By Rebecca Reicher, Physiotherapist – Bondi Junction Physiotherapy
Breastfeeding does not come easily or naturally to many mothers, and is not something that we instinctively know how to do. Unfortunately, some women can experience setbacks during breastfeeding including chapped nipples, pain during latching and feeds, strain to the neck and shoulders, breast tissue engorgement, blocked ducts and mastitis. Recurrent blocked ducts and mastitis is one of the more common reasons for premature weaning, but hopefully with good support, education and care, women should be able to feed for as long as they wish to.
So why breastfeed?
There are many reasons why we should support women to breastfeed. Breastfeeding has been shown to benefit and enhance the mother’s bond with her baby, assist in weight loss, and decreases the lifetime risk for ovarian and breast cancer if a mother feeds for 12 months or more1. Babies who are breastfed are less likely to have SIDs1, they have a decreased infection risk1, it helps in prevention of obesity in childhood and adulthood2, decreases the risk of developing Type 2 diabetes in adulthood, as well as decreasing the risk of developing hypertension in adulthood 3.
How can a physio help?
One of the first things a physio can help with is in education of good posture when feeding, and this is important whether a mum is breast or bottle feeding. You should be able to sit comfortably and relaxed for the full feed. It is important to sit with good posture, so that the strain to the body, neck and shoulders is less. When you consider that the mother of a newborn can spend up to 40 hours or more a week feeding her baby, you realise how important this is. Pillows can be used to help support the baby up to chest height, with the baby’s weight supported on pillows rather than held up by the arms. This also will stop mums from slumping forward during a feed.
Good posture will help the baby latch well. A good latch can help minimise the amount of damage and irritation to the nipples4. It will also help ensure that the breast drains well during feeds, and therefore decrease risk of developing blocked ducts and mastitis.
Physiotherapy for managing breast engorgement
Breast engorgement is a normal biological process that commonly occurs when milk first comes in, often between day 2–4. However, the breast can become engorged at any stage especially if a feed is missed. Women will experience a swollen, hard and throbbing breast. The swelling will compress ducts making it hard for milk to flow. The swollen breast also can make it harder for a newborn to latch. Physiotherapy can help with ultrasound to reduce inflammation and swelling, and instruction in gentle lymphatic massage to help reduce swelling. Use of a cold compress between feeds can help settle both the pain and swelling, and heat can be helpful to warm the breast just before a feed.
Physiotherapy for blocked ducts
Blocked ducts can occur whenever there is excess compression on a duct that stops the duct from draining fully, and the milk becomes stuck or “set” in the duct. The technical term for this is milk stasis. Causes of blocked ducts include poor latching, a missed feed, a rushed feed, an over-supply of milk, or wearing a compressive or poorly fitting bra. Physiotherapy is an extremely effective first line of treatment. Treatment may include gentle massage to help settle inflammation and clear the duct; ultrasound to settle the inflammatory process, as well as cause dilation of ductal tissue, both of which will help the blockage to clear; and use of warm and cold packs continue to be very helpful.
If the blocked duct fails to clear, a mother is at risk of developing mastitis. This is an inflammatory condition that can be accompanied by an infection4. If the set milk fails to clear, new milk will form behind the blockage and cause pressure on the duct and surrounding tissue, causing an inflammatory reaction. Mastitis is often diagnosed by the symptoms of fever, flu-like symptoms, chills, a red, hot and tender breast that often has a localised hard lump or wedge-shaped area. It is always ok to continue breastfeeding with both a blocked duct and mastitis, and in fact this can often help clear the duct and settle symptoms. Again, ultrasound is extremely effective at helping to resolve both the inflammation and assist in clearing the “set” milk from the ducts.
Physiotherapy for mastitis
Up to 1/3 of all breastfeeding women experience mastitis. And inexperience isn’t a risk factor! Rather, a previous history of mastitis will increase risk of developing blocked ducts or mastitis again. Many women have said that fatigue and tiredness, stress, poor diet, a change in feed patterns or a missed feed, infection and breast trauma are factors related to the onset of a blocked duct or mastitis5. Unfortunately mastitis causes many women to worry, have days in bed due to illness, experience pain, and can lead to early weaning. For this reason we should given women every bit of support possible to make this breastfeeding journey as smooth as possible.
At Bondi Junction Physiotherapy every effort will be made to see mothers with blocked ducts or mastitis as soon as possible, as our clinical experience shows that mothers who are seen early on generally recover much faster. We also promise to support women no matter what their breastfeeding goals are.
- Leung A.K.C., Sauve R.S. Breast is best for babies.J Natl Med Assoc 2005;97: 1010-1019
- Owen C.G., Martin R.M., Whincup P.H. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115:1367–1377.
- Owen C.G., Martin R.M., Whincup P.H. Does breast feeding influence the risk of type 2 diabetes in later life? A quantitative analysis of the published evidence. Am J Clin Nutr. 2006;84:1043–1054.
- Mastitis: Cause and Management. Department of Child and Adolescent Health and Development, World Health Organisation, Geneva 2000
- Riordan J.M., Nichols F.H. A descriptive study of lactation mastitis in long-term breastfeeding women. J Hum Lact 1990;6: 53-58