BREAST FEEDING -A TECHNIQUE

Breast feeding is an art that a new born mother should master in the post-natal period for a successful and self-efficient breastfeeding. According to the WHO guidelines a new born should be exclusively given breast milk for 6 months followed by supplementary nutrition up to 2 years of age or more.

• Breast feeding should be initiated within the first hour of life.
• It should be done as and when the baby demands during the day as well as during night.
• Use of bottles or pacifiers should be avoided.
• In primigravidas (first time mothers) milk ejection may take upto 72 hours.
• It is essential that the breastfeeding woman wears a bra immediately from the second day if delivery.
• The bra should always be one size larger which does not obstruct the milk flow and cause congestion.

Breast feeding works on the let down reflex. This happens when the baby sucks the nipple, signals are sent to the hypothalamus and pituitary which causes release of oxytocin in the blood which helps in milk ejection. Let down reflex can also occur even if the mother thinks of the baby or even hears his voice.

Breast milk composition: –

First two days after delivery, the secretion from breasts is called colostrum which is deep yellow in colour and high in vitamin A, protein, sodium and chloride and has low carbohydrate content. It contains antibody IgA.

	Protein	fat	carbohydrate	Water
Colostrum	8.6	2.3	3.2	86
Breast milk	1.2	3.2	7.5	87

Advantages of breast feeding: –

• Ideal composition for easy digestion
• Rich in lactalbumin and lactglobulin and less in casein so easily digestible
• It contains vitamin D which protects against rickets
• Lactoferrin, lysozyme, lactoperioxidase prevents growth of E.coli thereby preventing gastroenteritis
• Contains antibody IgA
• Breast feeding acts as a natural contraception
• Psychologic benefit to mother child relationship
• Helps in involution of uterus

Technique: –

Breast feeding can be done in various positions. But before that we need to be aware about the basic ergonomics to be followed while breast feeding.

• Always sit with an erect back which is supported.
• Pillows on your lap
• Maintain skin to skin contact.
• Support your breast by making a ‘C’ shape of your hand and not to squeeze between two fingers.
• Do not breast feed by bending down from your back.

Different positions for breast feeding are –

• cradle
• cross cradle
• football
• sidelying
• inverted sidelying
• Australian hold
• Back lying

Good vs bad latch: –

Always make sure that the baby has latched on properly to avoid sore cracked nipples.

Check your nipples post breast feeding: The nipples should look same as before if the baby has latched properly.

The picture above shows us a good and a bad latch.

Signs to look for a good attachment are:

1. Chin is pressed over the breast.
2. Low lip is flanged or turned out over the breast
3. Much of the areola should be in the baby’s mouth
4. No pain
5. Whole jaw movement of the baby can be seen while sucking

While breast feeding make sure that you feed the baby completely from 1 breast and then the rather than shuffling from 1 breast to another.

This helps in maintaining the satiety of the child. As while breast feeding there is a concept of foremilk and hindmilk. Foremilk helps to quench the baby’s thirst, high in lactose and protein and not high in calories or fat. Whereas hind milk is thick, high in calories and comes towards the end.

Sometimes it may happen that milk production and milk consumed by the baby does not match leading to breast engorgement. This should be taken care of immediately. Different ways of managing engorgement are-

• Icepacks
• Cabbage leaves
• Manual massage
• Expressing the milk in clean containers at regular intervals
• Breast pump
• Physiotherapy

Physiotherapists plays a major role in the immediate period post-delivery-

To teach the correct technique

Make the female aware of different positions

Look for breast engorgement

Teach manual massage to reduce engorgement

Manual expression of milk

Use of breast pump

Also, to inspect whether the nipples are retracted, cracked, sore and advise them the use of nipple shields.

Thus, by learning and becoming aware of these few techniques of breast feeding we can ease a mother’s journey with the new born and help the new born get the right nutrition.

Welcome back! After a brief overview of physiotherapy in womens health last week, today I am going to speak of post-natal care, its myths and recent physiotherapy care.

