Could Chiropractic Care Help With Breastfeeding? June 21, 2014 13:55
Written By Michelle Roth, BA, LCCE, IBCLC
Imagine your baby’s position in utero – all folded and curled. Now think about the trip your baby makes during birth. In the most favorable situations – when baby’s head is down and anterior, and mom’s pelvis is mobile and open – baby still needs to make several twists and turns to be born. Add to this a modern hospital birth – with induction, lying flat in bed perhaps with your feet in stirrups, immobility due to pain medications, prolonged pushing with pelvic movement restricted, delivery assisted by forceps or vacuum, cesarean birth, and more. It’s no wonder some babies (and their moms!) seem to suffer from physical birth trauma.
Babies are designed for birth – the bony plates of the skull aren’t fused, allowing them to move and overlap in order for the head to move through the maternal pelvis. A baby’s skull is made up of 22 bones with 34 joints or sutures; and, the structures necessary for feeding are controlled by 60 muscles and 6 cranial nerves. 1 While babies are programmed for birth and breastfeeding, if the mechanics of the body aren’t working right, the expected behaviors can be impacted. 2, 3 With so many bones, muscles and nerves involved, the chance for problems is increased, especially when the natural course of labor is impacted by interventions. 1, 3, 4, 5 In addition, even a spontaneous vaginal birth without intervention may cause changes in the infant’s spine, and this misalignment can lead to discomfort and difficulties with all the baby’s systems. 3, 6 The solution? Gentle manipulation and realignment. Treating these misalignments, movement of bones and impingement of nerves – through chiropractic, osteopathy, cranial sacral therapy, etc. – has the potential to improve feeding at the breast. 3 But this type of treatment is not free of controversy.
At the July 2013 International Lactation Consultant Association (ILCA) conference, Dr. Howard Chilton, a neonatal pediatrician, answered an audience question about chiropractic care for infants, saying “this type of management is unproven, has no basis in science and potentially dangerous, both of itself and from the delay in the application of sound medical and nursing procedures …”, going on to call chiropractic care “pseudoscience.” ILCA printed his comments in their newsletter for members, but also printed a response from Dr. Joel Alcantara, from the International Chiropractic Pediatric Association, saying, “Chiropractic is a vitalistic, holistic and patient-centered approach to patient care” and citing research for application in pediatric settings. 7 So what are parents to make of all of this? Can chiropractic care be a beneficial adjunct to allopathic medicine for babies? Could chiropractic therapy help specifically with breastfeeding difficulties?
Two recent literature reviews suggest, while more research needs to be done, the few studies available showed improvement of breastfeeding issues and other problems (such as colic and asthma) with chiropractic intervention for the infant. 8, 9 In addition, Vallone discusses several case studies in which low milk supply was resolved with chiropractic care of the mother. She theorizes that the misaligned vertebrae can disrupt nerve and hormone function, and this can impact breast development (whether before, during or after pregnancy). The type of lactation difficulty will depend on the location of the subluxation; but in the cases she reviews, spinal manipulation showed results (such as, improved milk production and infant weight gain, in addition to maternal comfort) quickly. 10
In a larger case series, Miller and colleagues looked at 114 cases of breastfeeding difficulties where standard care for the infant was supplemented with chiropractic therapy. Infants younger than 12 weeks were referred for chiropractic care after being diagnosed with suboptimal breastfeeding. In this sample, 78% of the babies were exclusively breastfeeding after finishing the course of chiropractic care, which for most babies, was 3 visits. 4
Finally, Holleman, Nee and Knaap write about a case where breastfeeding aversion was resolved with chiropractic care. An 8-day-old baby was seen with the chief complaints being latch problems and a weak suck. Along with these infant issues, the mother suffered from painfully sore nipples. While breastfeeding had gone well for the first 4 days, the baby showed preference for one breast only on day 5, and then began refusing the breast on day 6. After 4 treatments consisting of gentle spinal manipulation and cranium treatments, the baby was nursing normally again. The authors suggest birth trauma may have been to blame (induced labor and shoulder dystocia, in this case). 5
While case studies cannot provide proof that the intervention indeed led to the improvement, what they do show is that this is an area ripe with possibilities for improving breastfeeding and infant health. More study can be done to provide the evidence base for body work in addition to standard care. All of the authors suggest a collaborative approach to breastfeeding difficulties. Pediatricians, family doctors, lactation consultants, chiropractors, massage therapists, etc. should work together with the parents to plan a holistic course of treatment for the infant having feeding difficulties.
