Principle #5 (for generous-breasted women). Bra management and gentle movement of the breasts with woman's own palms of hands

Bra wearing increases risk but also helps with comfort for some women during lactation

Neuroprotective Developmental Care applies an evolutionary lens to argue that in Homo sapiens’ environment of evolutionary adaptedness, the mammary gland was subject to constant and irregular movement, occurring in the context of frequent and flexible breastfeeds.

In the human's environment of evolutionary adaptedness, breast position and conformation shifted in relation to gravity repeatedly throughout the day, including with tissue vibration in response to rapid fall or movements of the breast in space.

NDC hypothesises that the regular change of stromal pressure gradients in response to gravity constantly and irregularly tugged on the filaments which connect to the endothelial cells of the lymphatic capillaries, opening them and facilitating lymphatic drainage.

Bras may limit breast movement and tissue vibration and create areas of the breast, depending on breast shape and bra fit, which are exposed to minimal or no movement in response to gravity. This is particularly the case for very generously-breasted women.

NDC works with women's usual bra-wearing habits, acknowledging the physical comfort that bras offer some women (particularly those with very generous breasts), including when breastfeeding. NDC also acknowledges current socioculturally determined norms concerning bra-wearning and how this necessarily impacts women's choices.

NDC also accepts that bras can

• Interfere with fit and hold and the baby's positional stability

• Increase the risk of moisture-associated skin damage of the nipple and areola

• Increase the risk of nipple pain and damage

• Increase the risk of breast inflammation due to mechanical pressure on lactiferous ducts.

You can find out about the relationship between bras and nipple pain and damage in breastfeeding here.

'Breast gymnastics' may have a role in breast inflammation

The breast massage popularly referred to as ‘breast gymnastics’ requires lifting and gently moving the breasts in various directions, often with circular movements using the whole of the hand or palm laid gently over the breast. This form of breast massage may have a role, either preventatively in very early lactation or in the context of breast inflammation in generous-breasted women.

This kind of movement of one's own breasts has similarities with Japanese Oketani massage, which is traditionally administered early in lactation and weekly if breast inflammation or supply concerns arise. Oketani massage stimulates the pectoral muscles combined with a rolling massage of the breast, and has been found to have a preventative impact on breast pain.

• There is no reason to routinise this kind of breast care or to outsource it to a masseuse, since the woman herself can gently move her own breasts as often as she wishes, which may stimulate milk ejections, being careful not to cause microvascular trauma or to cause discomfort or pain. If she experiences relief, it is possible this is a result of the milk ejections, only.

• Upper limb stretching movements which engage the pectoral muscles may similarly help move the breast tissue, but also do not require exercise prescriptions or outsourcing.

• A woman might move her breasts in this way in a warm or hot shower.

• Anything (including massage) which irritates or agitates the inflamed breast tissue is likely to worsen, rather than heal, breast inflammation. For many women the risks of self-massaging of the breast may outweigh the benefits. For women with very generous breasts that are held very still inside a bra, there may be some benefit of this massage with the palms of her own hand, as long as she listens to her own body and stops if it feels at all uncomfortable or 'wrong'.

You can read why Therapeutic Breast Massage of Lactation or Manual Lymphatic Drainage don't help breast inflammation here.

References

Anderson L, Kynoch K, Kildea S, N L. Effectiveness of breast massage for the treatment of women with breastfeeding problems: a systematic review. JBI Database Systematic Reviews Implement Rep. 2019;17(8):1668-1694.

Cho J, Ahn HY, Ahn S, S LM, M-H H. Effects of Oketani breast massage on breast pain, the breast milk ph of mothers, and the sucking speed of neonates. Korean Journa of Women's Health and Nursing. 2012;18(2):149-158.