What to do if you have musculoskeletal pain, headaches, or a hand or wrist condition from breastfeeding + prevention

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

The gestalt method has been developed to protect your wrists, neck, shoulders and back from pain

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 occurs in women who are pregnant or in the first months of their baby's life.

So many of the breastfeeding women I’ve seen over the years have had musculoskeletal pain due to the fit and hold approaches that they were using! 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.

I began to work with women to develop an approach which protected a woman’s own spine and joint alignment during breastfeeding, at the same time supporting her body's healthy, pain-free neuromuscular function.

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.

Examples of fit and hold methods which increase the risk of the breastfeeding mother experiencing musculoskeletal 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 with your hands and wrists 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!

What makes women more likely to experience soft tissue injuries of the wrist and hand after having a baby?

The repetitive movements of breastfeeding, caring for and holding your baby can make you more likely to have wrist and hand pain. Here are movements and positions in breastfeeding which place unnecessary strain on your wrist and hands, and which are deliberately avoided in the gestalt method.

• Shaping your breast throughout a breastfeed

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

• Holding baby’s body weight with your hands as you sit upright

• Flexing or bending your wrist so that your hand rests supportively on your baby's body.

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 strain and pain

The gestalt method is primarily a method of repair, for use once problems have arisen. Something needs to be changed! But the principles of the gestalt method will also protect you from musculoskeletal or wrist and hand problems if you have any vulnerability to these.

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. But when you're out of the house, it’s about workability, not perfection. It’s possible to be quite slumped in the chair when you're out and breastfeeding, 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 can all seems too detailed or 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 you'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, so that your breast falls further 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 fall further off to the side, which can (depending on what’s going on) worsen breastfeeding problems

• You might develop pain or pinching in your upper back or between your ribs, which can sometimes also 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)

Selected references

Cîmpeanu MC, Roman N, Grigorescu S, Grigorescu OD, Miclăuș RS. Management of "De Novo" Carpal Tunnel Syndrome in Pregnancy: A Narrative Review. J Pers Med. 2024;14(3):240. Published 2024 Feb 23. doi:10.3390/jpm14030240

Smith GB, Young B, Titan AL. Incidence and risk factors for soft tissue hand and wrist conditions in pregnancy and postpartum. Journal of Hand Surgery Global Online. 2025;7(5):100778 doi:100710.101016/j.jhsg.102025.100778.