Post-natal period is the period after delivery of the baby and lasts up to 6months wherein all the body systems, hormones and uterus return to the pre pregnant state. It is also known as the postpartum period. It’s a very crucial period for both the mother as well as the child.

In this 6-month period you can see that the ligaments and abdominal muscles are more elastic and are still lax, entire abdominal corset is weakened. Pelvic floor muscles are weakened. Some females even experience urine leakage due to weak pelvic floor. Due to lax muscles and ligaments and postural changes some even start experiencing low back pain. Other causative factors for low back pain are poor breast-feeding positions, nappy changing positions, poor baby lifting techniques and overall fatigue. Other problems seen are oedema in both the legs immediately after delivery due to prolonged labour or pelvic congestion. Breasts become engorged, firm, hot, some women have cracked nipple, retracted nipple.

Due to all these problems special care in the postpartum period is required. Before going to the physiotherapy services needed in the postpartum period let us have a look at the myths about exercising and breast feeding.

MYTHS: –

1.Post a caesarean section immediate exercises are bad to the mother’s health.

FACT-an early exercise regime will lead to better fitness!

2.Post-delivery a woman should not wear a bra till she is in the hospital.

FACT-A woman can start wearing a bra immediately on the next day 1 in fact it is recommended for better support.

3.Post-delivery it’s better that she is not exposed to wind, cause that might go inside her body and harm her.

FACT-Wind does not cause any system changes in the body.

4.If the women have breast engorgement it should not be massaged or else, she will have puss formation inside her breasts.

FACT-Breast massage will clear out the blocked milk ducts and reduce the pain and engorgement and help in better breast feeding.

5.During breastfeeding the baby should be fed from both the breasts for 10-10 min each.

FACT-The infant should be fed from 1 breast completely so that he receives the foremilk and the hind milk. Hind milk usually maintains his satiety level.

6.By applying a tightly fitting cloth on the abdomen, the size of the abdomen reduces.

FACT-Cloth is of no benefit, but a corset in the initial days gives a better support to abdominal muscles as well as back.

7. A mother should consume more milk post delivery because she has to breast feed the baby.

FACT-Breast milk is generated in the body irrespective of the external milk the female consumes!

These are the things with no scientific basis at all.it is better to create awareness about it and pass on the right message so that we can educate maximum no. of females for their own benefit and fitness.

Now a day’s post-delivery even the hospital stay has been reduced as compared to previous years. On an average after normal delivery a patient is discharged within 2-3 days and post a caesarean section within 5-6 days if there is no complication. In this scenario we need to change our attitude towards resuming to an early fitness regime.

For a normal delivery with or without episiotomy (surgical cut made during delivery) physiotherapy can be started after 24 hrs and for a caesarean section after 24-48hrs depending upon the patient’s condition. Yes! of course the exercises to be done in both the cases vary in intensity and type.

In case of normal delivery with or without episiotomy the exercises to be started within 24hrs and its effects are-

1.static abdominal exercises-for strengthening of abdominal muscles.

2.core activation-for a strong abdominal capsule.

3.Static back exercises– for back strengthening and as a part of back pain prevention programme.

4.pelvic floor exercises in various positions-to prevent urine leak(incontinence), prolapse and to improve tone and strength of muscles. In cases where episiotomy is done it helps in faster healing.

5.postural correction exercises-for a better posture and correct muscle imbalance.

6.dynamic abdominal exercises for upper and lower abdominals-as a part of abdominal progression exercise for strengthening.

7.All active upper limb and lower limb exercises– for maintaining and improving general fitness.

Exercises for caesarean section to be started within 48 hrs.

Exercises which can put stress on the sutures are to be avoided for the first 2 weeks until suture removal. Rest all exercises remain the same.

After 6 weeks an endurance test can be done in both the normal and caesarean section females and then they can be put on an appropriate fitness programme.

So, lets spread the word and create awareness about post-natal physiotherapy and also the myths being followed for ages.

Open to all questions and queries.

