The Postpartum Diaries Part 3: The Good, The Bad, and The Hungry!

Author: Kara Schuft, PT, DPT: Doctor of Physical Therapy, Business owner, and Blog Contributor. Specializing in chronic pain, pelvic health and peripartum care. Passionate about health literacy and frank conversation around our changing bodies throughout the lifespan. Learn more about Kara here.

The Postpartum Diaries Part 3:
Breastfeeding: The Good, The Bad, and The Hungry!



You’re still with me! We’ve discussed pelvic floor weakness, postpartum pelvic pain, and now we’re on to tackle breastfeeding mechanics. This is my honest discussion about breastfeeding both from personal experience and my time as a physical therapist working with postpartum mothers. Remember, that every person and their experience is different. This is meant as a conversational starting point to think about some of the ways your body has changed, and options for helping if you are experiencing pain after childbirth.

The Hungry

Before the birth of my first child my husband and I took some Labor & Delivery, Breastfeeding, and Newborn Care classes. We had not been around very small children and really felt inexperienced with the whole thing. What I remembered the most from the breastfeeding course is that babies needed to eat all the time. We actually calculated out the max amount of time that a baby may need to eat and I was shocked. This was on paper. When that cute little bundle was actually eating all the time, I was ten times more shocked and sleep deprived to boot. No one can prepare you for what a physical demand it is on your body. It’s important to think about your overall mechanics when you breastfeed to avoid hurting yourself. Breastfeeding the “wrong way” can be like a repetitive injury or strain. I want to talk about how to get in the best position, what things can go wrong with breastfeeding, the importance of befriending your local lactation consultant, and how physical therapy can help.

The Good

If anyone is at all like me, breastfeeding is not as intuitive as it seems. It’s a lot more complicated when you are trying to move their little arms out of the way to get them to latch on to the nipple. Breastfeeding was a 3-being event the first few days or so as my husband would help with all the baby positioning in my latching efforts. With a shallow latch breastfeeding can quickly become quite painful. But there’s good news! You have a team, my friend! There are some things about breastfeeding that I am not going to cover. It is important to get your baby to take a very deep “latch” so that your nipple doesn’t get sore or damaged. There are multiple ways you can hold your baby to help with this (cross body hold, football hold.) Your baby could have a lip tie or tongue tie if their latch is too shallow. A lactation consultant can help with all of these areas. They are wonderful. Personally I have to give a shout out to Tracy at Legacy Good Samaritan Medical Center Lactation Services. She was my saving grace. The best part about it is that you bring your baby hungry, and then they weigh the baby before and after nursing so you can estimate how much breast milk they are taking in. Seeing the weight increase on the scale after nursing can be a great relief when you are concerned if your hungry baby is getting enough. Chances are a lactation consultant will check in on you during a hospital stay. If you did a home birth or stay in a birthing center, the midwives will recommend a lactation consultant to help postpartum.

Positioning yourself and your baby

The part of breastfeeding that I want to chat about a little is how you your body is affected when nursing your baby. Remember that first part of this blog? Those cute little beings need to eat ALL THE TIME. You want to make sure you have the best positioning as possible to avoid an overuse injury.

Step 1: Bring the baby up to you.

They make these great pillows to help with breastfeeding and I highly recommend getting one if you can. Both of mine were hand-me-downs. There are many brands out there but I am most familiar with the Boppy and the Brest Friend. I’ve used them both pretty extensively and, though this is NOT about product placement, the pictures below are with the Brest Friend because it is more firm. I liked the extra support with a very new infant. That being said, sometimes you need even more than just the pillow alone. It could be that adding another pillow underneath the nursing pillow helps to bring that baby up all the way to your breast so that you are not hunched over, possibly putting your back at risk for injury.

A quick note. I’m trying to keep my kiddos with as limited an online presence as I can possibly try (but boy is it hard not to post photos of them) so I’m illustrating some of my points with my dear friend, Mr. Socks, our household sock monkey.

JUST a nursing pillow without an extra pillow underneath

JUST a nursing pillow without an extra pillow underneath

A nursing pillow with a red couch cushion to bring it up even higher

A nursing pillow with a red couch cushion to bring it up even higher

Step 2: Check in with your shoulders.

