What Every Physio Should Know About Breasts:
Breasts are often the first bodily attribute that defines a human as female. Yet independent of their assigned sexual role, their function is cardinal to all members of the class Mammalia. In humans, the breasts operate as the extra-gestate placenta through the specialized system of lactation that is in and of itself part of the human reproductive system. Women’s Health physiotherapy concerns itself primarily with influences of the female reproductive system and improving the health outcomes of women throughout their life stages. Thus, an understanding of the Lactating Breast is essential to the practice of Women’s Health Physiotherapy.
The large and growing body of compelling evidence demonstrates that women and their babies who are not exposed to maternal lactation and infant breast-feeding and / or breast-milk feeding are at risk of serious negative health outcomes including but not limited to diabetes, cardiovascular disease, obesity, osteoporosis and cancer. By re-positioning lactation and breast-feeding as the biological norm, physiotherapists, as primary contact clinicians have a significant role in improving health outcomes across no fewer than two generations.
Supporting women to establish and maintain lactation is an investment in the long-term health of our community. In 2011, the US Surgeon General released the “Call to Action to Support Breastfeeding” highlighting the need to ‘provide education and training in breastfeeding for all health professionals who care for women and children’ (US Department of Health and Human Services, 2011). Ward & Byrne (2011) reiterate the recommendation of the WHO that at least 18 hours’ education for all health professionals who advise pregnant women and mothers should be undertaken. The Public Health Association of Australia advises that nationally consistent training and education for health professionals need to be developed (2010). Our own physiotherapy profession has been advised since 2004 that the primary aim in the immediate postpartum period is the establishment of breastfeeding, and therefore Women’s Health Physiotherapists, are to remain informed with regard to breastfeeding so that they can support [the woman] as best as possible (Mantle 2004).
Women’s Health physiotherapists have a responsibility to the mothers’ in their care to be well educated on this subject. Knowledge of human lactation and infant breastfeeding is as important as all and any other knowledge of the human reproductive system.
In addition to informed support, physiotherapists have a pivotal role in providing practical treatment to assist in maintaining breastfeeding. One of the main areas of physiotherapy management is in inflammatory breast conditions including mastitis, a key contributor to women prematurely weaning. Mastitis has a rate of incidence of up to 33% in the puerperium with most episodes occurring in the first 2-3 weeks post-partum (Spencer, 2008). Mastitis in human lactation is not fully understood and careful assessment is required to determine causative factors. Fetherstone (2003) suggests that the greatest risk factor for developing mastitis is a previous episode and thus it is the clinician’s duty to assess and treat effectively to prevent further recurrences.
Early detection and management by a suitably trained physiotherapist can assist in resolving lactation problems promptly, allowing breastfeeding to continue successfully thereby reducing the risks of negative health outcomes from non-human milk feeding. Physiotherapy management includes and is not limited to education to minimize contributing risk factors, maternal positioning for breastfeeding, application of techniques to reduce inflammation such as therapeutic ultrasound, low level laser therapy, cryotherapies, the use of breast pumps and manual techniques to improve lymphatic drainage. Much of the skills and resources of physiotherapy practice is relevant to assessing and treating women suffering from inflammatory breast conditions in lactation.
Melinda Cooper has accepted the challenge to re-position lactation and breastfeeding as the biological norm. She recognizes that physiotherapy has much to offer women and their babies achieve optimal lactation, thus creating an important step on their path to better health. Over the last 20 years, Melinda has developed and presented The Lactating Breast for Physiotherapists Courses. Melinda facilitates two days of solid theory covering research and evidence of health outcomes, physiology, functional anatomy, pathology, clinical assessment and treatment interventions in an engaging style. Melinda uses research-enhanced teaching methods so participants are ready to ‘take the theory, put in their bodies’ and use it immediately. Joined by her colleagues on the third day of the programme, Melinda takes the participants through the practice of a range of physiotherapeutic interventions. All practical sessions are conducted in small groups to allow for maximum participation.
At the conclusion of the course, participants will be ‘abreast’ of research and will have hands-on skills to influence their practice.
