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Protect breastfeeding, a shared responsibility. How can Physiotherapists help?

by SRC Health

One in every three mothers cease breastfeeding due to pain or infection 1, despite the World Health Organization recommending that all infants are exclusively breastfed for the first six months of life 2. Breastfeeding helps to create a strong emotional and psychological bond between mother and baby and assists optimal development, growth and health 3, 4. There is compelling evidence to suggest that lactating and breastfeeding for mother and baby are associated with increased health benefits 5.

Physiotherapy is not the first thing that comes to mind when mothers are having difficulty with breastfeeding. But as a Women’s Health Physio, and training Lactation Consultant, here are two important points I’d love you to know…

  1. Physiotherapists can help treat inflammatory conditions of the lactating breast (ICLB). Conditions considered an ICLB may include engorgement, blocked milk ducts and mastitis 6.
  2. Breastfeeding is NOT a reason to cease exercise. Exercise has so many known health benefits both physically and psychologically. Physiotherapists can help set up appropriate exercise programs or give exercise options for a graduated return to exercise.

Let’s explore both points…

Firstly, those who have had mastitis or blocked milk duct know that symptoms can be disabling 7. Physical symptoms of ICLB may include both local symptoms (breast pain, tenderness, redness and heat) and systemic symptoms (fever, hot sweats, cold shivers, lethargy, fatigue, nausea and vomiting) 7, 8.

Treatment for ICLB aims to provide a quick reduction of clinical symptoms and pain to allow mothers to continue breastfeeding 9. Therefore, interventions must reduce inflammation and clear the obstruction causing milk stasis 9. Specific interventions to meet this aim have some positive outcomes in research, however, none are supported by robust clinical trials 3.

  • Superficial hot and cold packs helps reduce swelling and pain 10-13
  • Cabbage leaves effective in reducing engorgement, pain and swelling 11-15
  • Acupuncture treatment decreases breast tension and pain 16.
  • Education on breastfeeding positions, advice on self-management and rest are essential 17.
  • Therapeutic ultrasound, which is commonly used by physiotherapists 18 aims to reduce inflammation and assist the efficacy antibiotics by destroying bacteria’s outer most layer.

Being armed with this knowledge should enable mothers to commence early treatments of their breast conditions with the aim of protecting and enabling breastfeeding. Mothers suffering with an ICLB should ensure they seek help from their GP or health professional, lactation consultant and physiotherapist, who all can help!!

Secondly, exercise is an important part of their life for many breastfeeding mothers. Exercise assists in the wellbeing of mothers in so any ways, including, improved heart health 19 and general fitness 20, improved mental wellbeing and energy levels 21, assist with weight control 21, reduce stress level 21 and assist with treatment of post-natal depression 22.

Some mothers worry that exercise will affect their ability to breastfeed, either by altering milk production, components of breastmilk or the babies taking the milk. All of which is disproven by research.

Research into lactic acid in breastmilk supports that both low and moderate intensity exercise (which is the intensity most mothers return to postnatal) does not cause lactic acid  in breastmilk 23, and additionally doesn’t affect a babies ability to take the milk 24. High intensity exercise (exercising to the extreme of exercise intensity) can increase lactic acid in breastmilk 23, however there is no research to suggest that breastmilk with lactic acid harms the baby in any way 25.

Importantly, moderate exercise does NOT affect:

  • Breastmilk supply 20, 26
  • Immune factors such as SIgA, lactoferrin and lysozyme 27
  • Major minerals (calcium, magnesium, potassium, sodium) 28, or major nutrients (fat, protein, lactose), or energy density 26.
  • The growth of their baby 29

So if you’re thinking of exercising, a few things to remember:

  1. Wear a good, supportive bra
  2. Breastfeed prior to exercises for your comfort
  3. Stay hydrated!
  4. See a Women’s Health Physio for exercise modifications as needed
  5. Have fun!

I’ll leave you with my favourite quote “Breastfeeding is the most cost effective, disease preventing and health promoting activity a mother and baby can do” 4. So, lets make sure we promote breastfeeding with evidence based and excellent clinical reasoning practitioners when treating ICLB, and additionally look after both the physical and mental wellbeing by promoting staying active during the breastfeeding journey.

Lauren x

@themummaphysio

 

