Newsletter #47: Chiropractic Care for Breastfeeding

By Dr Eve Van der Perre, BMSG Volunteer

Dr Eve is a practising chiropractor who was previously a volunteer with BMSG between 2018 and 2020. She is currently based in Senegal, West Africa.

All babies want to breastfeed, but sometimes things just get in the way

Ideally when a baby is born, they would be placed ‘skin-to-skin’ flat on their tummy, allowed to rest until they’re ready to search for a nipple, and left in peace until they’ve latched on, fed and are ready to sleep. Unfortunately, this doesn’t happen as often as it might. At the hospital, babies are invariably placed up in a cradle position and a sheet or towel is usually placed between baby and mother; they have hats put on them, they get whisked away for weighing and measuring, even injections, and sometimes they’re routinely suctioned. However, babies’ instincts are strong and even when conditions aren’t ‘perfect’, they prevail. Babies are smart and are always learning. Even if they don’t get to have a “golden hour” (or two) of uninterrupted skin-to-skin as soon as they arrive, it still works when they’re reunited, and it always helps to initiate breastfeeding. Placing a newborn baby’s bare skin to the mother’s own skin immediately calms both the mother and baby and triggers the baby’s innate feeding reflexes – it’s magical.

Birth Interventions

Some babies need a little time, and sometimes a little help, to get the hang of breastfeeding. When I meet a baby who is struggling to feed, I want to know all about the birth, and if mother and baby were separated for any reason. I want to know if the labour was long – perhaps the head was tilted to one side and labour didn’t progress. Imagine how sore your neck would be if you held your head to one side for hours, even without contractions going on around you! Perhaps the labour was very fast and the head had to mould very quickly, or perhaps there was an assisted delivery – imagine the headache you’d have! 

Eve, a practising chiropractor, sees babies with musculoskeletal issues including breastfeeding difficulties. [Credits: Eve Van der Perre]

Unfortunately, birth interventions are common and can negatively impact breastfeeding. Apart from the physical aspects, mothers who have had to have “help” in birth may feel less capable and less confident that they can breastfeed.

How Can Chiropractic Help Babies?

Chiropractors are musculoskeletal specialists, meaning they are interested in bones and the joints between them, and in all the soft tissues that hold everything together and facilitate movement – the muscles, tendons, ligaments, fascia. They’re also especially interested in helping the nervous system function optimally because it controls and regulates everything in our bodies.

Chiropractors are trained as primary care providers, meaning they’re able to diagnose and know when to refer if needed, if something is out of their scope.

Paediatric chiropractic adjustments are not like chiropractic adjustments for adults! The purpose of each gentle adjustment is to release restrictions to enable proper balanced movements to happen. These releases only need as much pressure as you would use to feel how ripe a tomato is.

Paediatric chiropractic care is gentle and safe for babies. [Credits: Eve Van der Perre]

Common Issues Chiropractors See

Breastfeeding requires 60 voluntary and involuntary muscles all working together in concert. 22 bones are involved, connected at 34 sutures (joints), and 6 cranial nerves. Musculoskeletal issues in the skull, jaw, neck or shoulder can all affect breastfeeding.

Common issues chiropractors see include:

  • babies who hold their head to one side, often refusing to feed on one or other side
  • babies who are clearly uncomfortable and arch away when brought to the breast 
  • babies whose suck is weak or disorganised, often after having a tongue-tie cut
  • babies who fall asleep at the breast, tired out from the effort of feeding 
  • babies who clamp down on the nipple or who are not opening their mouth wide enough to get a good deep latch

Often problems are attributed to breastmilk flow, and usually that is part of the picture. However, remember that breastmilk production is determined by stimulation. For example, a baby who is latching well on one side will stimulate that side more which will then produce more milk. This then reinforces the baby’s preference for that side.

Chiropractic care for breastfeeding is evidence based; new research is always welcome but a growing body of studies continues to be published to show chiropractic to be safe and effective.

Chiropractic Can Also Help Breastfeeding Mothers

When I observe a mother and her baby breastfeeding, as a chiropractor I’m interested in the baby’s alignment but also the mother’s posture – is everyone comfortable?

