In keeping with the theme of Women's health blogs mixed in with Pilates blogs, I'm going to share some informational points I feel are important to know when it comes to the topic of lactation and the breast feeding.
Broken into 3 points of interest let's talk about the breast and lactation, mastitis and management options.
Lactation & the breast
- Lactation is the most important part of the post partum period (the period after giving birth) and will often be prioritised over musculoskeletal pains and other health complaints.
- A well functioning lactation systems protects the mother against health issues relating to cardiovascular health, mental health, and bone density.
- 30% of the mother's metabolic energy goes towards breast feeding, which is a reason why breast feeding mothers can experience a gradual weight loss after pregnancy.
- Lactation is vital to the babies health as maternal breast milk acts as a exterogestate placenta (placenta outside of pregnancy) and provides vital nutrients to help protect and develop the babies immature neurological system.
- Exercise does not pose any risk to breast feeding and visa versa.
- Once lactation is established it will continue throughout the women's life until the supply of milk has ceased.
- In the breast, blood drains medially (towards the sternum) and superiorly (towards the collar bone), while the lymphatic system drains towards the arm pit.
- Milk ducts in the breast are not linear, instead they are like the roots of a tree with 9 ducts and 9 lobes opening onto the nipple.
- The ducts act very differently when lactating compared to not i.e. the ducts dilate between 50-150% during milk production. There if obstruction or blockage occurs, the tissue is vulnerable to pressure overload.
- Mastitis is inflammation of the breast with or without infection.
- Up to 30% of women will experience mastitis in the first 12 weeks post partum.
- Inflammatory reactions in the lactation system are often very big because of this system is so importance to human survival.
- It can be difficult to tell the difference between inflammation and infection:
- Inflammation has signs of redness, fever, pain and loss of function.
- Fever can be present in both infective and inflammatory mastitis.
- However, just because a fever is present doesn't mean that antibiotics are required.
- Most symptoms should resolve within 3 days of onset.
- Reoccurrence is very high and the primary risk factor is a previous episode of mastitis.
- The severity of symptoms is not a reliable predictor of the outcome and each case should be treated with equal seriousness.
- Some symptoms you may take note of to help measure the severity of mastitis are:
- Erythema (redness)
- Breast size
- Breast tissue tension
- Local breast temperature
- The breast tissue and ducts are much softer when compared to muscles and other tissue and very vulnerable to abscess and bleeding if handled vigorously.
- Ducts need to be able to relax, expand, and move so consideration of bra type and clothing tightness is very important.
- The number 1 supported treatment in the literature is horizontal bed rest.
- Breast expression is more effective in reducing blockage than manual therapy.
- Breast feeding is not the reason mothers feel fatigue. Fatigue is caused but the 30% increase in pro-inflammatory hormones which are produced to protect the mother's body.
- But in the case that you're needing additional help then Physiotherapy can be helpful.
- Physical Therapy treatment options which aim to reduce inflammation include: advice, ice therapy, manual therapy (massage), electrotherapy (vibrator, therapeutic ultrasound, and TENS).
- There is no solid evidence and consensus in the literature about the dosage and efficacy of therapeutic ultrasound. In saying this, as a Physiotherapist it is my preferred treatment option. I aim for 1MHz and turn the intensity up to a warm tolerable sensation…. being mindful that temperature sensation might be reduced so test on the unaffected side of different area of skin.
- There is also no evidence for the prescription of antibiotics - no high quality randomised controlled trials.
Like most aspects of motherhood, every person is going to experience a differnt journey and this is because our bodies are so unique. Hopefully what you've taken away from this blog is that breast feeding is a natural and very important aspect of motherhood, that breast feeding placing big demands on the mother but also protects her again diseases, and that mastitis should be addressed as a serious condition and that there are many ways to approach treatment. I'd advice you discuss this with your doctor, midwife and other treating health professionals such as a lactation nurse so that you can understand all the options available and make the best informed decision for you.