Hello readers. It’s been a few months since I’ve posted. I’ve been working on finishing an updated draft of my book on postpartum health through the yoga therapy lens, which I’m thrilled to say will be published August 2024.
The following is a tailored excerpt from my book, shared with permission from my publisher*, and offered as guidance for both the breast-and bottle-feeding momma. I meant to get it out in honor of Breastfeeding Awareness Month in August…but, well, you know, life happened.
We’ll review some of the common conditions lactating mommas face, and then explore complementary yoga therapy tools. While written for yoga therapists treating postpartum clients, any momma with some yoga familiarity will find utility. If you’re a postpartum woman reading this, put yourself in the place of the client I describe below. If this isn’t relevant to you, I hope you’ll share this with the women in your life for whom it is. Heck—even bottle feeding dads will benefit from postural and breath awareness suggestions.
So much of our early interaction with baby is determined by the ease we can manage amidst the inevitable challenge. These yoga therapy tools are geared to engender ease in body, mind, and spirit, so that baby can enjoy the nourishment of momma’s pacifying presence.
I also offer this section as an introduction to my new Substack site The Yoga Therapy Lens. I’ve just published a piece on the pancamaya kosha model, the ancient yet timeless model by which yoga therapists assess and treat the whole person. Through semi-regular postings, I’ll aim to translate between allopathic and yoga therapy realms. While working as a yoga therapist in the acute ward of a Maryland hospital, it became clear how essential—and how lacking—the whole-person perspective is in contemporary healthcare. The Yoga Therapy Lens aims to be a bridge between these two realms. Check it out at theyogatherapylens.substack.com.
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There are many wonderful resources, both hardcopy and virtual, for the milk producing momma. You can’t throw a virtual rock without hitting an online forum where every possible variation on feeding baby is discussed. I’ll reference the one I considered gospel: The Womanly Art of Breastfeeding, a resource compiled by La Leche League International, an organization that for decades has supported women in breastfeeding, and general attachment-style parenting.
At the outset of this section, it’s important to say that I am not a lactation consultant. I am a mother who has breastfed three babies into toddlerhood, and am generally an advocate of breastfeeding. In my client work, I am more specifically an advocate of the mother who is in front of me. While I may have personal feelings about the importance of breast-feeding, I don’t let those take up any space in the room with the client. It’s not important what I think about breastfeeding. It’s only important that I am available to the client as a space where she can explore her relationship to what can be a very difficult choice, whether she breastfeeds or bottle feeds.
Some clients may choose not to feed directly from the breast, but instead pump and bottle feed. Though I’ll focus on how to hold breast while nursing baby, the following discussion on postural and breath awareness is relevant to pumping and bottle feeding, as the same principles apply.
Some women may choose to not breastfeed at all; and in some cases, circumstance may make the choice for her. The work is often both the mitigation of pain secondary to engorgement as the body transitions to a non-milk producing state, as well as processing what arises when riding the waves of the emotional body.
As I asked myself how yoga therapy can bring added value to the breastfeeding conversation, the answer that kept arising was in how mother holds herself and baby as she nurses, pumps, or bottle feeds. Postural and breath awareness are two of yoga therapy’s greatest gifts; an additional endowment is the focus on the power of relationship. The simple act of being present with your client as she struggles through this time may be healing in and of itself. We are not supposed to do this alone. Say it with me: We are not supposed to do this alone! Women have energetically and physically held women through this challenging time for millennia, if not longer! We have forgotten that simple, essential fact. Let’s be part of the revolution of postpartum care that remembers the importance of community support.
