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

Approximate Reading Time: 6 minutes

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

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