Dear Evonne, as with most things, I'm interested in mastitis because 33
years ago my second contact with LLL was becasue of my hot, sore breast,
fever and generally unwell state. In the old Blue Bible (WABF) on pages 102
& 103 the directions were:
1. Apply HEAT.
2. Get plenty of REST.
3. KEEP THE BREAST FAIRLY EMPTY.
That was my mantra as I struggled through multiple problems with plugged
ducts, laying on the couch with my heating pad under one arm and the baby
in the other, riding herd over the other kids.  I've used it for all these
years with any mother who asked for help.  Page 137 in newest WABF says in
bold: Apply Heat; Get Plenty of Rest; and keep the breast comfortably empty
by Frequent Nursing.

The BF Answer Book pages 418-425, gives a thorough discussion of  sore
breasts.  Mentions all of the above, plus a discussion on constricting
clothes (which was ultimately my problem - too tight bra and oversupply -
deadly combination ).

"Sore Breasts" a pamphlet by LLLI says apply heat; breastfeed often on the
affected side, and rest.

Riordan & Auerbach (1999) have a good discussion on pages 502-507 with a
teaching plan that includes: rest, frequent feedings and warm moist packs.
They also include mention of temporary slight decrease in supply on
affected side.  I had observed this personally and always mentioned it to
mothers having problems as anticipatory guidance - saving lots of grief and
bottles :-)

Biacuzzo, BF the Newborn: Clinical Strategies for Nurses (1999) covers
plugged ducts and mastitis on pages 260-262. She also discusses milk stasis
as a large part of the problem.  (This is recognized by all of these
resources.) She is the only resource to mention use of hot or cold packs in
the care plan.

Jack Newman has a reprint (Handout #22) on Blocked Ducts and Mastitis which
makes an excellent handout. He discusses better drainage, breast
compression during nursing (helps unplug ducts) heat and rest.

Mastitis in Lactating Women by Marsha Walker, LC  Series Two, Unit 2 is an
excellent resource with color pictures, lots of discussion on causes, a
care plan, pros and cons of antibiotics, pus stripping  and much more. It
is 16 pages long and is a truly comprehensive gathering of info available
and is a must addition to a LCs library (as are all the LC Series :-).  It
would also make a very appropriate handout at a Grand Rounds presentation
on Mastitis to the docs who attend.

Stress, fatigue and poor emptying are mentioned over and over by each
author as being major contributory problems. I think it is important to be
familiar with all of these resources as each tends to highlight one or
another of the factors or treatments in more detail.  So the cumulative
effect of learning from a number of sources is more comprehensive and
useful for helping moms..

  Sincerely, Pat in SNJ

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