I ask mothers to imagine they’re drinking a big glass of wine or something else they really enjoy and haven’t had for a while – that usually gets a smile! Try tucking your chin down to your chest, how easy is it to enjoy your drink? Or turn your head round to one side, how long would you want to keep drinking? It’s logical that babies will feed better when they’re comfortable.

The mother’s posture is very important; breastfeeding positions need to be comfortable and sustainable. Postpartum bodies are often achy and are vulnerable to strains and sprains from the increased relaxin released in the body to allow the pelvis to open. It affects all the joints and ligaments and takes up to 5 months to go back to normal, coupled with the new bio-mechanical stresses of caring for a newborn.

I like to get mothers lying back with lumbar support, taking the pressure off their pelvis and recovering perineum area. I want to see their neck and shoulders relaxed and their arms supported. When we’re stressed and sore, the milk doesn’t let down so easily!

It’s not uncommon for mothers to experience neck and upper-back strains in birth, which are then compounded by hunching to breastfeed – all while tired and overwhelmed. Plus the low back and pelvis are finding their new normal after pregnancy and birth. Gentle chiropractic treatment for the postpartum mother helps restore normal movement and nerve function, increasing wellbeing and supporting recovery.

Chiropractic care can help breastfeeding dyads get past some of the things that can get in the way – so babies can get on with growing, healthy and connected, and mothers can ease into their new role a little more comfortably.

Newsletter #46: Breastfeeding Crucial During COVID-19

By BMSG Editorial Committee

Since it appeared in late 2019, we have been continuously learning about the SARS-CoV-2 virus and COVID-19. We don’t yet know of its full impact on the world. Understandably, parents have particular concerns for their young children including wanting to know if breastfeeding is safe during this pandemic.

Why Breastfeeding Should Continue During COVID-19 

It is imperative to understand that breastfeeding is not just for nutrition and nourishment; it also plays a huge role in the developing immunity of a child.  It has been shown that the level of SARS-CoV-2 virus particles present in the breastmilk of mothers who test positive for COVID-19 is  insignificant, and that COVID-19 does not pass through breastmilk.

When  the human body encounters  a virus, the immune system works to produce antibodies to part or all of it. Generally  these antibodies, specific  to particular viruses and pathogens, are present in breastmilk. There are some preliminary findings which suggest that breastmilk actually provides babies with protection against COVID-19.

When a mother is infected with COVID-19, it is recommended that simple hygiene measures such as hand-washing and mask-wearing should be taken when breastfeeding. Breastmilk is still the best food (in the presence of COVID-19 or not) for babies – including for those who require donated breastmilk.

Breastmilk Contributes to Food Security  

The COVID-19 pandemic has also had  massive economic repercussions. Rates of unemployment have increased exponentially due to disrupted economies. In a highly commodified world, this naturally translates to limited resources, including food.

Formula milk, which has become a very common milk substitute for babies in developed countries, is expensive and is also vulnerable to supply disruptions. In times of crisis, it may become an even more costly commodity and may run off the shelves due to panic buying. The World Health Organization (WHO) is now encouraging mothers to consider relactating  or delay weaning off the breasts, to continue providing immunity to their breastfeeding children.

Improving Management of COVID-19 for Postpartum and Breastfeeding Mothers in Singapore  

WHO guidelines on management of COVID-19 encourage breastfeeding and advise against the separation of mother and child. 

As the only Singaporean charity that supports breastfeeding mothers via various counselling channels, BMSG encourages mothers to continue breastfeeding and for family members to give their strong support. A previous article outlined the worries of our mothers during the initial Circuit Breaker period and we want to offer recommendations for mothers to continue breastfeeding even if they are infected with COVID-19 at the time of their pregnancies or when giving birth.

  • Infected Mothers Should Continue Rooming-In with Newborns After Giving Birth

Most hospitals which are Baby-friendly Hospital Initiative (BFHI) certified have policies where mothers and babies are able to room-in together after birth, unless there is a medically indicated reason for it. It also allows mothers and their newborns to have unrestricted skin-to-skin time after delivery, a recommendation by the WHO that helps to facilitate  breastfeeding. Hearteningly, this guidance has been instituted at the various maternity hospitals in part or in totality since 2013.

