GOLD Learning Day: Pain Assessment & Management During Lactation

Breastfeeding biomechanics is a field that combines physics with knowledge from biological and medical sciences, psychology and cultural studies. A better understanding of the nursing mechanics will help us to recognize which cultural concepts of feeding posture may be associated with ergonomic risk factors for the parent's body. Breast engorgement and nipple pain should not be taken as an inevitable part of the early postpartum period. With the help of the «Mindful latching» method (techniques for concentrating parents on their own sensations of postures and movements) we can control the ergonomic risks of repetitive movements. If we still have to deal with engorgement, «3D Inertial hand expression» method (the synthesis of traditional practices and modern knowledge of breast biomechanics) could be helpful. Breast biomechanics focus on how forces act on the breast structures and fluids and how the breast tissues respond to these forces.

Background: There are many factors associated with nipple and breast pain in breastfeeding women. The aetiology and management of mammary candidiasis can add additional challenges for the clinician as they endeavour to provide expert care to the breastfeeding dyad.

Review: The literature was reviewed to explore the diagnosis and management of candida in the breastfeeding dyad.

Findings: There remains a lack of robust evidence in the literature to support accurate diagnosis of candida. Correct treatment and avoidance of over treatment is important.

Conclusion: An exploration of the differential diagnosis for nipple and breast pain is indicated for all women presenting with nipple and breast pain. Culture of breastmilk is important for women suspected of mammary candidiasis, however, analysis is not without challenges.

Deep breast pain and milk stasis are often blamed on back pressure on milk ducts, incomplete emptying and fungal infection. Although these issues can be attributed to backpressure in the case of milk stasis, or "not likely to be related to" in the case of fungal infection inside the breast, the forgotten role that structural integrity plays in breast health can explain those problems that develop and persist despite proper milk removal and general health care of the breast. This presentation covers the anatomy and physiology of rib and vertebral subluxation and myofascial trigger points in generating deep breast pain and milk stasis. Several case reports illustrate the concept; proper care for resolution of these issues is covered.