I am perhaps a bit late in replying to this as I am only just now catching
up with several weeks of Lactnets. I just wanted to follow up on Barbara's
comments regarding prospective studies on mastitis incidence. I have
published a further study (to the retrospective study of 1995 quoted in
Barbara posting) which was a prospective cohort followed for 3 months post
partum. I found a cumulative incidence of 27.1% for mastitis episodes
suffered during this time. The reference is: Fetherston, C.1997.
Characteristics of lactation mastitis in a Western Australian cohort.
Breastfeeding Review. 5(2):5-11. In addition to the Kinlay et al. paper
Denise quoted, there has also been a recent publication of a New Zealand
study that followed women prospectively for 12 months post partum and found
an incidence of 23.7% for women experiencing one or more mastitis episodes.
The reference is; Vogel, A., Hutchinson, A., & Mitchell, E.A. 1999. Mastitis
in the first year post partum. Birth. 26(4): 218-225.

There is no doubt that mastitis remains a significant problem in affluent
communities and that there are many many areas that require investigation if
we are to begin to make inroads into prevention of the problem. However
prevention relies upon a thorough understanding of the etiology of mastitis.
I feel there  are many factors (some researched, but a great many not)
ranging from cultural and breastfeeding practices to physiological and
pathological factors that contribute to the high incidence of mastitis.
Until we can broaden our understanding of these areas it is important that
we continue to highlight successful treatment strategies as Lisa's paper in
Current Therapeutics does. This paper provides clinicians with a very easy
to follow and succinct Management Guide Flow Chart outlining current
management. In addition, the JHL paper draws attention to many issues that
need to be considered by clinicians treating mastitis - not the least being
inadequate documentation of diagnosis, relevant history and substantiation
of antibiotic treatment. These papers are important because they raise the
profile of mastitis as a significant problem among lactating women and
reinforce currently accepted treatment strategies.

Cathy Fetherston
Clinical Midwife IBCLC MSc

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html