While there have been no reports of infected mothers giving birth as of yet in Singapore, there was a mother in Australia who was infected with COVID-19 and was allowed to room in together with her baby until discharge. The baby did not contract COVID-19 and was breastfed by the mother from Day 1. India has also reported that 100 babies born to mothers who had contracted COVID-19 before they went into labour had shown negative results for COVID-19, with the exception of two babies. These babies were also quick to bounce back, showing negative results after subsequent tests were done just a few days later. These mothers and their babies were also allowed to room-in together and the mothers had breastfed their infants.

If you come down with COVID-19, you can insist on rooming-in with the baby as long as you and all visitors practise good hygiene. The precious hours and days right after the birth are when babies receive the goodness of colostrum which can be considered their very first immunisation. Every single drop is filled with antibodies and immune factors that serve to develop the child’s fighting capacity against the very pathogens that we seek to protect them from.

  • Babies of Mums with COVID-19 May Not be Allowed in Quarantine Facilities  

In relation to the above point, BMSG has contacted the Ministry of Health (MOH), and from our communication there seems to be no clear guidelines as to whether or not  breastfeeding mothers can be housed with their babies should they be infected with COVID-19.  

If you find yourself in this situation, advocate strongly for your baby to be allowed in the facility with you to protect your breastfeeding relationship. Breastmilk is one of the best ways to protect babies from the infection, which is why it is crucial to ensure that the breastfeeding relationship continues.

If it is not possible for you to be with your child (e.g. warded in ICU), you can still continue to pump milk. As always, practise good hygiene while pumping, such as washing hands before pumping and storing milk, sterilising all pump parts before pumping and making sure that milk is stored according to the recommended milk storage guidelines.

  • Lack of Postpartum & Breastfeeding Resources for Mothers at Home 

Many mothers struggle with breastfeeding in the few days after birth, particularly after discharge from hospital. Breastfeeding challenges typically arise around days 2 to 4 when breast engorgement, difficulty in latching, and the overall struggle of caring for a newborn can impede mothers’ efforts to breastfeed.

The Circuit Breaker that started in early April 2020 affected mothers and infants at their most vulnerable period. Mothers who required a Lactation Consultant (LC) to assist with breastfeeding were not able to have one visit them and yet may not have been well enough to visit one at the hospital. Families who were expecting confinement nannies from Malaysia to help care for newborns had to cope on their own. Other postpartum care services such as postnatal massages were similarly nonexistent for isolated new mothers, and more so with no visits from extended family members for support. This posed a huge challenge and strain, physically, emotionally, mentally.

We know that the first two to four weeks are when both mothers and babies learn how to latch well and we often refer to this as the “golden period”. When mothers receive adequate support during this time, they tend to have a better breastfeeding journey. By the time a mother is able to access help, she may have already given up on breastfeeding.

Breastfeeding feeds not just a baby, but the whole nation. If we aim for a healthier generation, we need to be able to support our breastfeeding dyads.

How Should Singapore Move Forward?

It is clear that Singapore needs to create or adapt our own national guidelines to safeguard our vulnerable young children in the event of a future crisis – be it another pandemic, a natural disaster, or others. 

Australia updated its IYCF-E guidelines this year after the catastrophic Australian bushfires in 2019. Dr Karleen Gribble, a breastfeeding advocate, produced detailed recommendations for families with young babies to plan for evacuation. We also looked for inspiration from Safely Fed Canada, an organisation that offers very clear advice to parents on how to facilitate breastfeeding and sustainable infant feeding during times of crises. 

We urge Singapore to create ICYF-E policies that will help policymakers and our nation be more prepared on safe infant feeding during national crises, which include and promote breastfeeding at home and in institutions, and which guide parents and carers in detail on safe formula preparation and feeding. The availability of formula milk for babies is at the mercy of supply chains and carries with it increased risk of infections and contamination, especially in emergencies. Ample preparedness will safeguard the health and security of our children.

We also urge that Singapore create a national breastfeeding committee to encourage, facilitate and protect breastfeeding at a national level, for all times. When breastfeeding becomes part of our national policies, and our culture as a society, we will be providing our babies their primal rights, maintaining food security and improving overall health for our children now and in the future.