- latching difficulties, especially when accompanied by nipple pain or damage
- uncoordinated sucking, or difficulty with suck-swallow-breathe
- preference for only one feeding position or one breast, fussiness in other positions
- needing to nurse “all the time” or cannot transfer milk even though they seem to be nursing
- just as much trouble with the bottle as with the breast
- a fussy, uncomfortable, colicky baby
Openness to new modalities can often be the solution when a mom is about to give up on breastfeeding. Chiropractic care has the potential to alleviate discomfort for baby and mom, and to preserve the nursing relationship.
1Smith LJ & Kroeger M. (2009). Impact of Birthing Practices on Breastfeeding. 2nd ed. Sudbury, MA: Jones & Bartlett.
2 Frymann VM, Carney R, & Springall P. (1992). Effect of osteopathic medical management on neurologic development in children. J Am Osteopath Assoc, 92(6), 729-744.
3 Tow J & Vallone SA. (2009). Development of an integrative relationship in the care of the breastfeeding newborn: Lactation consultant and chiropractor. J Clin Chiropr Pediatr, 10(1), 626-632.
4Miller JE, Miller L, Sulesund AK, & Yevtushenko A. (2009). Contribution of chiropractic therapy to resolving suboptimal breastfeeding: a case series of 114 infants. Journal of manipulative and physiological therapeutics, 32(8), 670-674.
5Holleman AC, Nee J, & Knaap SF. (2011). Chiropractic management of breast-feeding difficulties: a case report. Journal of chiropractic medicine, 10(3), 199-203.
6 Towbin, A. (1969). Latent spinal cord and brain stem injury in newborn infants. Developmental Medicine & Child Neurology, 11(1), 54-68.
7 Lactation Matters. (2013). A Response from the International Chiropractic Pediatric Association.Retrieved from http://lactationmatters.org/2013/11/01/a-response-from-the-international-chiropractic-pediatric-association/
8 Fry, LM. (2014). Chiropractic and breastfeeding dysfunction: A literature review. Journal of Clinical Chiropractic Pediatrics 14(2), 1151-1155.
9 Gleberzon BJ, Arts J, Mei A, & McManus EL. (2012). The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. The Journal of the Canadian Chiropractic Association, 56(2), 128-141.
10Vallone S. (2007). Role of subluxation and chiropractic care in hypolactation. Journal ofClinical Chiropractic Pediatrics, 8(1&2), 518-524.
11 Ohm, J. (2006). Breastfeeding difficulties and chiropractic. Pathways To Family Wellness(11), 24-25.
Can a birth doula improve breastfeeding success? March 29, 2014 15:26
Written By Michelle Roth, BA, LCCE, IBCLC
Continuous labor support during childbirth has many advantages, including a decreased risk of interventions (including cesarean birth), less use of pain medication, and more positive birth memories (Hodnett 2013). But did you know a doula may also increase breastfeeding success?
From the Greek word for slave, doula has evolved to mean a woman who supports another woman during the birth process. During childbirth, she supports the laboring woman and her partner physically - helping mom change positions, providing massage or counterpressure, and giving the birth partner suggestions on how to help – as well as emotionally and intellectually. She is typically with the couple from the start of labor to the time of birth. Because of her presence and her trusted position with the new parents, she may be the ideal member of the birth team to help a mom initiate breastfeeding.
