August marks Women’s Month in South Africa. This year we are drawing your attention to World Breastfeeding Week! Breastfeeding is not always as straightforward as one might think. For some, it comes naturally, while for others, it’s a seemingly impossible task. For mothers to successfully breastfeed, they need support from those around them. So we asked our new neighbour, Physiotherapist and Owner at Van Niekerk Physiotherapists, Stephani van Niekerk, to share her expertise with us.
Stephani is a passionate, energetic young physiotherapist practicing right next door to Fish and Field Biokineticists at Woodside Village in Rondebosch.
Breastfeeding is a wonderful and natural process after birth, but as with any new phase comes new challenges. Breastfeeding mothers may experience symptoms like tender nipples, engorged or full breasts, mastitis or neck and back pain.
But, rest assured, with a few of the following tips you can help your body adjust to these changes during and after pregnancy.
Tender nipples commonly occur during the initial phase of breastfeeding. The sensitive skin around the nipple is not yet accustomed to the repetitive sucking action when a baby drinks, and incorrect latching and unlatching could worsen the effect. With a few adjustments the nipple can heal quicker and feedings may become easier.
Massage a few minutes before feeding. This initiates milk let-down and elongates the nipple for easier latching.
Latching and Unlatching correctly is very important. To promote more effective latching, make sure your baby is relaxed. This can be achieved through skin-to-skin contact, backrubs, singing, etc. Gently stroke around your baby’s mouth until their tongue protrudes and they start “seeking” the nipple. Position your baby’s body against yours with your nipple just above their mouth. As the mouth opens, “roll” the nipple into their mouth, putting as much of the areola (the dark skin around the nipple) into their mouth. To unlatch, gently insert your pinkie finger in the corner of your baby’s mouth to break the vacuum seal.
Feeding more frequently for shorter periods can help your baby drink less aggressively as they will be less hungry. Start with nursing on the less painful side and changing positions at every feed will ensure the baby’s gum position changes, creating less friction on the same part of the nipple.
Skin Care is important for the healing of your nipples. Medical-grade modified Lanolin cream, such as Lansinoh or Bepanthon are highly recommended, and may be used after every feed or shower. These creams are completely safe for babies to ingest. Using a dabbing method, cover the whole nipple and areola with the cream. The cream acts as a moisturising healer, increasing tissue healing, and preventing scab formation and cracking. Avoid using soap, alcohol, lotions or perfume on the nipples. Rinsing with clean water is sufficient for hygiene of the nipples. Dab a little bit of your breastmilk on your nipples after feeding and let it dry – the milk has great healing properties!
Use washable cotton breast pads as they allow for airflow which is essential for healthy nipples, and are less likely to stick to the nipples. Change the nursing pads after every feed or as soon as they are damp, as the moisture delays the healing of the nipples. If the pad sticks to the nipple, wet it thoroughly with water before removing it slowly.
Two to three days after giving birth you may find your breasts are extra swollen, tender, or “full”. This is a temporary phase until your body adjusts to the amount of milk that needs to be produced to feed your baby.
A warm shower with light massage can soften the breast and help with the milk let-down.
Hand massaging engorged breasts can alleviate the swelling and discomfort. Start by massaging one breast with both hands, starting on the outsides and working towards the nipple. Grasp the areola with your thumb and two fingers below, and apply pressure towards your chest wall while rolling all three fingers towards the nipple but not over the nipple. Rotate the fingers around the areola to cover the whole circumference and repeat 3-4 times until the breast is drained. You can collect the expressed milk in a clean container and use, refrigerate or freeze it immediately.
Applying a cold cabbage compress after every feed can soothe pain and discomfort – be sure to cut a hole for the nipple as the taste of the cabbage on your nipple could hinder baby’s latching and feeding.
Wear supportive underwear, even when sleeping. But make sure it’s not too tight. Avoid wearing an underwire bra to decrease pressure on the soft breast tissue.
Mastitis is the inflammation of breast tissue that often involves an infection. The inflammation can result in pain, tenderness, warmth, redness and swelling of the breast. It usually features one or two red streaks extending from the breast to the areola and swollen lymph nodes in the neck or armpits. It may also include flu-like symptoms such as fever, fatigue and chills.
Ultrasound treatment has shown to be an effective form of treatment of Mastitis. This can be carried out by either your GP or a physiotherapist. Milk from a breast with mastitis is not infected and is completely safe for your baby to ingest. At home management includes cold cabbage compress, and warm shower massages.
Women often experience increased back and neck discomfort during and after pregnancy. This is due to of weakened and stretched abdominal muscles, uncomfortable feeding positions, long periods of looking down at your baby while feeding, picking up and carrying around your growing baby and natural body changes. Completing the following everyday activities with correct posture and positioning can help prevent chronic back and neck pain as your body adjust to its new role.
The feeding position, whether bottle- or breastfeeding, should be comfortable. Ensure good back support, with both your arms and feet supported – consider using of a footstool. Elevate your baby to the breast or bottle level with pillows and cushions rather than holding them in the air with your arms, and try to keep your shoulders relaxed. Frequently change the positioning your neck when looking down at your baby. You can also try a less strenuous position such as lying down with good pillow support under your back, neck, shoulders and arms.
Physical exercise is also very important post-pregnancy and should commence as soon as your doctor gives you the green light. A regular exercise routine with a combination of stretching and strengthening can help manage the new load of a baby on your body. Get to a Biokineticist for your post-partum session as soon as possible and prevent back and neck aches before they become chronic!
Stephani van Niekerk is a passionate, energetic young physiotherapist practicing right next door to Fish and Field Biokineticists at Woodside Village in Rondebosch. She graduated with a Bachelor’s Degree of Science in Physiotherapy from Stellenbosch University, and completed her community service year in Ladysmith (KZN). Over the past few years, Stephani has enriched herself with numerous postgraduate courses including dry needling, sports massage, and kinesiology taping to optimise patient care at the practice.
Her experience includes working as a physiotherapist in Durbanville Mediclinic, in both out-patient and in-hospital settings. She especially enjoys working in the maternity and paediatric wards with post-partum mothers and babies. Stephani follows a holistic and all-rounded evaluation and treatment protocol with only the best evidence-based, data-driven treatments to reach patient goals. This means that every patient receives unique, individual and patient-specific care and treatment as needed.
For advice on how Fish and Field Biokineticists may assist you, please contact us.