Importance of this course:
The body of knowledge about human lactation and its impact on health outcomes beyond the childbearing year continues to grow and along side this increase in knowledge is the role that the physiotherapy profession plays. As the scope of clinical practice in physiotherapy continues to develop, there is demand for clinicians to participate in a course covering the lactating breast for all physiotherapists who treat women in pre-pregnancy and childbearing life stages. Clinicians in general practice will benefit from this course as patients are more aware of what physiotherapy can offer women with disorders of lactation. Physiotherapists working in paediatrics will also benefit from this CPD activity since lactation serves to support the health of the infant as well as the mother.
Overall aim of this course:
At the conclusion of the course, participants will have the knowledge and confidence to provide appropriate advice, treatment and/or referral for inflammatory conditions of the lactating breast. Further, by accessing research-enhanced strategies the participants will be able to support women achieve optimal lactation in whatever clinical scenario these women present.
- Understand the health outcomes across at least 2 generations of lactation and breastfeeding
- Understand the role of the physiotherapist in lactation and breastfeeding support.
- Understand the anatomy and physiology of the lactating breast that are relevant to physiotherapy
- Demonstrate an ability to identify problems within the context of the lactating dyad using research-enhanced theory
- Identify and perform the key components of a lactating breast assessment for inflammatory conditions
- Demonstrate the ability to provide informed choice for assessment and intervention and competency in Infection Prevention and Control principles and application
- Demonstrate clinical reasoning from a research-enhanced base when advising &/or applying a therapeutic intervention
- Develop a repertoire of physiotherapeutic modalities that are applicable to the lactating breast
- Appreciate the roles of lactation consultants and other health practitioners with expertise in lactation and breastfeeding
- Develop a network of multidisciplinary support with colleagues, lactation consultants and other health practitioners involved in pregnancy, peri-partum care, lactation and breastfeeding.
Please note: During this course, participants will be required to act as models and practice on each other.
Audience: This course is open to physiotherapists, naturopaths and midwives.
Prerequisites: All participants will need to complete the IPAC hand hygiene course (no cost for this). You can follow this link to the IPAC course: https://ipac-canada.org/hand-hygiene-e-learning-tool.php. You will need to show a certificate of completion at least one month prior to the start of the course emailed to Sarah (firstname.lastname@example.org). Participants must have professional indemnity insurance to participate.
Australian Health Ministers’ Conference. 2009. The Australian National Breastfeeding Strategy 2010- 2015. Australian Government Department of Health and Ageing, Canberra.
Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. Lancet, 360:187–195.
Danforth, K.N., Tworoger, S.S., Hecht, J.L., Rosner, B.A., Colditz, G.A., Hankinson, S.E. (2007). Breastfeeding and risk of ovarian cancer in two prospective cohorts. Cancer Causes Control. 18: 517 – 523.
Featherstone C (2003 ) Physiological changes in the lactating breast during mastitis. Proceedings from Milk, Mammals and Marsupials: An international perspective. Conference and annual Meeting of the ILCA August 1-3, Sydney p377-38
Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D. … Lau, J. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report – Technology Assessment, 153:1–186.
Krogh C, Biggar RJ, Fischer TK, Lindholm M, Wohlfahrt J, Melbye M (2012) Bottle-feeding and the Risk of Pyloric Stenosis Pediatrics; originally published online September 3, 2012; DOI: 10.1542/peds.2011-2785
Mantle, J. (2004). Physiotherapy in obstetrics & gynaecology. Oxford:, Butterworth-Heinemann. P 209
Schwarz, E.B., Ray, R.M., Stuebe, A.M., Allison, M.A., Ness, R.B., Freiberg M.S., & Cauley, J.A. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics and Gynecology, 113:974 – 982.
Spencer, J. P. (2008). Management of mastitis in breastfeeding women. American Family Physician. 78(6):727-731.
Stuebe, A.M. & Schwarz, E.B. (2010). The risks and benefits of infant feeding practices for women and their children. Journal of Perinatology, 30:155-162.
Stuebe, A.M. & Rich-Edwards, J.W. (2009). The reset hypothesis: lactation and maternal metabolism. American Journal of Perinatology, 26:81–88.
U.S. Department of Health and Human Services. (2011). The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General.
Ward KN and Byrne JP (2011) A critical review of the impact of continuing breastfeeding education provided trigger point nurses and midwives. J Hum Lact July 14