Breast feeding and awareness of the importance of doing so for new mothers is commemorated annually in August. Physiotherapy plays an important role in the education of posture and positioning during breast feeding, as well as providing information and treatment of conditions which new mothers may experience. “Breast-feeding is a matter of concern because it has such a wide range of often under-appreciated consequences’’

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.

Optimal 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
Here are some videos which may be of interest to new mothers:

How to breast feed

How to position your baby while breast-feeding

Common Problems experienced by mothers

Engorgement

For the first few days after giving birth, a new mother’s breasts remain soft. During the next few days, the breasts will become full, firm, warm, and perhaps tender. The term for this is engorgement. Engorgement is normal, and lasts for various periods of time depending on the individual woman. The breasts will adjust over time, eventually making exactly the right amount of milk for the baby. If poor latch results in poor emptying of the milk, the build-up can cause breast engorgement to become severe. The breasts may redden and become painful.

Mastitis and Blocked Ducts

Mastitis is an infection in the tissue of the ducts inside the breast. There is often a hard, sore spot inside the breast. This can result from a blocked milk duct or because bacteria enter the breast through a break in the skin. Mastitis that occurs during breast-feeding is also known as lactation mastitis and can usually be easily treated. Most women make a full recovery very quickly.

Symptoms of mastitis

  • anxiety and feeling stressed
  • chills and shivering
  • elevated body temperature
  • fatigue (more than normal)
  • general aches and pains
  • a feeling of malaise

Complications from mastitis or engorgement.

  • Untreated engorgement and mastitis can sometimes lead to MORE complications.
  • Recurrence: If mastitis has happened once, it is more likely to happen again. Recurrence often results from late or inadequate treatment.
  • Abscess: Without proper treatment, a collection of pus, or abscess, can develop in the breast. This usually needs surgical draining.
  • Septicaemia or sepsis: These are life-threatening conditions that can result if an infection is not treated.

Pain, fever, inflammation, and any persistent difficulty with breast-feeding should be discussed with your physiotherapist.

Physiotherapy treatment for breast-feeding

In a randomised controlled trial, scientists examined a range of different treatments for breast engorgement and mastitis by a physiotherapist. They found that acupuncture, ultrasound, dry needling and massaging of the breast do help with relief for struggling new mothers. Other advice includes:

  1. Cabbage leaves applied to the breasts (make a whole for the nipple to breathe)
  2. Cold gel packs, Use cold compresses for 10 minutes after feedings to reduce swelling.
  3. Pharmacological treatments – medications such as ibuprofen and anti-biotic to reduce pain and inflammation.
  4. Gently massage and compress the breast when the baby pauses between sucks.
  5. A well-fitted, supportive nursing bra makes some women feel better.

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 a 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.
  • 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.

This article was updated by Jenilee Fortuin who practises at Lamberti Physiotherapy Fourways. Contact her to discuss treatment of engorgement, blocked ducts or mastitis. Alternatively, for further advice and instruction in posture and successful attachment please make an appointment with any of our Physiotherapists at a branch near you.

 

References:

  1. The breastfeeding breast vhttps://www.fairview.org/patient-education/85662 (2017) Reviewed by Debra Rose Wilson.
  2. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect for The Lancet Breastfeeding Series Group (2016)- Cesar G Victora, Rajiv Bahl, Aluísio J D Barros, Giovanny V A França, Susan Horton, Julia Krasevec, Simon Murch, Mari Jeeva Sankar, Neff Walker, Nigel C Rollins, etc.
  3. Breast Pain: Engorgement, Nipple Pain, and Mastitis (2015)- PAMELA D. BERENS, MD