Let's talk bras (important, even though it gets tricky!)

"When you find burden in either belief or apparel, cast it off." Amelia Bloomer (1818-1894) American suffrage reform, pioneer of the Victorian Dress Reform Movement

Does bra-wearing help breastfeeding?

Unfortunately, wearing a bra for much of the day can increase some women's chances of developing breastfeeding problems. This is because bras

1. Alter the biomechanics of breastfeeding in a way that might cause fit and hold problems, if you're feeding with a bra on.

2. Increase the chances of overhydration of the nipple skin, which makes our nipples less resilient when they're exposed to the stretching and expanding pressures which are a normal part of breastfeeding. You can find out about this here.

3. Interfere with the natural bouncing or vibrating movements of the breast in relation to gravity, which support lymphatic drainage. This is mostly only relevant for generous breasts. You can find out about lymphatic drainage of the lactating breast here.

4. Increase the risk of breast inflammation or mastitis if not fitted well. You can find out about this here.

How can we get around these challenges, living as we do in 21st century cultures which seem to have expectations that women will wear bras? And how can we get around these challenges when bra-wearing is necessary for the physical comfort of many women?

It's possible to wear your bra as necessary, at the same time as you make sure your bra doesn't interfere with your capacity to enjoy breastfeeding your baby. The first step is to be educated about the risks bras pose. Then you can work out what's right for you, living in your own unique and precious body and with your own unique and precious breasts.

1. On breasts, bras and biomechanics

Even though bras are a reality of the world we bring our baby into and there are women who find that wearing a bra much of the time is a necessity, even at night, it makes sense to go without a bra as much as possible, especially in the early days after giving birth.

If we're not careful, bras can shape the breast in a way that interferes with baby's capacity to fill his mouth with the right amount of nipple and breast tissue. This makes it difficult for breastfeeding to work properly.

Our milk-producing glands lie deep to the nipple, areola and skin, mostly in a three-centimetre radius around the base of the nipple. We want baby to draw up just as much of your nipple and breast skin and underlying glandular tissue as possible. You can see how babies suckle at the breast in an animation here.

There are the biomechanical things to look out for when you're breastfeeding with a bra on.

Your bra can encroach on your breast's landing pad, interfering with breastfeeding

Always make sure there is a ten-centimeter-wide landing pad exposed all the way around the nipple and areola, even when you are wearing a bra. You can find out what I mean by the landing pad here.

Bras often encroach on the ten-centimetre diameter circle which the baby needs so that she can achieve a stable face-breast bury, especially if we are out and trying to be discrete. But if there is any garment or cloth in the way (including part of the bra, baby's bib, or a tucked-in towel), your baby might

• Fuss and pull off

• Cause you pain, or

• Be unable to transfer milk efficiently.

If you wear a singlet or camisole bra, it's usually best to roll the soft cloth cup inwards. By rolling the material of the cup inwards, into a very tight roll, we can then position the bra material out of the way, tucked up snug where your breast meets your ribcage.

Simply pulling a soft bra cup down to expose your breast without rolling it inwards can leave quite a lot of cloth sitting over your ribs and tummy under the breast. Often there is a light built-in foam pad, under which you've slipped the breast pad. This pulled-down cloth and breast pad can bulk up, making it more difficult for your baby to have a snug rib-cage wrap with good biomechanical angles for the face-breast bury.

For some women, rolling up the cup and garment, and tucking it high up under the breast, lifts the landing pad and better exposes it for baby. For others, this just conveniently gets the excess cloth out of the way.

For more petitely-breasted women, rolling the cup inwards doesn't work because the its bulk interferes with baby's face-breast bury on the landing pad. In this case, try pulling the top of the singlet bra down with only a single layer of cloth, removing any breast pad, and flattening it out over your tummy so that it doesn't get in your baby's way.

You can find out about fit and hold when you have a petite breast here.

Bras can alter the shape of your breast's landing pad, interfering with breastfeeding

Sometimes, a bra with its cup unfastened and the material bunched up under the breast shapes the breast into what looks like a narrow firm protruding ledge when you look at the breast side on. This ledge-like shaping of the breast means that the breast falls quite differently to the way it would without a bra. Some women even hope this kind of shape might help the baby. But unfortunately it often causes problems.