Dr. Mithila Pawar (PT)

Regno.:2015/04/PT/003871

7798627730

mithilapawarr3@gmail.com

Women’s health is a vast field which includes diagnosis and treatment of various conditions that affect women. It is divided into various gynaecological conditions and reproductive health care. Between developed and developing countries there is a vast difference in the awareness of addressing these issues and taking proper care of women. Gender inequality, class, access to education, domestic violence, suicidal cases are the major problems faced in India at present due to which women’s health is hampered. According to a survey by WHO 31% of women are victims of domestic violence.

99% of maternal deaths are occurring in developing countries. The causes are mostly haemorrhage, sepsis, hypertension, prolonged labour, multiple deliveries, poor nutrition and hygiene.

Physiotherapy plays an important role in most of the conditions suffered by women and also in preventive care. Women’s health being a less explored domain of physiotherapy in a country like India, creating awareness regarding it feels necessary. The different gynaecological conditions that could be treated by physiotherapy are urinary incontinence (unable to control urine or faeces), faecal incontinence, prolapse (slipping down of a part or entire organ of the body), physiotherapy post different surgical procedures like abdominal hysterectomy (surgical removal of uterus), vaginal hysterectomy, hernioplasty (repair of hernia) and many more. In reproductive healthcare we have physiotherapy in the antenatal period.i.e.: during pregnancy and postnatal physiotherapy i.e.: after delivery.

Community health, a branch of physiotherapy deals with this aspect in particular. Other aspects covered under this branch are geriatric rehabilitation (rehabilitation of old people), industrial physiotherapy, physiotherapy for the disabled, creating awareness about various disabilities, various laws made for disabled, industrial health, injury prevention, hazards and risks, ergonomics etc.

In today’s article I am going to give you all a brief introduction about physiotherapy services available during the antenatal period, post-natal period, different gynaecological conditions.

Starting with the antenatal period, Pregnancy is a normal physiological process experienced by many healthy women. Various physical and biological changes take place during this period for which special care needs to be taken. In developed countries women are aware of the special needs that are required during pregnancy and opt for various activities like swimming, Pilates, relaxation exercises. On the other hand, in developing countries like India, most of the women deliver without even consulting a medical professional. Looking at the statistics, every day 830 women die during pregnancy from preventable causes related to childbirth and pregnancy.

All this can be reduced with appropriate medical guidance and creating awareness among women regarding different medical facilities available to them during the antenatal period.

Physiotherapy is thus of utmost importance in the antenatal care. The various aspects covered under this are-

1.increase the knowledge of couples regarding physiology of pregnancy, labour and puerperium.

2.different ways to cope with physical changes during pregnancy and the associated discomforts.

3.pregnancy back care and ergonomics

4.various exercises targeting pelvic floor and pelvic mobility exercises. This has been shown to reduce post-natal incontinence.

5.exercises promoting circulation and for frequent cramping experienced during pregnancy.

6.relaxation techniques which help induce stress relaxation.

7.upper limb and lower limb mobility and strengthening exercises.

 Gynaecological conditions like incontinence (unable to control urine or faeces), prolapse (slipping down of a part or entire organ of the body), hernia occurs due to muscular imbalance, weak pelvic floor musculature, weak abdominal muscles, multiple deliveries or congenital weakness of muscles. All these can be treated using appropriate physiotherapy services, some of which are-

Preventive care

Muscle re education

Pelvic floor Muscle strengthening

Abdominal strengthening

Use of various electrical modalities for extremely weak muscles.

So, this was a glimpse of the services available in physiotherapy for conditions especially suffered by women. Let us all keep aside the gender discrimination and spread this awareness among everyone, so they can avail physiotherapy during their gestational period and every family can have a healthy mother and healthy baby home, also prevent a lot of surgical procedures by early physiotherapy intervention. So, let’s all strive for balance for better!!!

Dr. Mithila Mukesh Pawar (PT)

Reg no.:2015/04/PT/003871

mithilapawarr3@gmail.com

Contact no.-7798627730

Thanks for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton