Breast Feeding

August sees the celebration of National Breast Feeding Awareness Week which strives to provide awareness of the importance of breast feeding.  Physiotherapy plays an important role in the education of posture and positioning during breast feeding, as well as providing information and treatment of breast engorgement and blocked ducts which may develop as a result.
How Breast Feeding Works
The breast is made of a network of ducts.  Fatty and glandular tissue containing these small ducts end in alveoli in which milk is produced.  Research has shown that the ducts are close to the surface of the breast and are approximately 2mm in diameter and easily compressed (Ramsay, et al, 2005).  Small nerves within the breast are stimulated when the baby suckles and causes a release of a hormone, Prolactin, which stimulates the production of milk.  Oxytocin is also released which allows the glandular tissue to contract and release milk into the ducts.  The more the baby suckles, the more milk is produced thus allowing a supply and demand effect.
Posture and Positioning
When breast feeding, it is important to maintain a good posture both for yourself and the baby.  This allows for the breast to be positioned straight which makes it easier for the baby to attach.  Bring the baby up to the nipple and prop them up using a pillow for support.  You should not feel like you are taking the weight of the baby in your arms, but rather guiding the baby into the correct position.  Do not lean forward and take your breast to the baby as it provides a more difficult position for the baby to attach and can lead to back and neck pain for you. Poor posture can lead to painful attachment and feeding owing to the abnormal pressure on the nipple, and can cause cracking or open areas.   The baby is usually held in a “cradle” position or under the arm as this helps to drain the breast completely.  Side lying is also an option when positioning for breast feeding, especially when you are tired.
Breastfeeding-Postioning-300x110Correct positions for breast feeding
Common Problems
Engorgement

This can occur with milk production and is quite uncomfortable.  The swelling may restrict the flow of milk by compressing the ducts. Breasts may also be quite hard which makes it difficult for the baby to attach and feed well.

Blocked Ducts and Mastitis

 Blocked ducts may occur when there is excessive compression of the ducts causing restriction of milk flow.  The restricted milk can “set”, therefore blocking the ducts.  Many factors can cause blocked ducts, namely; bruising, swelling, poor positioning, poor attachment, finger compression, and hurried feeds. If a blocked duct is not cleared, it can develop into Mastitis.  This is an infection of the breast tissue and feels like a hard lump.  The area will be tender and swollen, and may also become red.  A fever may develop if left and a generalized ill feeling.  Mastitis can develop into an abscess if left untreated and on occasion pus can be seen in the breast milk. A blocked duct can develop into Mastitis within hours.  If you are unable to clear the blockage by yourself, it is advised to seek help.  If a fever starts to develop it is advised to see your doctor and go on antibiotics.

Physiotherapy Management
Physiotherapy can help with the discomfort and swelling of breast engorgement, as well as opening or clearing of blocked ducts.  This is done by the use of Ultrasound, drainage massage of the breast, as well as education on correct positioning during feeding.   Demand feeding and using heat just before breast feeding may be beneficial, and using something cold on the breast after feeding may assist with swelling.  Continuing to breast feed is important as it may help clear a blockage.
How to avoid problems
  • Milk flow can be restricted by a poorly fitted bra, poor positioning of you and or the baby, compression from your fingers holding the breast, if too firm, and even sleeping on your stomach.
  • Incomplete drainage with hurried feed can cause the milk to settle in the ducts and cause a blockage.
  • Positioning yourself and your baby correctly to avoid back and neck pain as well as avoiding compression of the ducts is very important.  On occasion it is advisable to feed in different positions (sitting, side lying) if you have already experienced a problem.
What to do
  • Fully drain the breast at each feed, either by feeding or expressing.
  • Stand in a warm shower and express the lumpy blocked area and follow up with a feed.
  • If the blockage does not clear within 12 hours, seek help from your Physio, GP or Obstetrician.
For treatment of engorgement, blocked ducts or mastitis, or advice and instruction in posture and successful attachment please make an appointment with one of our Physiotherapists.

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