see people walking around with masks on.) That night my fever continued to hand around 102-103. I felt achy throughout my whole body and felt like I couldn’t stand up. But I kept nursing my little angel hoping she would sleep longer than 2 hours at a time so that I could rest. At around 3AM my right breast started hurting extremely badly. Every time Violet nursed it felt like a thousand pins and needles stabbing me through my nipple. She started crying too because she wasn’t getting enough milk out. I woke up my husband again and asked him to get my book. he knew exactly which book I meant. In the first few months of Violet’s life “my book” meant The Complete Book of Breastfeeding by Sally Wenkos Olds. I kept that book hand at all times. He went to retrieve it from the living room and brought it back to me in bed. After some reading I realized that I probably had a plugged duct. The rest of the night I kept trying to feed her hoping it would clear itself out without turning into mastitis. By the time it was time for Violet’s appointment I was exhausted and overwhelmed. My husband dropped us off at the hospital for her check up and had to get to work. We got in and got checked in for her appointment. Because Japan has socialized medicine (which by the way, I LOVE!) everyone with a baby around 1 month old was there for their check up. There is no specific appointment time. It goes by order of arrival. So you just sit and wait until you are called. Sometimes it goes quickly, other times it does not. This was one of the times when it did not go quickly. Violet kept wanting to nurse and I was still using nursing covers at that time. She kept pulling it off and I was getting sweaty from my fever breaking and so I gave up on the cover. I sat in the waiting room with my shirt half open and let her drink. When it was finally our turn the Dr. checked out Violet and said she was perfectly healthy and gaining weight at a normal rate. He was pleased with her breastmilk intake and told me we were doing a great job. Then he finally looked into my eyes and saw how tired I was. He asked if I was ok and I told him what was going on. He immediately called upstairs to the OBGYN ward and asked if they could see me. They were no longer seeing patients but the head midwife said she would check my breast for me if  I came up. So we walked up the stairs and waited to be seen by the midwife. She came out and I recognized her from my prenatal visits. She, thankfully, was not the nipple twisting nurse from the previous story. One of the administrative clerks came in to hold Violet while the midwife felt around my breast. She said that there was definitely a clog and most likely mastitis. She called the OBGYN and had consulted with him over the phone. He decided to call in a prescription for antibiotics and suggested that the midwife massage my breast to get the clog out. She asked me if I that sounded ok. Massage! Sure why not! I quickly agreed. Then she informed me that this was going to be extremely painful and was I sure I wanted to go ahead. I thought about the pain I was having already and decided it would be better to get the clog out and done with. So the torture began. She was as kind and gentle as she could be but honestly, this hurt worse than my 73 hour drug free labor! She started from under my arm and worked inward manually expressing milk from my nipple. She found the clog and started to massage that area. She twisted and pulled on my breast until finally, at last, my milk was once again spraying from my nipple and the other 5 holes on my areola.I felt a like a huge weight had been lifted off my body. Poor Violet cried the whole time and I am sure that helped my milk let down. Once she saw the milk spraying she cried even harder like she was saying, “Hey I have been waiting for that! Don’t waste it!” So they let me feed her back in the exam room until she was satisfied. The pain continued while I nursed her even though the clog was gone. She told me that was because of the infection. She assured me that the best way to heal was to keep nursing through the pain. So that is what we did.

