The lactating mother/parent in hospital
Mastitis & Breast Abscess
For general information about making a diagnosis of mastitis, see the GP Infant Feeding Network page. The NICE Clinical Knowledge Summary makes it clear that both parent and infant should be admitted together if admission is indicated for mastitis or abscess, to allow continuation of breastfeeding/chestfeeding as part of the treatment process. The parent should be advised to continue breastfeeding/chestfeeding if possible (including from the affected breast/chest). A lactation specialist should be involved to assist in improving the infant's attachment to the breast/chest, improving milk removal and preventing further nipple damage. If breastfeeding/chestfeeding is too painful, or the infant refuses to feed from the affected side, the parent should be advised to express the milk (by hand or with a breast pump) until they are able to resume feeding from that side.
Of note, a transmasculine parent who has given birth will be at risk of mastitis if they have any mammary tissue - which they usually will even if they have had chest surgery. They may indeed be at higher risk than a cisgender woman because surgery may interrupt the milk ducts and there may be mammary tissue within the chest whose drainage is blocked. This applies whether or not the individual wants to continue lactation or not and therefore all pregnant transmasculine parents should be advised how to check for signs of, and manage, mastitis.
Many NHS settings admit those needing admission for mastitis-related sepsis, or abscess, to postnatal wards rather than general surgery wards, which will improve their lactation-specific care and facilities.
The Academy of Breastfeeding Medicine has a protocol for breast/lactating chest masses, complaints and diagnostic breast/chest imaging in the lactating person.
Other breastfeeding/chestfeeding problems presenting to the emergency department
Parents may occasionally come to the Emergency Department with other breastfeeding/chestfeeding related problems such as pain. See the NICE Clinical Knowledge Summary for more information.
Admission for other reasons
When a lactating parent is admitted to hospital for any reason, health professionals need to be aware of their specific needs. If breastfeeding/chestfeeding ceases suddenly they will be at risk of pain and mastitis, particularly when the infant is exclusively breastfed/chestfed. Where at all possible breastfeeding/chestfeeding should be supported to continue with the help of an additional carer to take responsibility for the infant while the parent is unwell. Some NHS settings have policies that all lactating parents should be supported to be admitted with their babies (join our facebook group to discuss this further). If this is not possible then expressing milk will reduce discomfort and risk of mastitis, as well as providing milk for the infant or child.
The mother/parent may hand express if a pump is unavailable or that is their preference. See a video on hand expressing technique here. Electric pumps are often available from maternity settings, children's wards or the emergency department. Those who aren't used to expressing may find it difficult to get 'let-down' (milk ejection) for a pump or via hand expressing. Warming the breast/chest may help, for example hand expressing in a shower, or looking at photos and videos of the baby and smelling objects belonging to the baby. Maternity infant feeding teams may be able to offer support to those admitted on general wards.
It should also be noted that it may be very difficult for an exclusively breastfed/chestfed baby to suddenly feed by another route. When milk is expressed to provide milk for the infant or child, it should be stored correctly (see advice here), and transported efficiently.
We have a downloadable poster that may be helpful to educate staff on these issues.
Medication and lactation
See separate page on medication and lactation, including contrast agents and anaesthetics