Your women’s health physio is well placed to help you manage the common problems that arise during breastfeeding including mastitis, engorgement and block ducts.

Breastfeeding is a learned skill. While it’s a joyful experience, it often does not come naturally.   

Up to 49 per cent of women have trouble breastfeeding on the day of delivery. This reduces to 15 per cent a week later. Women are now likely first exposed to breastfeeding when they try it themselves as compared to women in previous generations who learned to breastfeed by watching women in their family breastfeed. 

There are many factors that can influence breastfeeding and attachment early on; poor attachment and difficulty feeding is more likely to happen with your first baby, if you have had a caesarean section, or have flat or inverted nipples. The position you hold the baby in, the way baby reacts, and your anxiety levels can also influence breastfeeding. 

Problems with breastfeeding can range from difficulty or painful attachment to engorgement, blocked ducts, and mastitis. It can be painful, debilitating and stressful.

How breastfeeding works

The breast is made of a network of ducts; fatty and glandular tissue containing small ducts and alveoli. The milk is produced by these glandular tissues within the fatty and fibrous tissue of the breast. The coloured area surrounding the nipple known as areola has small nerves that are stimulated as the baby suckles the nipple. This causes the release of the hormone prolactin which helps milk production. This release of milk from breast tissue to the nipple is called “let down reflex”.

Nipple stimulation signals the brain to trigger the release of another hormone called oxytocin. This hormone causes cells surrounding the alveoli in the glandular tissue to contract and release milk into the ducts. The milk is then transported through the ducts to openings in the nipple.

Babies suckle in a two-phase pattern. As the baby starts to feed they suckle in a shallow and fast suck, suck pattern. This progresses to a deeper suck and swallow action as let-down occurs. The stimulation of the nipple triggers further oxytocin and prolactin to be released so further milk is produced and let down. The more the baby suckles, the more milk you make, so supply usually equals demand.

Common inflammatory conditions of lactating breasts

Engorgement

Breast engorgement  occurs when the milk comes in between two to four days after the baby is born. The breast can be hard and swollen which may restrict the flow of milk by compressing the ducts. This can make it difficult for the baby to attach and feed well. 

Relieving the discomfort of engorged breasts

• Continuing breastfeeding on the effected side. Feeding on demand when the baby cues can help the milk flow. Change sides each time you begin a new feed.
• Hand expressing small amount of milk before the feeds can relieve the fullness in breasts. If this is uncomfortable then you can also stimulate some milk to flow by placing heat packs before the feeds for few minutes or having a hot shower.
• Cold packs can be used after the feeds as this helps to reduce the swelling. Cabbage leaves, especially if kept in the freezer and slipped into your maternity bra between feeds, are said to be comforting.
• Wear a supportive bra, make sure it does not dig in.
• Therapeutic ultrasound can be performed on engorged breasts by your physiotherapist.

Blocked ducts and mastitis

Excessive compression of the ducts and restriction in milk flow can result in blocked ducts. The compression does not need to be strong at all for the ducts to get compressed. The restricted milk can then ‘settle’ and block the ducts. 

Any obstruction to normal breast drainage including bruising or swelling, hurried feeds or poor positioning, poor attachment, nipple soreness, poor bra design and finger compression, can block the ducts. 

The breast milk produced behind these blockages seeps into the surrounding tissue which then causes an inflammatory response. When these blocked ducts are not cleared you may develop mastitis causing infection of the breast tissue.

Signs and symptoms

• There can be tenderness, swelling, a hard lump can be felt, and sometimes a red flare over the affected area of the breast.
• Some can experience flu-like symptoms – feeling hot and cold with aching joints.
• If left untreated, mastitis may become a breast abscess.

We find blocked ducts often occur more with weather changes, Friday afternoons, public holidays and when there is family coming to visit! 

Treatment for blocked ducts and mastitis

• Your breast milk is safe for your baby even if you have mastitis, so continue to breastfeed or express from the affected breast.
• Drink plenty of water throughout the day.
• Rest as much as possible. Get help with household chores from partner, family and friends.
• Physiotherapy treatment consisting of Therapeutic Ultrasound, and effleurage or draining massage to clear the ducts.
• Kinesotape and Tubigrip to provide support for oedematous breast tissue and improve blood and lymph circulation. If addressed early enough this may clear the duct and prevent infection.

A blocked duct can become mastitis within hours. If you can’t clear a blockage yourself within 12 hours, seek help!  If antibiotics are prescribed by your doctor, take as directed. It is safe to continue to breastfeed when taking these antibiotics

What do I do if I have problems breastfeeding?

• Try feeding in variety of positions - cradle hold, football hold or side-lying.
• Try to fully drain the blocked breast at each feed either by feeding or expressing.
• Express the lumpy blocked area whilst in the shower and follow up with a feed.
• If the blockage doesn’t clear within 12 hours, seek help from your physio, GP or obstetrician.

Physiotherapy can help mothers who are breastfeeding

Therapeutic Ultrasound and massage to unblock the ducts (usually up to three treatments are advised). 
Advice on positioning and posture during breastfeeding

It’s important to bring your baby with you for treatment if possible as the baby helps clear the blockage once the ultrasound and massage have loosened it.

Please contact us on 95801985 and Danielle will be happy to help you.

References and external links

Australian Breastfeeding Association

Ramsay DT, Kent JC, Hartmann RA and Hartmann PE (2005), ‘Anatomy of the Lactating Human Breast Redefined With Ultrasound Imaging’, Journal of Anatomy, 206 (6), pp 525-534.

Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ (2003), ‘Risk factors for suboptimal infant breastfeeding behaviour, delayed onset of lactation, and excess neonatal weight loss’, Paediatrics, Sep:112(3 Part 1):607-61.

https://healthtimes.com.au/hub/physiotherapy/8/news/kk1/physiotherapy-making-waves-in-treating-mastitis/1544/