When your breast is contoured into a narrow ledge like this, it is more difficult for baby to achieve a lovely symmetrical face-breast bury, because her lower cheek can't bury in to your breast properly. This too can result in fussy behaviour, poor milk transfer, or nipple pain.

Bras can make your nipples look too much to the front, interfering with breastfeeding

You can read about the diverse directions nipples look when the breast is falling naturally in response to gravity here.

Sometimes, firm bras which are designed to enhance cleavage can push a woman's breast and nipple too much towards the midline.

This kind of bra, in pushing your nipple towards the middle of your chest, ends up causing your nipple to look more to the front than it would if allowed to fall naturally without a bra. Your breast tissue to the outside of the nipple becomes more mounded up. In this situation, your baby

• Might have difficulty achieving the slight tilt-back of the neck required for relaxed breastfeeding

• Is more likely to fuss and pull off because the airflow through her nose is blocked off. Her nostrils are more likely to bury too deeply into the mounded-up breast tissue off to the side of your nipple (even when you have a newborn and are holding her in high tight rib-cage wrap)

• Is more likely to accidentally drag your nipple and breast tissue off to the side (again even with the best possible rib-cage wrap, if you have a newborn)

• Will spread further off to the opposite side. Your little one's toes and legs will extend further off to the side than you would expect if the nipple wasn't pushed towards the mid-line.

Often when your breast is allowed to fall naturally, without a bra, these problems disappear.

Does your breast fall a long way to the side without a bra?

Sometimes, particularly when a woman has a very generous breast, her nipple falls very much off to the side of her body.

A woman in this situation might even find that she is leaning towards that side herself when breastfeeding, as she tries to see what is going on for the baby, but this accidentally causes her breast to fall even further in that direction, worsening problems. If baby needs to feed by following the breast off to the side and 'around the corner', with some forward bending or flexion of his neck, it becomes very difficult to drink and he will tend to fuss and pull off.

Sometimes a woman in this situation finds that a bra with a side strap supports the outer part of her breast and prevents her breast and nipple falling too far off to the side.

Other women in this situation use their upper arm to support the breast and hold it so that the nipple stops falling off to the side.

You can find out about fit and hold when you have a generous breast here.

Do your nipples look downwards without a bra?

With a very generous breast and nipples that look downwards, you might again find that the support of a bra is helpful - though it's often the case that a bra still doesn't stop the nipple looking downward.

This is when using a facecloth rolled up very tightly can be helpful. Sometimes, a woman with very generous breasts needs two facecloths rolled up together.

• You can find out how to create an effective cloth roll here.

• You can find out about fit and hold strategies to experiment with when you have a generous breast here.

2. Bras trap moisture and overhydrate the nipple skin, increasing the risk of nipple pain and damage

Bras are a kind of occlusive dressing, despite our best efforts to create breathable fabrics. Compared to breast and nipple skin not enclosed in a bra, inside a bra we are likely to find

• Increased skin temperature

• Increased carbon dioxide levels

• Decreased oxygen levels

• Increased humidity, and

• Increased acidity.

These changes predispose to nipple skin overhydration and moisture-associated skin damage, which increase the risk of inflammation or a crack in your nipple's epidermis.

Breast pads also absorb and hold moisture (mostly milk and also sweat). This further predisposes to nipple skin overhydration and moisture-associated skin damage, which increases risk of a crack or ulcer of the nipple.

You can find out about nipples and moisture-associated skin damage here.

3. Bras eliminate the deep vibrations which are part of the mechanical effects of gravity

The bra restricts breast movement in relation to gravity. Many women wear bras for exactly this reason.

But especially in generous-breasted women, the downside to this is that the weight of the breast inside your bra may compress lymphatic vasculature, limiting the natural lymphatic movement from your nipple area into the draining lymph nodes.

This is why, if you are a generously breasted woman, it makes sense to gently use the palms of your hands to move your own breasts around sometimes, even though usually there usually isn't a role of therapeutic breast massage in lactation. You can find out about this here and here.

4. Outside pressure on the breast from a bra can compress milk ducts, predisposing to breast inflammation

Because a bra that is too tight across a particular part of the breast can put you at risk of breast inflammation (or mastitis), nursing bras need to be well-fitted.

You can find out about breast inflammation starting here.

Recommended resources

A short history of the bra