There are strong forces pushing against an already tired new mother’s attempt to swim against the tide and choose to breastfeed. As the Centers for Disease Control says, “Breastfeeding disparities exist.” According to data reported on the CDC website, mothers 29 and younger are less likely to breastfeed than older mothers. Infants born to lower income mothers eligible for supplemental nutritional programs that provide assistance in paying for formula are less likely to be breastfeed (CDC, 2022b). Demographically, infants born to Asian parents (91 percent) are more likely to be breastfeed than non-Hispanic White parents (85 percent), Hispanic parents (83 percent), and Black parents (74 percent), according to the CDC’s National Immunization Survey of children born 2012-2019. The CDC cites the following factors as influencing a new mother’s actual duration of breastfeeding, relative to her intended duration: lactation and latching issues; infant weight gain concerns; a mother’s concern about medications while breastfeeding; lack of parental leave and unsupportive work policies; lack of familial and cultural support; unsupportive hospital policies and practices. All this is to say, your work with a new mother may be her lifeboat.
Nipple Trauma, and Clogged Ducts and Mastitis: A Brief Biomedical Overview
Nipple Trauma. Bruised, bloody, cracked and chapped—that is often the state of a new mother’s nipples, and that’s before baby even has teeth! According to a 2016 retrospective analysis of 653 maternal-infant records of women attempting to breastfeed, nipple trauma presented in nearly 63 percent of cases (Thompson et al.) What the numbers can’t tell us is how many women end breastfeeding early because of it. Some nipple trauma is inevitable as mother and baby learn to give and receive. However, with the correct positioning of breast and baby, and latching of baby to breast, most nipple trauma is largely surmountable and avoidable. There are so many good resources that speak to nipple trauma. Here I will point you again to The Womanly Art of Breastfeeding, which includes excellent information regarding positioning, what constitutes a good latch, and how to tend to sore, bruised and bloody nipples while they heal and acclimate to baby’s changing mouth and needs.
Clogged Ducts and Mastitis. If you’ve never seen a drawing of the system of ducts that run through a lactating mother’s mammary tissue, I invite you to search for one now—it’s awesome. Ducts and lobes spread through the breast like roots of a tree. Fitting, then, that the fruits of this system nourish so perfectly. When mother’s brain receives the hungry baby message, it signals for the release of prolactin and oxytocin, which then stimulate the production and release of milk. In a healthy, hydrated mother, breasts are never completely empty—the body always keeps a bit on reserve for baby. But, it does take the gentle pawing of an infant hand, or the not-so-gentle crying of a hungry mouth, to invite the milk to, as it’s called, “let down.” The breasts are designed to produce and promote the flow of milk from the breast to baby’s mouth. Sometimes, though, something interrupts the system, and the duct clogs.
The reported number of plugged or clogged ducts varies depending on the source, most settling on about 20 percent of breastfeeding women, though I doubt the number is that low as so much in postpartum is underreported. Plugged ducts occur when milk does not drain properly from the channels through which it flows. Signs that a duct has clogged include red, tender spots or lumps, often where a hand will normally hold the breast, or the underwire of a bra might press. A number of factors might inform the development of clogged ducts, including poor positioning of baby and breast, too much time between feedings, too tight garments, and not enough fluid intake.
When inadequately treated, a clogged duct can lead to the development of mastitis, a very painful infection that often requires antibiotic intervention; estimates suggest that some 10 percent of lactating mothers develop mastitis—again, I’m willing to bet that this number, too, is underreported. Symptoms include flu-like symptoms that come on fast. When I called in at three a.m. to complain of severe breast pain, body aches and a fever, my midwife asked me: “Does it feel like you got hit by a truck? If the answer is yes, it’s likely mastitis.” We discussed pain, its implications, and specific treatment measures in the previous section of this book; turn back now if you need a review. For now, let’s turn to the yoga therapy lens and tools, and how helping your client develop her awareness around how she breastfeeds can be the key to a healthy breastfeeding journey.
