What to do if you have musculoskeletal pain or headaches from breastfeeding + how to protect your body from this

Please see your local physiotherapist or bodywork therapist for help if you are experiencing musculoskeletal pain. If you are experiencing headaches, please see your family doctor.

The gestalt method is specially developed to protect your wrists, neck, shoulders and back from pain

So many of the breastfeeding women I’ve seen over the years have had musculoskeletal pain due to the various approaches to fit and hold they were using! I began to work with women to develop an approach which protected a woman’s own spine and joint alignment, and supported her body's healthy, pain-free neuromuscular function.

The gestalt method is an evolutionary bodywork, which integrates the principles of traditional bodywork to

• Support your spinal alignment and muscle relaxation

• Protect you from neck and back pain

• Protect you from pectoral muscle pain

• Protect your wrist from

  • Repetitive bending strain, which can result in inflamed and painful tendons, or

  • Worsening of pre-existing carpal tunnel syndrome and wrist pain, which quite often occur in women who are pregnant or in the first months of their baby's life.

What causes musculoskeletal pain in breastfeeding women?

There are many reasons why you might experience musculoskeletal pain while caring for your breastfed baby. Caring for a baby or toddler involves a great deal of physical work, including carrying, bending, and lifting. This repetitive physical work can cause pre-existing musculoskeletal problems to flare-up, or trigger new ones.

Commonly recommended approaches to fit and hold in breastfeeding can place high levels of mechanical pressure or physical strain on various parts of your body, repeatedly, day and night, resulting in pain.

Examples of fit and hold methods which increase the risk of the breastfeeding mother experiencing pain are

• Shaping of the breast, or using a ‘c’ hold of the breast

• Using your thumb or finger to make sure your breast tissue isn’t blocking off baby’s nose

• Holding baby’s body weight as you sit upright

• Leaning forward to breastfeed

• Leaning over (even slightly) towards the side your baby is feeding from [lateral flexion]

• Twisting your body (even slightly) to accommodate your child across your legs e.g. with koala or straddle hold

• Holding your shoulders somewhat high as you support your baby at the breast

• Looking down at your baby while breastfeeding so that you can see what is going on, or interact.

If you use any of these methods as you breastfeed your little one, next thing you know you might have pain, and, if the strain is in your neck and shoulders, maybe even headaches. This is awful - the last thing you need right now!

Will a breastfeeding pillow across your lap prevent neck and shoulder strain?

Sometimes, you might be advised to use a breastfeeding pillow across your lap so that you don’t need to carry your baby’s weight.

It’s right to think about protecting your shoulders from tension and strain, but a breastfeeding pillow is not a solution, and often makes everything much worse. Breastfeeding pillows limit your ability to experiment with the way baby fits into your body. This perpetuates nipple and breast tissue drag.

The gestalt method aims to protect a woman’s body from breastfeeding-related pain

In the gestalt approach, I suggest that you

1. Sit semi-reclined, drawing on the principles of biological nurturing or laid-back breastfeeding, with shoulders relaxed and open, not tight and forward hunched.

2. Have a soft supportive cushion or pillow in the small of your lap as you lie back at 45 degrees, with your head resting at a comfortable angle.

3. Have footstool support, with your feet comfortably planted on the footstool. This footstool shouldn’t be too high. This helps activate your core stability, and supports spinal alignment. I explain to women that when they are out, it’s about workability, not perfection. It’s possible to be quite slumped and no-one would notice.

4. Have a hard cushion or pile of towels under your elbow once you've more or less worked out where the baby feeds without breast tissue drag, so that you can still use your forearm as a level but have good elbow support. This allows you to relax her neck and shoulders.

5. Make sure that as you use your forearm like a lever to make micromovements and eliminate nipple and breast tissue drag, that the adjacent wrist is in a neutral position (not flexed or extended). In practice, this means allowing the hand on that arm to rest in a loose way. It’s important not to try to flex your wrist.

This all seems too detailed and impossibly contrived at first, but if you’re struggling with nipple pain or a baby who won’t come on or stay on the breast, in my experience the gestalt method is transformative, even saving breastfeeding.

Breastfeeding when you're out of the house

I often say to breastfeeding women: “When you’re breastfeeding out of the house (and life goes easiest if you and baby and any other children are out and about a lot of the day), then breastfeeding at that moment is about workability, not perfection. You’ll be surprised,” I say, “at how much of a 45 degree slump you can get without anyone noticing!”

I’m hoping that before you know it, you’ll not have to think about any of this. You’ll be bringing your baby on casually, not worrying about fit and hold – but if even the slightest problem emerges, you’ll now know what to do to make sure it quickly goes away.

Two common causes of musculoskeletal pain

1. Elevated shoulders cause upwards nipple and breast tissue drag

It’s quite normal, if we’re experiencing nipple pain, to tighten up our shoulders. Unfortunately, this can worsen nipple and breast tissue drag upwards, which worsens nipple pain or causes baby to fuss at the breast.

To help with this, I suggest

• Practicing deep breathing and conscious muscle relaxation, letting your arms and shoulders go very heavy on the out breath, relaxing and dropping your shoulders

• Completely dropping your elbow onto a firm pillow under the forearm which you’re using as a lever, making sure you have very good solid support.

2. Leaning to the side over baby, with your breast falling off to the side

It’s also quite normal to find ourselves taking up a nurturing position of leaning over to one side, almost curling over and around our breastfeeding baby. This has two effects, though.

• Your breast will also fall further off to the side, which can (depending on what’s going on) worsen breastfeeding problems You might develop pain in your upper back or between your ribs, which can sometimes feel stabbing or radiating.

This is why it’s important to stay aligned in the midline, not leaning off to the side, with your shoulders relaxed and open, not gathered tightly forward.

Recommended resources

Finding the best position for a relaxed and comfortable breastfeed

Consciously relax your shoulders and take slow deep breaths as you bring baby onto your breast

Physical comfort when you're breastfeeding includes thinking about chairs and cushions (especially in the early days)