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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 care can also benefit the breastfeeding mother.
[Stock Photo]


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 #42: Preparing to Breastfeed Before You Meet Your Baby

by BMSG Editorial Team

With greater awareness of the importance and benefits of breastfeeding, many expecting mothers want to prepare themselves for this momentous journey. But how can you actually get ready to breastfeed when you haven’t even met your infant yet?

 

Information is Power

Pregnancy often makes mamas attracted to peaceful, calm photographs of mothers breastfeeding their infants. It looks like the easiest, most wonderful thing in the world – and, of course, it can be.

However, the truth can be very different for many mothers after delivery, when your body feels as though it has been torn into two and you are battling with blood loss, pain, fatigue and hormones. Breastfeeding may look natural but it is in fact a learned skill that takes time and effort to figure out.

Yes, the truth is that many mothers may face difficulties breastfeeding in the beginning. These issues could range from flat nipples, sleepy jaundiced babies, tongue ties, extra-large breasts or nipples, or even just trying to figure out the best way to hold your floppy newborn.

Breastfeeding can be hard work but with some support and mental preparation, it can be a satisfying journey. [Credits: Lisa Matthews]

 

On the bright side, most of these problems are common ones with established solutions, and being empowered with information before you give birth can be the best way to prepare. If you know beforehand the kind of issues that many mums face, you will be less thrown off if it happens to you, and you and your partner will know that there are solutions you can employ to help make your journey a little easier.

Some ways which you can prepare yourself:

  1. Speak to mummy friends who have breastfed their children and ask them to share with you honestly what their pitfalls and problems were, and how they addressed them
  2. Join the Breastfeeding Mothers’ Support Group Facebook group and read posts as they pop up on your feed. This is an easy way for you to get a quick handle on the common issues that many mamas face
  3. Attend prenatal classes (including BMSG’s Breastfeeding 101 workshops) to find out more about the journey ahead of you and how you can make it easier for yourself and your baby

 

Knowing where to find support, including seeking comfort in other mothers, can be helpful if you are overwhelmed or just need reassurance. [Credits: Lisa Matthews]

Form Your Support Team

Although much is made about the breastfeeding mother, the reality is that we create breastfeeding families. A mother is never alone in her journey and the best way to make sure you can succeed is to ensure you have everyone on the same page.

First and foremost, it is crucial that you have your spouse on your side. It is a wonderful way to bond and prepare for baby’s arrival by attending prenatal breastfeeding classes together and understand how important the role of each parent is. 

Fathers must also buy in to breastfeeding, fully understand and support the decision to breastfeed. After giving birth, mothers are often disoriented, in pain, and may find it difficult to advocate for themselves. This is where Dad needs to step in and step up to support Mom. Be the guardian and a wall to block off unhelpful advice and unnecessary comments that may come from people who have good intentions but do not know better.

Daddies, don’t undermine your presence – mummies need you more than ever especially in the challenging early days of breastfeeding. [Stock Photo]

 

Choose Postnatal Support That Suits You

As mentioned before, being prepared is the best plan of attack. It would be useful to have the contacts of some good International Board Certified Lactation Consultants (IBCLC) whom you can speak to if you have any problems.

Many newly-delivered mothers in Singapore also hire confinement nannies to help out in the first month or more. Very often, mums hire these nannies based on word of mouth and friends’ recommendations.

However, it is really important to note that different mothers have different needs and requirements. A nanny who worked out well for your friend may not be as helpful for you if your needs are different. Therefore, if you intend to breastfeed your infant, look specifically for a confinement nanny who is fully supportive of breastfeeding and who can help you succeed. She should be up-to-date with breastfeeding knowledge and be willing to assist you as needed.

For example, while many confinement nannies try to make themselves useful by offering to take the baby at night so that you can “rest”, remember that night feeds are crucial to establish and maintain your milk supply and avoid engorgement, blocked ducts and mastitis. A breastfeeding-supportive confinement nanny can help by changing baby’s diaper at night and then passing baby to you for a feed. 

Confinement nannies and any other family member who is helping the breastfeeding mum should support the mother without imposing on her wishes. They can focus on helping mum on other mundane tasks such as changing baby’s diaper, cooking meals for her or doing other household chores to keep mum comfortable. [Stock photo]

Ditch the Pump

Many mothers are told to bring the pump to the hospital and to start pumping diligently from the beginning. Wanting to ensure they have sufficient milk supply, mums bring out their expensive dual electric pumps and go at it in the hospital room – only to be devastated and panic when they find they are getting nothing.

 In the first few days, your breasts make colostrum, a thick, rich, sticky liquid that is highly concentrated, full of protein and nutrient-dense. It’s the perfect food for your newborn and helps to fight infection, supports baby’s immune system and gut, and flushes out bilirubin through baby’s poop. Did you know that colostrum is similar to amniotic fluid? It’s the best bridge between the fluid baby has been swallowing in the womb, and the mature breast milk which he will eventually drink.

The keyword in all that information up there is “sticky”. Because colostrum is so thick and sticky, it is hard for a pump to extract it efficiently from your breast. Because your newborn baby has a tiny little belly, your breasts do not need to make a lot of it to fill baby’s tummy. Because of both these things, when a new mother tries to pump, most of the colostrum will stick to the flanges or on the sides of a bottle – wasting all that precious goodness.

Credits: Morgan Temple, IBCLC

 

 New mums expect to see a bottle full of milk when they express milk; it is what we are naturally conditioned to see. So when we look at a handful of viscous droplets sprayed all over the flange and barely covering the base of the bottle, we panic.

What is the solution? Ditch the pump and hand express instead. Massage your breasts gently in circular motions to loosen the sticky colostrum from your milk ducts. Learn how to hand express effectively and gather the droplets in a 3-5ml syringe rather than in a bottle. The colostrum can be chilled and fed to baby, which can be especially useful just in case baby has jaundice or other unexpected medical issues which may result in prolonged separation from mum. A very helpful resource to watch and learn hand expressing from is this video by the Stanford School of Medicine, which explains and demonstrates via real mothers how hand expression can be especially helpful for new mums and newborns. 

The pump is not a need as long as your baby is with you right from birth and breastfeeding well. When your milk supply is well-established, pumping may cause an oversupply. Use it wisely and only when necessary. [Stock Photo]

 

You Are Not Alone

Last but not least, remember that millions of women around the world have been where you are and come through on the other side. You are not alone, even though the nights can feel lonely. When your baby arrives earthside, cuddle that soft, sweet little infant (even when she’s bawling and angry and red in the face) and know that you have made a strong, wonderful choice to breastfeed. Hang in there Mama! We are rooting for you.

Credits: Illustration by Paula Kuka from Common Wild

 


Looking for resources for your partner? Read the following articles written by the BMSG to help dads learn how they can better support the breastfeeding mum: Role of Dads in Breastfeeding Families Part 1 and Part 2.

If you need help with breastfeeding, reach out to our BMSG volunteer counsellors by calling or sending a WhatsApp message to +65 339 3558 between 9am and 9pm daily.