Breast care is very important during and after pregnancy. here are some physiotherapeutic measures to do so.

1. Breast care during
pregnancy
Radhika Chintamani

2. Introduction
• Special care of the breasts during pregnancy is an
important preparation for breastfeeding.
• Changes to the breasts are one of the early signs of
pregnancy
• During antenatal period, the breasts often have a feeling
of fullness and become larger, heavier, and more
pendulous because of the stretching of the cooper’s
ligament that supports the breast

3. • Many women feel a change in sensation in their
breasts such as tingling and soreness (particularly of
the nipples).
• This is due to increased levels of the hormone
progesterone and the development of the milk ducts.
• As pregnancy progresses the nipples and areola
become darker in color and the veins on the surface of
the breast may become more noticeable.
• The Montgomery glands get bigger and can become
more noticeable.

4. • From about 16 weeks of pregnancy the breasts are
able to produce milk (colostrum)
• In the last few weeks of pregnancy the nipples
become larger and the breasts continue to expand as
the milk-producing cells get bigger.
• A few women may have occasional leakage of blood
from the nipple. This is due to the increased number
and sudden growth of blood vessels

5. • Antenatal preparation of pregnant women for
breastfeeding raises awareness of the importance of
breastfeeding, empowers them with practical
knowledge and skills in breastfeeding techniques, and
prepares them for possible difficulties.
• Proper education of mother and relatives is possible and
mandatory during pregnancy. Flat or inverted nipple
can lead to difficulties in breastfeeding for the child.
Hence, during pregnancy women can become aware of
it & take necessary steps.

6. • Some studies have demonstrated that the use of soap,
alcohol, and other such materials during the antenatal
period tends to be detrimental to the integrity of the
nipple tissue because they remove the protective skin
oils and leave the nipple more prone to damage.
• Cleanliness of the breasts is important, especially as the
woman begins producing colostrum.

7. • Every pregnant woman should wear a well-fitted
brassiere to support the breasts in a normal uplifted
position.
• Proper support of the breasts is conducive to good
posture and thus helps to prevent backache

8. Problems with Breast Feeding
• Flat Nipple
• Inverted Nipple
• Protruded nipple
• Nipple Soreness
• Heaviness of breast

9. CARE OF FLAT AND INVERTED NIPPLES
• Nipples can be flat, normal, long or inverted (nipples
cannot be gripped easily postnatal).
Long Normal Flat Inverted

10. Steps of care:
• Try gentle pulling of nipples for flat nipples by fingers

11. ‘Nipple pinch test’

12. • Make a “C” shape with your right hand.
• Place your thumb and first finger around the
areola.
• Push back against your chest.
• Gently squeeze the thumb and finger together.
• Use a mirror to look at a side view of both
nipples as you do the pinch test.
• A normal nipple will move forward.
• Flat or inverted nipples move back and may
cause problems with breastfeeding.

13. • A 10 ml syringe at the front. end,
remove the plunger from hind end and
insert it from the cut front end.
• Then press open hind end of the
syringe lightly over the areola
covering the nipple and withdraw the
plunger (which is now at the front cut
end) so that the nipple is pulled into
the syringe.
• Maintain pull for 20 to 30 seconds and
then release. Gently remove the
syringe. Nipple will remain protruded.
Then put the child for breastfeeding.

14. • Use “Nipple Shell” (hard
plastic shell with holes worn
over nipples) for flat and
inverted nipples.
• If not available in the market,
make it at home from wood,
plastic or cap of feeding bottle.
• Remember, to make it with
smooth margins So file all
sharp margins, as there can be
injurious.

15. During the first trimester
• Incorporate and educate partners, parents, and friends
about the benefits of breastfeeding for mothers and
babies.
• Address known common barriers such as lack of self-
confidence, embarrassment, time and social
constraints, dietary and health concerns, lack of social
support, employment and child care concerns, and
fear of pain.

16. During the second trimester
• Encourage women to identify breastfeeding role
models by talking with family, friends, and colleagues
who have breastfed successfully.
• Provide time for discussion of breastfeeding basics
such as the importance of exclusive breastfeeding and
supply/demand, feeding on demand, frequency of
feedings, feeding cues, how to know an infant is
getting enough to eat, avoiding artificial nipples until
the infant is nursing well, and the importance of a good
latch.