In an early study of the effect of doula care on breastfeeding success, researchers found that women in the intervention group (doula care) were more likely to be exclusively breastfeeding at one month after the birth (Langer et al, 1998). These women were also less likely to wean or supplement for perceived low milk supply. In closing, the researchers write, “These results provide grounds to consider that psychosocial support during labour and the immediate postpartum period should be part of comprehensive strategies to promote breastfeeding “ (1062).
In another study, Nommsen-Rivers and colleagues (2009) assessed the timing of the onset of lactation and the proportion of breastfeeding moms at 6 weeks postpartum for two groups – those with and without doula care for the birth. Compared to the standard care group, women in the doula care group were more likely to have their milk come in by day 3, were less likely to use a pacifier in hospital, were less likely to report concerns about milk supply, and were more likely to be breastfeeding at 6 weeks. After looking at relationships between confounding factors, the authors conclude, “Among mothers with a prenatal stressor, doula care was particularly effective in increasing the odds of continued breastfeeding” (172).
When studying the effectiveness of a hospital-based doula program, Mottl-Santiago and colleagues found that women with doula care were more likely to express an intention to breastfeeding, and were significantly more likely to breastfeed within the first hour after birth. The authors caution, however, that their results may not be a direct effect of a doula at the birth, since the doulas also provided prenatal breastfeeding education to the expectant mothers.
A recent study showed even more promising results. Of the women who had doula care during birth, nearly all initiated breastfeeding (97.9% compared to 80.8% in the general low-income population studied). When looking at a subgroup of women who are less likely to initiate breastfeeding, the researchers found 92.7% of African American women with doula support initiated breastfeeding, significantly higher than in the general population studied (Kozhimannil 2013). The authors suggest that “access to culturally appropriate doula care may facilitate higher rates of breastfeeding initiation,” with the key being suitable matching of doulas to the client population.
What more evidence do we need? Having doula support for your labor and birth may increase the chances of your breastfeeding. Choose a doula who shares your same values and birth philosophy so you feel comfortable and confident in her care. Ask friends, family, your care provider, or your childbirth educator for referrals or check the DONA International website for a doula in your community. Be sure to interview the doula you choose – even asking about her background in breastfeeding education and support. Let her know you plan to nurse your baby, and ask if she will help you get started. Her support may be essential.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7.
Kozhimannil KB, Attanasio LB, Hardeman RR, O'Brien M. (2013). Doula care supports near-universal breastfeeding initiation among diverse, low-income women. Journal of Midwifery & Women’s Health. E-pub ahead of print 9 JUL 2013.
Langer A, Campero L, Garcia C, Reynoso S. (1998). Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers’ wellbeing in a Mexican public hospital: a randomised clinical trial. British Journal of Obstetrics and Gynaecology (105), 1056-1063.
Mottl-Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P. (2008). A hospital-based doula program and childbirth outcomes in an urban, multicultural setting. Matern Child Health J 12, 372–377.
Nommsen-Rivers LA, Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. (2009). Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae. JOGNN 38, 157-173.
ACUPUNCTURE: An Ancient Practice for Breastfeeding Health November 13, 2013 20:10
You may know someone who has treated their migraines or muscle pain with acupuncture, but did you also know that this ancient Traditional Chinese Medical practice is also effective in treating common breastfeeding complications and increasing milk supply?
WHAT IS ACUPUNCTURE, EXACTLY?
Acupuncture is a five thousand year old practice that, combined with herbal treatments, massage, nutrition, and other various practices, forms the wider umbrella of Traditional Chinese Medicine (TCM). TCM approaches the body as a vessel full of vital energy. This energy flows throughout the body on a system of meridians. This energy is called chi (qi). The premise is that when your chi is off balance or blocked, your body can experience all kinds of pain and illness. Through acupuncture, these maladies are alleviated or eliminated by manipulating (or stimulating) specific meridian points associated with the flow or balance of energy.