My attempt at the "relaxed shoulder" look

My attempt at the "relaxed shoulder" look

If you get that baby high enough, you should be able to nurse and have your shoulders relatively relaxed. If they feel like they are rounding forward or you are holding a lot of tension and shrugging them up towards your ears this can lead to pain. Keep your shoulders as down and relaxed as possible.

Step 3: Check in with your wrist.

Many women, including myself, have to deal with carpal tunnel pain, numbness, or tingling during and/or after pregnancy. One of the last areas I thought about was my wrist position when I was nursing. It is very easy to try to form that wrist around your baby which leaves you in an awkward position for the remainder of nursing. Try to keep your wrist in neutral so that it does not have any kind of extreme bend in it. This can help limit any symptoms of carpal tunnel and pain.

A gripping "bent" wrist and hand

A gripping "bent" wrist and hand

A relaxed wrist and hand

A relaxed wrist and hand

The Bad

Unfortunately, there are some things that can happen during breastfeeding that can lead to issues and you need to watch out for. Here are three biggies:

  1. Engorgement:
    This is when the milk comes in and doesn’t leave fast enough. Your breasts get very hard and the tissue of the breast itself feels very firm. Sometimes you may have to hand express or even pump prior to nursing so that your breasts can soften enough for the baby to have a good latch. A moist heat like a wet washcloth or warm compress before nursing can be helpful to soften the tissue.

  2. Mastitis:
    Mastitis is a breast infection. If your breasts stay engorged or there is a clogged duct (more about that below) causing a backup of milk, you can be at risk for developing mastitis. If you develop ANY flu like symptoms - fever, chills, really feeling unwell - then contact your doctor or midwife immediately. You will likely need to start on antibiotics right away. Fortunately for most women, once they start the antibiotics they feel a lot better. Feeling like you have the flu while you need all of your reserves for nursing is no good.

  3. A Clogged Duct:
    A common occurrence is for milk to backup in just one or two ducts. Sometimes this is because some residual milk dries up there and blocks the rest of the flow. This can result in very painful, ropey, breast tissue. There’s a lot of ways to try to help women dealing with a clogged duct. A typical pattern would be to use moist heat right before your baby is going to nurse, try to massage your breast WHILE the baby is nursing right along the clogged duct to encourage that area to start flowing, and then use the heat again afterwards. Some women have tried the butt end of an electric toothbrush to try to bust up the clog. Something to consider is that your breast tissue can start all the way back by your armpit. When you massage, you start at the back and massage towards the areola to encourage milk flow.

How can physical therapy help?

If you haven’t first seen a lactation consultant, that’s where you start. Physical therapy, however, can help in a few specific ways.

  1. For all of those nursing complications listed above (engorgement, mastitis, and a clogged duct) physical therapist can use therapeutic ultrasound to ease the symptoms. I have seen it work the best for engorgement and clogged ducts. Often if women are experiencing mastitis they are referred after they start antibiotics so that the ultrasound can help remove the cause of the mastitis (clogged duct or engorgement.)

  2. Physical therapy can help make sure your body mechanics are appropriate when you are nursing. Sometimes it’s hard to really tell if you have a posture that’s not going to lead to pain later on.

  3. Should you develop pain or an injury, a physical therapy can help rehabilitate you and give you exercises if needed to strengthen and lengthen the muscles involved. In the short run this can seem like yet another thing to think about and try to fix, but in the long run it can save you weeks, months, and even years of pain.

What else can be done about it?

I’m so glad you asked! Here are some other resources to assist with breastfeeding:

1. Kellymom:

This website is chock full of information. The thing about the articles on this site is that the authors comb through the research for you to come back with answers. There is so much there from breastfeeding support and newborn/child development to nutrition and wellness facts for both mom and baby. I still check this site regularly.

2. La Leche League:

Also an invaluable resource, La Leche League international provides all kinds of support to breastfeeding moms. One of the best features is that they will help you to find lactation consultants in your area!

When in doubt, call up your team to develop a plan for you. Whether it be working with a lactation consultant, physical therapist, or both, breastfeeding should be a comforting, calming, feel-good experience for all women. In Oregon, many insurances allow for direct access where you can go straight to a physical therapist without seeing your doctor first. However, typically OBGYN’s, Midwives, and other providers are more than happy to refer you to a physical therapist when needed. Don’t delay, see one today!

Join me next week for The Postpartum Diaries Part 4: How am I supposed to pick up my child? And other mechanical mysteries.