18. During the third trimester
• Demonstrate how to hold the breast and
positions of the baby such as cradle, cross-
cradle, and the clutch hold
• Repeat the breast and nipple examination
• Recommend the purchase of properly fitting
nursing brasseries

19. Antenatal Interventions
• For decades, mothers were taught antenatal nipple
conditioning techniques in the hope of preventing sore
nipples
 Nipple rolling
 Rubbing with terry cloth towel
 Hoffman’s exercises (areolar stretching)
 Avoidance of soap on nipples
 Masse cream or other ointments
 Air exposure under clothing

20. Treatment of inverted nipples
• The use of breast shells is often suggested for
inverted nipples. The shells are worn in the
brassier and apply gentle pressure around the
base of the nipple to stretch the adhesions.
• Gently compressing the areola about an inch
(2.5 cm) behind the base of the nipple.

21. • Even the pregnant woman can use a device called the
Niplette - mechanically stretch the shortened internal
tissues.
• Supple Cup has been used for prenatal eversion of
flat nipples
• Supple Cups are small thimble-like silicone cups that
are squeezed to evacuate the air, placed over the
nipple and released to create a vacuum that exerts
traction on the nipple.

22. Niplette
Supple Cups

23. Antenatal expression of colostrum
• Colostrum is a thick yellow-colored substance and is
very rich in immune-promoting proteins
• The antenatal expression of colostrum is becoming more
common.
• From about the 16th week of pregnancy, a mother’s
breasts begin to make colostrum.

24. Antenatal Banking of Colostrum
• Benefits of expressing and banking colostrum
 Helps to stabilize baby's blood glucose levels in the
newborn period to prevent hypoglycemia and
neurological complications
 Reduces artificial milk (formula) being offered to baby
after birth if you have chosen to breast feed
 Helps develop the skill of hand expressing breast milk
which continues to be useful

25. POINTS TO REMEMBERED DURING PREGNANCY
• Put the baby to breast immediately after delivery and allow it to
suck for 10 to 15 minutes.
• Colostrum (initial breast milk), should be given to the baby as it
is nutritious and protects against diseases.
• Give nothing except breastfeeding.
• Allow child to suckle 8 to 10 times a day even if breast milk is
less.
• Breastfeeding decreases bleeding from uterus and helps to
decrease its size faster.

26. • Breast milk is the best food for the new born. Its
quality remains high unless mother is taking certain
drugs for her serious disease.
• Do not start bottle-feeding as it causes “nipple
confusion” and the baby thereby gets used to bottle,
as it requires no effort in comparison to
breastfeeding.

27. • Do not use pacifiers or artificial nipples.
• Ability to breastfed does not depend on size of breast.
• Mothers should always keep confidence in breastfeeding.
It solves all the problems.
• There is no other milk as a complete substitute to breast
milk.

28. Breastfeeding Education
• Prenatal breastfeeding education includes the following:
• Guidance for mothers about anticipated situations and
signs of effective breastfeeding or breastfeeding
problems.
• The benefits of breastfeeding to mother, baby, and
society.
• Correct positioning to help the infant latch onto the
breast effectively.
• Specific needs in the early days of breastfeeding.
• Common fears, concerns, problems, and myths.

29. Breast feeding Holds
Cradle hold – an easy, common hold
that is comfortable for most mothers
and babies. Hold your baby with his or
her head on your forearm and his or
her whole body facing yours.
Cross cradle or transitional hold –
Hold your baby along the opposite
arm from the breast you are using.
Support your baby’s head with the
palm of your hand at the base of his or
her neck.

30. Clutch or “football” hold – This hold allows
you to better see and control your baby’s head
and to keep the baby away from a c-section
incision. Hold your baby at your side, lying on
his or her back, with his or her head at the level
of your nipple. Support baby’s head with the
palm of your hand at the base of the head.
Side-lying position – useful for mothers who
had a c-section or to help any mother get extra
rest while the baby breastfeeds. Lie on your
side with your baby facing you. Pull your
baby close so your baby faces your body.

31. The benefit to the infant
• Human milk is species specific, it offers ideal nutrition,
protein and fat content is suited to the needs of the
infant and provide protection against iron and vitamin
deficiency.
• Breast milk contains over 100 biologically active
ingredients. It offers immunological protection to an
infant. Protects from various diseases.

32. Cont..
• Breast feeding provides a close interaction between
mother and infant and helps to develop a strong,
positive, emotional bond which has long –term
psychological advantages.
• Action of breast feeding facilitates correct jaw and
dental development and the incidence of sudden
infant death is lower in breast infants.

33. The benefit to the mother
• Psychological satisfaction and close maternal bonding
with her infant
• Exclusive breast feeding associated with lactational
amennohea is an effective, reliable method of birth
control and child spacing
• Prolonged breast feeding reduces the risks of
premenopausal breast cancer and ovarian cancer.
• It reduces the post partum anemia.

34. THANK
YOU