When we got to the pharmacy the pharmacist asked if I was exclusively breast feeding. I told him that I was. He looked at me and asked if I had any formula in the house for emergencies. I told him I had the free can from the hospital but that was it. He told that I would need to use that unless I had a storage of breastmilk because it wasn’t good for Violet to nurse while I was on antibiotics. Well that through me for a loop. The midwife just told me to continue nursing to help my breast heal faster! I explained this to him and he said that I would need to take the medicine at the beginning of a feeding and then she could have my milk until 6-8 hours later! What!!! I freaked out! I did have pumped milk but Violet had never had a bottle before. We had never even tried because nursing was going well and I was terrified that if I skipped a feeding my supply would drop. I told him she drank every 2-3 hours still. He sighed and said that at most we could wait 4 hours. I cried all the way home worrying about how I was going to feed my baby. When my husband got home I told him my predicament. He assured me that he would help and that we would get through it. I would pump so that I wouldn’t miss a feeding and we would give her a bottle of previously pumped milk until it was safe. So I took my medicine and started a feeding. She feel asleep and I was so relieved! I hoped that she would sleep for at least 3-4 hours so that we wouldn’t have to worry. ! I got the milk ready from the freezer and pulled down one of the bottles that were still in the package. We sterilized the bottle and had everything ready just in case. She woke up after 2 hours! I decided to try the bottle. Violet cried and cried and pushed the synthetic nipple out of her mouth each time I tried to put it in. She looked up at me with eyes that said “Why are you torturing me! You have what I want! Why aren’t giving it to me!” I started to cry. I told my husband that it wasn’t working. So he stepped in and tried. She still wouldn’t take the bottle. Later I learned that when introducing a bottle for the first time it helps if the source of the milk (ie Mama) is not around. So we just had to rock her and console her as best we could until the 4 hour mark. She did calm down but she definitely wanted the boob! I pumped to get out the “tainted milk” and tossed it out. When it was finally time I sat on the couch with her and her eyes were filled with anticipation. I couldn’t get my shirt open quickly enough. She cried and cried and once my full breast was in her mouth her whole body gave way to a relaxation I had not yet seen, since she had never been denied my breast before. She slept and we all took a deep cleansing breath of relief. I decided to do a little research after that. The antibiotics that I was prescribed were considered safe for breastfeeding. The pharmacist was being overly cautious as he is required to be. Also with my lack of Japanese we had somewhat of a communication mishap. It was of course safest if I waited until all of the medication was out of my body. But it would not harm her if I fed her before that. She could possibly react with thrush but nothing life threatening. I consulted my books and my Nurse Practitioner mother-in-law. After one more failed attempt at a bottle feeding I decided it was time to throw in the towel. I just gave her what she needed, me. And what I needed too. The thought of bottle feeding was putting too much stress on me and I didn’t want to do it. I can honestly tell you that the first time I put that bottle in her mouth I felt like I was poisoning her. I cried and cried and it broke my heart. I don’t know why I reacted that way. I know that bottle feeding is perfectly fine and I know that many women have no other choice but to pump and bottle feed. But this was not for me. It was not what was right for our daughter. So the bottles went back into the cabinet never to be touched again.Thankfully my pain subsided after the 3 day of antibiotics and my fever went down on the second day.

I wanted to list some of the things that helped me when I had clogged ducts and mastitis:

massaging the affected breast

warm compress (I used Breast Buddies, see link “soothing breast care” on side of page )

nursing as often as possible

warm bath or shower and manually expressing milk in the warm water

tylenol for fever or pain

pumpingin between feedings

Also, Just as a reference I am going to post a list of breastfeeding safe antibiotics. Of course always consult your doctor before taking any kind of medicine or supplement.

Amoxicillin Larotid, Amoxil Approved B L1

Aztreonam Azactam Approved B L2

Cefadroxil Ultracef, Duricef Approved B L1

Cefazolin Ancef, Kefzol Approved B L1

Cefotaxime Claforan Approved B L2

Cefoxitin Mefoxin Approved B L1

Cefprozil Cefzil Approved C L1

Ceftazidime Ceftazidime, Fortaz, Taxidime Approved B L1

Ceftriaxone Rocephin Approved B L2

Ciprofloxacin [more] Cipro Approved C L3

Clindamycin Cleocin Approved B L3

Erythromycin E-Mycin, Ery-tab, ERYC, Ilosone Approved B L1
L3 early postnatal Fleroxacin – Approved

NR Gentamicin Garamycin Approved C L2

Kanamycin Kebecil, Kantrex Approved D L2

Nitrofurantoin Macrobid Approved B L2

Ofloxacin Floxin Approved C L2

Penicillin – Approved B L1

Streptomycin Streptomycin Approved D L3

Sulbactam – Approved – NR

Sulfisoxazole Gantrisin, Azo-Gantrisin Approved C L2

Tetracycline Achromycin, Sumycin, Terramycin Approved D L2

Ticarcillin Ticarcillin, Ticar, Timentin Approved B L1

Trimethoprim/sulfamethoxazole Proloprim, Trimpex Approved C L3