Yoga Therapy Tools
When I presented with my first case of mastitis, my midwife said that clogged ducts and resulting infection are often a result of a new mother trying to do too much. “Rest,” she said. “Rest, and pay attention to how you are doing what you are doing.” It turned out, when I paused to notice, that I was trying to do too much. Maybe the dishes, laundry, sweeping and computer work—alongside caring for a very small child—didn’t all need to get done. It also became clear that I was holding my breath and body in ways that were promoting injury. In the interest of helping my tiny, hungry human latch, I was squeezing my breast with my thumb and forefinger, and always in the same place. As I brought awareness to that pattern, I also noticed that the exact place where my thumb habitually pressed was where my most persistent clogs developed. Desperate to ease my child’s hunger pains, I was also often holding my breath, and pinning my shoulders to my ears—which might have had something to do with my chronic musculoskeletal discomfort. None of this effort, though well intentioned, served me or the task at hand. Only awareness could interrupt the suffering-inducing patterning. Thank goodness for awareness!
Developing Awareness in Breastfeeding. Should your client present with regular clogged ducts and mastitis, consider it evidence of some dysfunctional, repetitive movement of body, breath, and mind. You will want to ask yourself: How can I help my client bring awareness to her patterns? One general way I recommend is by helping her slow down. When a hungry baby cries, momma’s whole body goes on red alert. It becomes nearly impossible to think, talk, or do anything except feed that baby. While brilliant survival software, it can make intelligent processing and problem solving difficult. She may engage in the same dysfunctional patterns again and again because the urgency of the moment renders her single-minded in her approach. Slowing down and inserting mindfulness into the process can help tease out what’s working, and what isn’t.
La Leche League offers an excellent tool in what it calls “breastfeeding in slow motion” (p. 47), outlining ten steps that help break down effective breastfeeding. We’ll review a few of them here, but more to offer the physical, energetic, and emotional setting in which employing these steps might take place.
Positioning Momma Properly. La Leche League describes what this might look like: Sitting up in a bed, armchair or rocking chair, your client should support herself and baby with as many pillows as necessary: behind back, elbows, and atop lap (and underneath baby). The goal, as La Leche League writes, is ease: “You should be relaxed with none of your muscles straining” (p.47). And so, you can encourage your client to primarily focus on her own ease when setting up for nursing. Rather than thinking only of getting baby fed, mom can ask herself: How can I be as comfortable as possible so that I can release into baby? A mother whose body and breath are held in an uncomfortable position, whose mind is straining toward a goal without examining how it is being met, will have a hard time giving herself over to the process of release that is fundamental to milk production, whether letting down for baby, or the pump. Before even attempting to latch, momma can take a moment to pay attention to how she is sitting. Where does she feel supported, and where might an adjustment serve her? Essentially, this is a body scan, with the specific goal of assessing areas of discomfort that can be eased by positional change.
A partner question is: How am I breathing while readying for baby? As your client scans her body, ask her to also notice her breath. Is it shallow? Staccato? Short? Depending on her presentation, share with her a breathing technique that helps bring balance to her breath, with the emphasis on slightly longer exhales.
Offering Breast and Encouraging Latch. Mom is encouraged, according to La Leche League, to hold breast in a kind of a C-shaped cup, between thumb and index finger, far behind the nipple and areola. Breast wants to be supported at its natural height, which will mean bringing baby to the breast, elevated atop a supportive pillow, so that mom doesn’t have to hunch over baby. Ask your client to notice: Where, and how hard are my fingers pressing against the breast? A tight grasp may promote clogged ducts and the downstream consequences. It can also inform wrist and thumb pain, common among nursing mothers. Attention to how she is holding baby and breast can help ameliorate these issues.
Think of how a bolt slides perfectly and easily into position when a well-oiled lock is turned; a good latch between breast and baby feels similarly right, and a new mother soon knows it when it’s in place. Nipple needs to be fully available, and baby’s mouth should open wide, like a yawn. Your client can encourage this most natural reflex by moving the nipple to and away from baby’s mouth. “Talk to him and encourage him,” La Leche League writes (p. 48). And, we’ll add here, let your language and tone be inviting and easeful. This is so key—a frantic mother forcing a breast on baby won’t engender the kind of response that will invite a good connection. If your client regularly tries to feed while frenzied, she’ll have a harder time, each time. Your client can set the stage for a comforting interaction in language, tone, caress and eye contact by finding comfort first in her body and breath.
