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The Staff of Femina Physical Therapy Blogs About Vaginismus, Pregnancy and Postpartum Best Practices, Treatments for Incontinence, and More

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Clogged milk ducts during breastfeeding | Image courtesy of Timothy Meinberg via Unsplash

Physical therapy can help women across their lifespan. This includes support with orthopedic considerations related to breastfeeding, as well as other breastfeeding care with clogged milked ducts and noninfectious mastitis.

Symptoms & Causes of Clogged Milk Ducts and Mastitis

Breastfeeding can be a joyous time for some, but unfortunately it can be painful for others. Clogged milk ducts can be extremely uncomfortable and painful. It often arises due to not being able to drain fully, causing a back-up of milk along the mammillary ducts. It can occur when feeding sessions are interrupted or skipped, as well as when mom is under stress. One may experience symptoms such as a painful lump in the breast tissue, pain during breastfeeding that subsides after, and/or decreased milk supply from the blockage. Sometimes if unresolved, it can lead to mastitis, or infection of the breast tissue. Monitor for symptoms such as fever, swelling of breast tissue, redness of breast tissue, and escalation of pain/breast tenderness. If you start to experience these aforementioned symptoms, give your doctor a call as soon as possible.

Treatment Options for Clogged Milk Ducts

Home treatments to help with clogged milk ducts include:

  • switching breasts more frequently
  • massaging the breast while feeding or pumping
  • applying and hot compress/towel on the breast before feeding

In office physical therapy treatments for clogged milk ducts include:

  • Postural re-eduation/ergonomic positioning for optimal breastfeeding positions
  • Many folks experience mid back and upper back pain from the many hours of breastfeeding. Physical therapists are trained to brainstorm the best positions for your specific needs and optimize breast milk flow
  • Modalities such as therapeutic ultrasound
  • Research has shown that applying heat through soundwaves can help bring blood flow to the area and reduce inflammation to help unclog the duct (Markowski, 2019)
  • Manual therapy addressing cervical spine, mid back and shoulder complex
  • We are connected through soft tissue and fascia head to toe; working on the neck or shoulder can help open up the breast tissue for more optimal fluid movement has been shown to improve clogged milk ducts

Physical therapy for clogged milk ducts:

Physical therapists can help with optimal breastfeeding positions, manual therapy and apply therapeutic ultrasound to improve clogged milk ducts and prevent the onset of mastitis. Usually 3-5 physical therapy sessions that include therapeutic ultrasound can make a significant improvement in symptoms. Any questions? Call our office to schedule an appointment with a licensed physical therapist at our offices today. Link to: https://feminapt.com/about-us/schedule-an-appointment

References:

Markowski Cucchiara M. Standard of Care: Physical Therapy Treatment of Clogged Milk Ducts. Department of Rehabilitation Services: Brigham and Women’s Hospital. 2019. https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/physical-therapy-treatment-of-blocked-milk-ducts.pdf

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Delivery of the Placenta | Image Courtesy of João Paulo de Souza Oliveira via Unsplash

Third Stage of Childbirth: Delivery of the Placenta

You made it!

Now, at this point you have delivered your baby and your body’s hormones have shifted tremendously! You may feel overwhelming emotions of joy and exhaustion at the same time. Oxytocin, the bonding hormone, rises sharply to compensate for the drastic drop in estrogen and progesterone. You may find yourself shivering, and this is normal immediately post-giving birth and can last up to one hour.

Delivery of the Placenta

The third stage of childbirth involves the delivery of the placenta. Oxytocin also helps with the delivery of the placenta, as it helps separate from the uterus. Depending on your birth plan, your team may help with delivery of the placenta with medications, gentle fundal massage, and gentle tugging of the cord. This will likely be in a position with you lying on your back. Or, you may continue to spontaneously deliver in any position that you feel comfortable, whether that is an upright position, hands and knees position, or even lying on your back. The placenta may come out on its own, or you may feel the urge to push again. The key is to choose a comfortable, yet appropriate position for you.

Read more: Vaginal Childbirth...

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postpartum pelvic health

Postpartum recovery should start Day 1.