When you undergo acupuncture, an experienced practitioner will place very fine needles into meridian points directly connected to the energy blockage. You might feel a slight twinge of pain as the needle goes in, or you could feel nothing at all. Once the needles are placed and wiggled a bit, you’ll get to rest quietly for fifteen minutes to an hour. You may even fall asleep! (The nap alone sounds good, right?) The needles are then painlessly removed and you’re on your way to wellness! Many women experience increased milk production and a decrease of symptoms of mastitis after just one visit, but it may take more depending on your particular condition.
From a western medicine mindset, this can be a little bit hard to stomach. It may help to know that in 1997, the National Institute of Health (NIH) gave their nod of approval for the use of acupuncture for the treatment of various conditions, with promise of future widespread approval. According to NIH’s National Center for Complementary and Alternative Medicine (NCCAM), the number of adults using acupuncture in the U.S. has increased by over a million since then.
WHY DOES ACUPUNTURE HELP WITH BREASTFEEDING?
According to Monica Legatt M.Ac., Dipl., NCCA, of Downtown Seattle Acupuncture, typical problems with lactation are a result of either insufficient energy or stagnant energy.
When you don’t have enough energy, you will often experience low milk production. It is fairly common for a new mother to be exhausted post-partum. Combine that with blood loss during delivery, and the levels of energy and blood flow necessary to produce sufficient milk are just not there. Acupuncture treatment actually increases the hormones necessary to produce and move breast milk. In TCM, your practitioner will combine diet recommendations with herbal treatments and acupuncture to achieve a healthy milk supply for your nursing infant.
When your energy isn’t flowing properly around the breasts, you may experience engorgement, pain and pressure, distention, and even mastitis (which also involves infection). This energy blockage generally stems from emotional stress such as anxiety, depression, resentment, anger, frustration, or any of the other day-to-day stresses you may feel as a new mother. These stresses cause a blockage in the flow of energy within the liver channel, which is related to nipple function in women and thus breast milk production and nursing. Aside from avoiding all stress (yeah, right), acupuncture can open up the energy blockages causes the painful symptoms.
When you receive acupuncture to treat these symptoms, you can rest assured that there will be no needles inserted into your breast! The practitioner will be treating the liver channel, which has points near the rib cage and on the torso, legs, and feet.
The best way to treat mastitis is by combining western medicine (antibiotics) to get rid of the infection, and acupuncture along with other TCM therapies to relieve the blockage.
HOW DO I FIND A GOOD ACUPUNCTURIST?
The first thing to do is to ask your best resource… your friends! A first-hand recommendation for a good acupuncturist who has worked well with lactation issues beats any search engine you can put your curser on. Ask at your mom’s group. Ask your lactation consultant, doula, or midwife. Ask your doctor. Once you get a small list of recommended practitioners, do your homework.
Check the acupuncturist’s credentials. There are several certifying bodies that train TCM practitioners in proper technique, and you’ll want a string of letters behind their name to ensure that you’re getting the highest quality treatment.
MD or DO: Your practitioner is a certified medical doctor, but ask if he or she has their Medical Acupuncture Certification through the American Board of Medical Acupuncture.
MAc, or M.A.O.M.: Masters in Acupuncture and Oriental Medicine. Your practitioner has completed a rigorous program through the Accreditation Commission for Acupuncture and Oriental Medicine.
NCAA, or NCAAOM: A certificate from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is required to obtain a state license to practice acupuncture.
Finally, you may want to check with your insurance company to see if acupuncture is covered. If it is, ask your provider if any practitioners on your list are within your network and if their services are covered.
As you embark on this new path to nursing health, please remember that unless an acupuncturist is also a certified doctor, they are not in a position to diagnose medical conditions. It’s best to always get a diagnosis from your doctor or midwife and then ask him or her if acupuncture would be beneficial to a holistic treatment plan.