Lactation Consultant's Thoughts On Bodywork For Breastfeeding Challenges

As you may have noticed by the title, I have got a bit to say about breastfeeding & bodywork. I pride myself on being a professional for the people, so to speak, and knowing that there is controversy on the subject amongst Lactation Consultants, it felt unfair to you all not to discuss it. My goal with this post is to arm you with the information you need to have a productive dialogue regarding bodywork with your care provider, regardless of which side of the matter you both stand.

The Facts

• Bodywork is a catch-all term for therapeutic techniques that involve working with the body, usually via touch or physical manipulation. Those commonly talked about in lactation care include Chiropractic care, Cranio-Sacral & Osteopathic Therapies, and Myofascial release.

• There is no scientific evidence supporting the claim that any of the therapies mentioned above are beneficial in resolving breastfeeding difficulties.

• There is a plethora (tons) of anecdotal evidence supporting the claim that these therapies are helpful, meaning people report it to have a positive and beneficial effect on overcoming their breastfeeding challenges.

• The little scientific evidence out there on the various therapies suggests that there is minimal risk.

The Controversy

The main controversy in the Lactation Community stems around the question "Should bodywork be recommended by Lactation Consultants for breastfeeding challenges when there is no evidence proving that it works?"

International Board Certified Lactation Consultants (IBCLCs) are responsible for providing evidence-based information to their clients. When there is a shortage of evidence-based information, which there often is in the medical community and with breastfeeding specifically, it's up to each consultant to use their professional & personal experience to guide their recommendations.

For those who have first-hand experience with seeing success in bodywork, it appears almost unethical to not suggest it when other techniques to resolve the issue have proven unsuccessful.

For those who have doubts about the practice, effectiveness, or safety of bodywork, it appears almost unethical to suggest it, especially when the cost of treatment is high.

My Thoughts

To be completely transparent, I am a proponent of chiropractic care and have utilized it for both my daughter Ariana and me over the years. I can only speak for the effects it had on me, but I know that after adjustments I have improvements with regards to pain and posture. For Ari, I took her to the chiropractor post NICU discharge and occasionally throughout her first year as a preventive approach not for any particular issue. Therefore, I can't say that I have personally seen a positive impact on her ability to breastfeed with chiropractic care during infancy, but it's logical to extrapolate my perceived benefits onto her.

In other words, I didn't have a specific breastfeeding issue I aimed to address with chiropractic care, and she couldn't tell me if it worked or not, but I assumed there was a positive impact based on my prior experiences.

I have, however, seen babies who struggled with breastfeeding improve after adjustments. Babies who had small gapes and were unable to latch onto the breast effectively before adjustments had an improved ability to open wide and latch after. In other cases I've seen, babies no longer had a breast preference, had increased mobility in head and neck movements, had improvements in oral function, as well as, had increased ability to manage the breast. More often, parents note less pain and pinching during feeds.

I have seen babies, however, where chiropractic care alone did nothing to improve breastfeeding, both in the way of latching or in the parent's perceived pain. And I've never had clients take me up on my suggestion to seek out CST or Myofascial releases, so I have no experience at all with those treatments.

The next question, naturally, is "how can I suggest bodywork techniques when I have no professional, personal or scientific evidence to support the suggestion?". It's a fair question. There are two reasons why I feel comfortable suggesting it.

1) IBCLCs who have more knowledge than I about breastfeeding and other therapies have had good success with it. I value their opinions on other breastfeeding-related topics. I am of the belief that if I trust their expertise in one department of lactation and their experience with bodywork has had a positive impact within their area of specialization, based on their established reputation, suggesting bodywork is appropriate.

For example, Catherine Watson Genna is a well -known & accomplished IBCLC, educator, researcher, and author, who specializes in working with babies with medical challenges such as tongue-tie, sucking problems, birth defects. Her book Supporting Sucking Skills is, in my opinion, a required text for any lactation professional working with babies. In the book, she has a whole chapter dedicated to on manual therapies and how when paired with lactation support it can be beneficial.

