Thanks, Naomi and Pamela, for your reactions.

Some things I have seen that all (Anne, Pam, Monica) are agreeing on, and could be helpful in the clinical management:
- There is far too much antibiotics prescription on mastitis that probably is not bacterial, but an inflammation through pressure (too much milk, edema, false positioning etc). 
- The idea of one plugged duct has to be evaluated - since they are far too small to be felt individually
- Deep massage is harming the tissue and contributing to the inflammation, so should not be recommended
- Too much pumping may aggravate the problem - try hand expression, just to resolve pressure.
- Pumping should be according to the need of the baby, not "overpumping". We are looking for an adequate term instead of "Too much milk", because "too much" isdependent on the need of the child/children. Obviously we need more milk for a twin then for a single child.

The more we exchange, the better we get the picture. Thanks for your contributions.
Kind regards,
Elien

Elien Rouw, MD, FABM
President-Elect Academy of Breastfeeding Medicine
Im Wasserbett 7
77815 Bühl
Email: [log in to unmask]


Date:    Sat, 9 Sep 2023 20:37:02 +0100
From:    Pamela Morrison <[log in to unmask]>
Subject: ABM Protocol # 36, Mastitis

Ellen Rouw, thank you for taking the time and trouble to join the conversation with your ABM President-Elect hat on.  I think we all place great reliance on the ABM protocols, and view them with great respect, which is what makes #36 of special concern – it is unexpected for so many of its recommendations to go against the observation, experience and understanding of so many of us who ourselves have worked with breastfeeding mothers for many years, and for whom prevention and treatment of  postpartum engorgement, mastitis, or abscess is almost a bread-and-butter matter.



Unfortunately I wont be registering to see the session you mention, though I will read anything written by anyone as long as it’s not behind a paywall.  I do have the presentation by Dr Mitchell from Oregon, University of Washington.  And of course the latest article by Pam Douglas.



This has been one of the most controversial topics to come up for quite some time.  I appreciate reading others’ opinions and continue to hope that if we all talk long enough, a way forward will be found.  We definitely do need more research.



Meanwhile, Anna asks, “While this is being thrashed out, I would treasure insights on how best to support families in the meantime.” Anna, I myself am also very troubled by this – I’ve recently written a booklet (still awaiting publication) which includes a section on mastitis and I’m very eager not to include unhelpful information!  Today in another second-guessing exercise, I again looked up some of the resources I feel I can trust.  Amongst them is the WHO protocol on Mastitis at
https://www.who.int/publications/i/item/WHO-FCH-CAH-00.13  Although published in 2000, this still seems like a a very useful and comprehensive document and the authors and contributors read like a Who’s Who in the lactation field.  But mostly, its rationale and recommendations make sense to me, and they reflect my observations and experience.  So for now, while keeping an open mind and hoping to learn more, I’ll be sticking to this.



Pamela Morrison

Retired IBCLC, Rustington, England

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