  1. Schwartz K, D'Arcy HJS, Gillespie B, Bobo J, Longeway M, Foxman B. Factors associated with weaning in the first 3 months postpartum. J Fam Pract. 2002;51(5):439-444.
  2. World Health Organization. Exclusive breastfeeding for six months best for babies everywhere. [Internet]. 2011 [cited 27 April]. Available from: https://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/.
  3. Mangesi L, Zakarija-Grkovic I. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2016; (6):1-59. doi:10.1002/14651858.CD006946.pub3
  4. Amir LH, Livingstone VH. Management of common lactation and breastfeeding problems. In: Jatoi I, Rody A, editors. Management of breast diseases: Springer, Cham; 2016.
  5. Stuebe AM, Schwarz EB. The risks and benefits of infant feeding practices for women and their children. J Perinatol. 2010;30(3):155-62. doi:10.1038/jp.2009.107
  6. Amir LH. ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med. 2014;9(5):239-43. doi:10.1089/bfm.2014.9984
  7. Lumley J, Amir LH. Women's experience of lactational mastitis: 'I have never felt worse'. Aust Fam Physician. 2006;35(9):745-747. Available from: <https://search-informit-com-au.dbgw.lis.curtin.edu.au/documentSummary;dn=362082565293497;res=IELHEA>
  8. Lawrence RA, Lawrence RM. Breastfeeding: A guide for the medical professional. 7 ed: Elsevier Health Science; 2010. 1128 p. p. 1-1128.
  9. Abou-Dakn M, Richardt A, Schaefer-Graf U, Wockel A. Inflammatory Breast Diseases during Lactation: Milk Stasis, Puerperal Mastitis, Abscesses of the Breast, and Malignant Tumors - Current and Evidence-Based Strategies for Diagnosis and Therapy. Breast Care. 2010;5(1):33-37. doi:10.1159/000272223
  10. Robson BA. Breast Engorgement in Breastfeeding Mothers (thesis). Case Western Reserve University. 1990
  11. Disha RA, Singh A, Suri V. Effect of chilled cabbage leaves vs. hot compression on breast engorgement among post natal mothers admitted in a tertiary care hospital. Nursing and Midwifery Research Journal 2015;11(1):29-32.
  12. Thomas AA, Chhugani M, Thokchom S. A Quasi-experimental Study to Assess the Effectiveness of Chilled Cabbage Leaves on Breast Engorgement among Postnatal Mothers Admitted in a Selected Hospital of Delhi. International Journal of Nursing & Midwifery Research. 2017;4(1):8-13. doi:10.24321/2455.9318.201702
  13. Wong BB, Chan YH, Leow MQH, Lu Y, Chong YS, Koh SSL, et al. Application of cabbage leaves compared to gel packs for mothers with breast engorgement: Randomised controlled trial. Int J Nurs Stud. 2017;76:92-99. doi:10.1016/j.ijnurstu.2017.08.014
  14. Roberts KL. A comparison of chilled cabbage leaves and chilled gel-packs in reducing breast engorgement Journal Hum Lact 1995;11(1):17-20.
  15. Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. J Hum Lact. 1995;11(3):191-194.
  16. Kvist LJ, Hall-Lord ML, Rydhstroem H, Larsson BW. A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation. Midwifery. 2007;23(2):184-95. doi:10.1016/j.midw.2006.02.003
  17. Cooper BB, Kowalsky D. Physical therapy intervention for treatment of blocked milk ducts in lactating women. JWHPT. 2015;39(3):115-126. doi:10.1097/jwh.0000000000000037
  18. Diepeveen L, Fraser E, Croft A, Jacques A, McMrdle A, Briffa K, et al. Regional and facility differences in interventions for mastitis by Australian physiotherapists. J Hum Lact. 2018;35(4):695-705. doi:10.1177/0890334418812041
  19. Amorim AR, Linne YM, Lourenco PMC. Diet or exercise or both for weight reduction in women after childbirth. Cochrane Database Systematic Reviews. 2008 (3)
  20. Lovelady C. Balancing exercise and food intake with lactation to promote post-partum weight loss (Review). Proc Nutr Soc. 2011;70(2):181-184.
  21. Rich M, Currie J, McMahon C. Physical exercise and the lactating woman: a qualitative pilot study of mothers’ perceptions and experiences. Breastfeed Rev. 2004;12(2):11-17.
  22. Daley A, Jolly K, MacArthur C. The effectiveness of exercise in the management of post-natal depression: systematic review and meta-analysis. Fam Pract. 2009;26(2):154-162.
  23. Carey GB, Quinn TJ. Exercise and lactation: are they compatible? Can J Appl Phys. 2001;26(1):55-74.
  24. Wright KS, Quinn TJ, Carey GB. Infant acceptance of breast milk after maternal exercise. Pediatrics. 2002;109(4):585-589.
  25. Australian Breastfeeding Association. Exercise and breastfeeding [Internet]. 2019 [Available
  26. Dewy K, Lovelady C, Nommsen–Rivers L, McCrory M, Lonnerdal B. A randomised study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. New Engl J Med. 1994;330:449-453.
  27. Lovelady CA, Hunter CP, Geigerman C. Effect of Exercise on Immunologic Factors in Breast Milk. Pediatrics. 2003;111(2):e148-e152.
  28. Fly AD, Uhlin KL, Wallace JP. Major mineral concentrations in human milk do not change after maximal exercise testing. Am J Clin Nutr. 1998;68(2):345-349.
  29. Daley AJ, Thomas A, Cooper H, Fitzpatrick H, McDonald C, Moore H, et al. Maternal Exercise and Growth in Breastfed Infants: A Meta-analysis of Randomized Controlled Trials. Pediatrics. 2012;130(1):108-114.

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