Here are some tips to help you get your postpartum pelvic health (and general health) back on track:

This article focuses on 5 key techniques you can use to improve postpartum pelvic health. It covers diaphragmatic breathing to activate core muscles and kickstart lymphatic drainage, pelvic floor muscle coordination, posture, and the benefits of a pelvic floor evaluation by a physical therapist to begin improving postpartum pelvic health on day 1. It also provides detailed instructions and references scientific studies to provide further research.

1. Breathing With Intention

One of the most important recovery tools for postpartum pelvic health is one that we do all day, but are you doing it with intention? Diaphragmatic breathing can help you tap into your deep core muscles and assist in the healing process. When you focus your attention on breathing into the abdomen you activate the muscles of the core (diaphragm, intercostals, transverse abdominis, and the pelvic floor muscles). This breathing technique also helps to assist the pelvic floor muscles in another important job, lymphatic drainage. This can help eliminate excess waste and inflammation to help with healing. This is a great exercise to begin right after birth, when given the OK by your medical provider.

Additional benefits of diaphragmatic breathing were seen in the study by Fiskin et al., 2018, which concluded improved psychological state and increased mother-baby attachment. Not only are you reaping the benefits but so is the baby!

Read more: 5 Things you can do to...

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Levator Ani Avulsion - Injury during Childbirth

Levator Ani Avulsion: Understand your pelvic anatomy to better understand your injury

The pelvic floor is a group of muscles positioned like a hammock along our saddle region.

The group of muscles attach from our pubic bone on the inside and then to our lateral pelvic walls with a bundle of collagen fibers called the levator arch, and attach to the ischial spines (the inside of the sit bones) and tailbone on the back side. During vaginal childbirth, the pubococcygeus muscle, a group of pelvic floor muscles, stretches 3.26 times more than its normal length to make room for the coming baby in the vaginal canal! As you can imagine, this may result in some perineal tearing and/or levator ani avulsion.

Levator ani avulsion occurs when muscle fibers of the puborectalis (the innermost muscle of the pubococcygeus group) are detached from its insertion on the pubic bone. This is somewhat frequently occurring, and about 20% of women experience an avulsion during their first vaginal childbirth. Risk factors include instrumental-assisted delivery (forceps presenting a higher risk than vacuum), older age at vaginal birth, second stage lasting longer than 2 hours, baby weighing over 8 pounds and 13 ounces, and those who had a grade 4 perineal tear.

What does this mean for folks that have this injury?

As bad as it sounds to have an Levator Ani Avulsion, research has shown that it does not necessarily increase perineal pain in postpartum or beyond. However, it does put women at risk for pelvic organ prolapse either early in postpartum or in their later years.

Read more: Pelvic Floor Injury During...

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Getting Back to Exercise Postpartum

A healthy lifestyle includes getting back to exercise postpartum

Exercise has shown to be beneficial in all stages of life, and the postpartum period is no exception.

Some of the benefits of postpartum exercise are:

  • Strengthen and tone abdominal muscles
  • Boosts energy
  • May help prevent postpartum depression
  • Promotes better sleep
  • Relieves stress
  • Can help you lose the extra weight that you may have gained during pregnancy
    (ACOG, July 2019).

Even with all these benefits, research shows that most mothers stop participating in exercise programs which leads to increased weight gain and obesity (Minig et al., and O’Toole et al., 2003). There are many adjustments that have to be made when becoming a new mother and the information on the internet regarding postpartum exercise can be misguided and overwhelming. Let's break down what the literature says about guidelines for returning to exercise postpartum.

Read more: Getting Back to Exercise...

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mommy tummy

Mommy tummy aka diastasis recti abdominis (DRA) is a prevalent issue.

One in three American moms have DRA that persists greater than a year.

So what is a diastasis recti? It is the stretching of the linea alba, a connective tissue that runs down the midline of the abdomen and connects the abdominal muscles. The stretching happens during pregnancy in almost 100% of mothers to make room for a growing baby. Many of these moms are told this is a normal part of pregnancy, even by their healthcare providers.

DRA is not just about appearance, it is also connected to pelvic floor dysfunctions as well as pelvic and low back pain. In a study by Kari Bo et al., they found that mothers in the US with DRA were also more likely to have the following:

Read more: Mommy Tummy - Not Something...

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** This information is for educational purposes only **

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      I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be. It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally...

      Read more Testimonial by S.H., age 24

  • Testimonials

    • Testimonial by S.H., age 24

      I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be. It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally...

      Read more Testimonial by S.H., age 24

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