Further reading: Development of an Integrative Relationship in the Care of the Breastfeeding Newborn:Lactation Consultant and Chiropractor

2) I firmly believe that it's up to each family to decide what approach is best for them. My role is to help identify the issues and provide them with information and resources to consider. Frankly, without suggesting it, I would be failing my clients.

There's an argument against recommending body work due to the potentially prohibitive costs of treatment. I am acutely aware that financial barriers exist and it's the primary reason I've made my business model the way that it is. I know that not everyone is in a position to spend money on a treatment that has no scientific backing or that may not have a quick and immediate result. With all of that said, it's not my position to assume a family's ability to pay for treatment or be the gatekeeper of information based on perceived financial stability. I have learned over the years that families are quite resourceful when necessary and can at times create miracles after a bit of readjusting their budget. And those who literally cannot afford treatment will not be impacted in any way by my suggestion of potentially helpful therapy.

Ability to pay for a tongue tie revision does not prevent me from suggesting that it may be helpful in resolving breastfeeding difficulties.

Ability to pay for a Lactation Consultant does not prevent me from telling families that it would be helpful in reaching their breastfeeding goals.

Ability to cover the costs of Occupational Therapy or Speech-Language therapy does not prevent me from recommending their treatment approaches.

Insurance coverage and ability to pay for a doctors visit doesn't prevent me from suggesting they see their care provider.

I think you get the point.

My job is to identify & inform and suggesting therapies that might POSSIBLY help them is within that realm.

Some families are in no way comfortable with manual therapies for themselves or for their babies. I understand this completely and will never pressure any family to do something outside of their comfortability. Throwing the suggestion out there and letting them know that I am here if they have any questions or concerns is all I need to do to feel satisfied that I've done my due diligence in assisting them in the best way I know how.

Some argue that suggesting alternative therapy techniques reduces our credibility with other health care professionals. I can't say this is untrue and maybe it does. But the fact remains, while I am mindful of my responsibility in elevating the role of the lactation profession, my primary focus is on helping families and babies breastfeed effectively. If that means making recommendations that are low risk but potentially high in impact, then I will continue to do so.

Many things we suggest in the lactation field are low in evidentiary backing. Galactogogues (substances that improve milk production), most breastfeeding position changes, and paced bottle feeding are just three of the many topics that are scarce in scientific evidence that supports our recommendations. In fact, there is more conflicting information than information that confirms their use!

The final point that I want to make before I wrap up the post is that I am not too US-centered that I turn my nose up to alternative therapies that I am familiar with or understand. Many cultures around the world have been using techniques and treatments that have been helpful to them for centuries. I respect and trust their collective knowledge when scientific evidence is lacking.

There's a lot of power in respecting peoples truths. I do that for my clients, and I expand that globally, to the way I view care.

Not everyone shares my beliefs and as I've recently found out, not all Lactation professionals feel comfortable suggesting alternative therapies for breastfeeding issues. It can be confusing for clients who've seen multiple providers when they get different suggestions or when they've gotten a recommendation that other providers have avoided. It can naturally breed distrust in the proposition of bodywork therapies, especially when it already falls outside of the client's comfort zone.

The Final Takeaway

Bodywork alone will most likely not resolve all of your breastfeeding woes. It usually takes a comprehensive treatment approach to see the best results. Knowing when bodywork is appropriate and when it's not the best option can help save time and money. Occupational Therapists and Speech-Language pathologists are other professionals we use to help round out our care team when serious feeding difficulties persist or when signs point to therapy being the best course of action.

My goal with this post was to provide some background information as to why some lactation professionals may be hesitant in or completely avoid suggesting bodywork for breastfeeding issues. Many hold firmly to the concept of only providing evidence-based care, and no amount of anecdotal evidence will convince them of its place in a care plan. At the end of the day, everyone must stick within their area of comfortability.

I also wanted to let you all know what my stance on the subject is. Having knowledge is never a bad thing especially when you're trying to find a lactation professional that you are comfortable with. These blog posts provide me a chance to connect with you all and let you into my mind a bit.

Now I want to hear your thought!

Are you for or against bodywork? Do you have concerns?

Let me know what you think in the comments!