What we do:
I have been working in the maternity wards of Panorama Mediclinic and Louis Leipoldt Mediclinic for 16 years. Working exclusively with mothers that struggle with breastfeeding. I have completed extra courses in Breastfeeding over these years and view myself as an expert in this field.
In hospital we generally provide immediate treatment to patients in the maternity ward for the following conditions:
- Cracked/bleeding/blistered/inflamed nipples (O92.1)
- Breast engorgement (Mastalgia)/ Early onset Mastitis/Mastitis (O92.2)
These problems are usually identified by the nursing staff while doing rounds. Both Louis-Leipoldt and Panorama Medi-clinic are baby friendly hospitals and strongly promote breastfeeding. The Gynaecologists then write a referral for physiotherapy.
1. Cracked nipples (O92.1)
Painful nipples are one of the most common reasons new mothers give for discontinuing breastfeeding, often during the first week of feeding. This condition is extremely painful and leaves many moms fearing or refusing to continue breastfeeding. The degree of soreness varies greatly, with some experiencing slight tenderness, and others severe pain and cracked, bleeding nipples. New-born babies need to feed frequently (8-12 times or more in a 24 hour period) and the nipples do not have a chance to recover in-between feeds. There is literally trauma to the nipple. As we all know, breastfeeding is extremely beneficial for babies. There are numerous studies promoting this. Many mothers that needs to stop breastfeeding at an early stage, has such guilt feelings and are at a very real risk of developing post-natal depression.
We treat this condition with laser therapy and ultrasound, but also with a lot of counselling and assistance with the causes for the cracked nipples, i.e. positioning, latching, and feeding times. Laser intervention has been proven to stimulate wound healing (Pietschnig et al. 2000). With a combination of counselling the mother on correcting the causes of the cracked nipples and doing laser and ultrasound treatment to stimulate healing and decrease pain and inflammation, the mother feels confident to continue breastfeeding and there are studies proven that mothers might experience relief within 1 to 12 hours. (Coca et.al., 2016) Hopkins et al., 2004 and Fulop et al., 2009, also show the efficacy for laser therapy.
The Women’s Health Physiotherapy Group (“WHPG”) suggest, as a global public health recommendation, that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. It further states:
"It is undeniable that breastfeeding is the very best way to nourish babies - there is, literally, no substitute for it. Physiotherapy intervention and treatment of breastfeeding issues enable a mother to continue exclusive breastfeeding which is the aim of the Tshwane Declaration of Support for Breast feeding.”
“Even though it is a natural act, breastfeeding is also a learned behaviour. Virtually all mothers can breastfeed provided they have accurate information, and support from the health care system and within their families and communities. They should also have access to skilled practical help from physiotherapists, who can help to build mothers’ confidence, improve feeding techniques, and prevent or resolve breastfeeding problems. Painful nipples are one of the most common reasons new mothers give for discontinuing breastfeeding, often during the first week of feeding. Most mothers will experience some degree of soreness during the early stages of breastfeeding. The degree of soreness varies greatly, with some experiencing slight tenderness, and others moderate to severe pain, together with cracked and bleeding nipples.”
2. Engorgement/ early onset mastitis /Mastitis (O92.2)
Engorgement of the breasts occurs when the milk comes in, usually on day 3 post-delivery. Engorged breasts are hot, hard and very painful and make latching of the new-born very difficult. Ultrasound has a micro-massage effect on the breast tissue, facilitates a flow of milk, thereby softening the areola and enabling the baby to latch. Ultrasound provides enormous relief. Education of the mother on self-help techniques and coping strategies are a very important part of early management. Self-clearing techniques are often not effective. Cooper and Kowalsky (2006) found that physiotherapy intervention significantly reduced pain, stress and difficulty breastfeeding. None of the cases progressed to mastitis.
Mastitis is a condition in which a woman’s breast tissue becomes abnormally swollen or inflamed. It can be caused by blocked milk ducts that occur in milk stasis or it can be caused by an infection of the breast ducts with bacteria. It occurs almost exclusively in women who are breastfeeding. Mastitis does not clear without treatment.
Mastitis can occur with, or without, the presence of infection. As it progresses, mastitis can cause the formation of a breast abscess, which is a severe complication. This is a localized collection of pus within breast tissue. The abscess can become very painful and may eventually require surgical drainage. Severe cases of mastitis can be fatal if left untreated. Estimates suggest that around 1 in 10 women who develop an abscess are permanently disabled from using the affected breast to feed their baby in the future.
When a mother presents with either early Mastitis or cracked/ bleeding /inflamed nipples, it needs to be treated as soon as possible, to increase the speed of healing, identify the causes and help the mother be able to continue with breastfeeding. It may also lead to worse conditions as mentioned above that might lead to even longer hospitalization.
The mother’s life is not in immediate danger,
but terminating breastfeeding increases the risk of all the following conditions in the baby:
- Type 2 Diabetes
- Asthma
- Obesity
- Ear infections
- Leukaemia (during childhood)
- Eczema (atopic dermatitis)
- Lower respiratory infections
- Necrotizing enterocolitis (in premature babies)
- Most importantly SIDS (sudden infant death syndrome)
For the mothers:
- Breastfeeding lowers a mother’s risk of the following: Type 2 Diabetes
- Ovarian & Breast cancer
- Heart disease