Avoid Pain. Help your client learn early to avoid grinning and bearing pain as if it’s fundamentally bound up with the breastfeeding process. Yes, sometimes severe discomfort early on is common as the tissue of nipple, areola, and breast adapt to new sensation. Yes, nursing does involve pain, particularly early on; some women will experience a sharp, shooting sensation alongside milk let down, and the initial clamp of that tiny but mighty jaw can be jarringly painful. And no, it shouldn’t hurt in a way that feels injurious to the tissue. Your client may need to break the latch (by inserting her finger into the side of baby’s mouth and breaking the suction gently) and try again—and it’s very likely baby won’t be happy about it. Here, again, is where mindfulness will play a crucial role. It’s totally natural that momma’s body and breath will tense in response to her infant’s frustrated cries and how she eases will be a sign to her infant that everything will be alright. A mother teaches her infant as much by her behavior as she does by her words. If breastfeeding hurts, and your client needs to pause, unlatch, and reevaluate her approach, she’ll want to do so with the same qualities of patience, awareness, and gentleness with which she began—even as her baby winges in frustration. You can help her practice exactly that.
Stage a “Nurse In.” The setting for slowing down may come in the form of the revolutionary act of staging a “nurse in.” Invite your client to take that baby to a safe and comfortable surface, and cuddle and hold, with breasts available to baby for the time when hunger presents. Encourage her to do this for as long as possible—a day, a week even. These nurse-ins are only revolutionary in a society that has forgotten how to prioritize breastfeeding. By nursing-in, momma and baby can get to know each other. Momma can become more present to baby’s hunger cues before they become deafening, and before they offline her capacity to problem solve. This, of course, necessitates that someone be present to attend to mother’s needs, or the needs of other children in the home, and may be a luxury that many new mothers feel they don’t have. And, it’s likely that your client can make the space for this revolutionary act if she understands its importance. Wherever possible, invite your client to put down the tasks that aren’t immediately relevant to her household’s functioning—there will always be dishes to do—and instead spend that time letting the gravity of motherhood pull her into orbit with baby so that they may feel the rise and fall, the give and take of each other’s breath and being.
Lastly, and I offer this as a yoga therapist interested in my client’s ease and health, and not as a lactation consultant, you might consider suggesting that your client try out what La Leche League calls “laid back nursing.” This is a positioning that offers momma the greatest amount of ease possible, while helping baby feel safe and secure so that both momma and baby can relax into their instinctive biological processes of releasing and receiving.
Here’s the gist: Your client will want to lie back in a supported, semi-reclining position that allows her chest and shoulders to relax, creating a soft and open surface for baby. Mom will then bring baby to lie against her, baby’s whole front resting across the body at any comfortable angle. Once baby’s feeding reflexes are triggered—and they will as soon as a hungry baby smells momma’s milk—baby will begin to seek out the breast and find the latch. In “laid back nursing,” gravity will help deepen and secure the latch rather than work against it as it does when mom is leaning over baby. In this style of nursing, momma’s hands are free to pat and caress their babe—contact which further promotes the production and release of lactation and bonding supporting hormones like oxytocin.
However your client’s feeding processes are taking shape, remind her of this important edict: Make these moments of motherhood her meditation. Yes, a pumping, bottle feeding or nursing session can be an opportunity to catch up on emails or social media posts, but they can also be opportunities to practice mindful observance of the specialness of every moment, whether they be joyful, or challenging.
* Published with permission from Jessica Kingsley Publishers.
References
Wiessinger, D., West, D., & Pitman, T. (2010). The womanly art of breastfeeding. 8th edition. New York, Ballantine Books.