Effective milk transfer and the importance of fit and hold

In the early days and weeks with a newborn, breastfeeding parents are often asked about baby’s latch and position and how they are feeding. For most women who are not familiar with this language this is often a very difficult question to answer, but also leads to the question, “does it matter?” Does the fit and hold, or how mums and babies fit together, impact on effective milk transfer?

To adequately answer this question, we first need to understand the anatomy of the breast. Human breasts are mostly comprised of lactiferous glands (ie milk makers) and adipose tissue (better known as fat cells). The ratio between these varies significantly between women, and a little between breasts in the same woman. The lactiferous glands are comprised of clusters of alveoli which contain lactocytes, or milk-producing cells. The milk drains from the alveoli into milk ducts, which make their way to the nipple (1). Ducts often sit just under the skin, and two-thirds of the glandular tissue is situated within a 3cm radius of the nipple.¹ The superficial location of the ducts makes them very susceptible to external pressure.

Breast tissue drag is a term used to describe the conflicting forces exerted on breast tissue during feeding. The natural variation in breast and nipple size, shape and position along with the effect of gravity and body shape creates the stunning diversity we see between women. When combined with the variability of babies’ mouths and faces it is unsurprising that the perfect fit and hold is different for each woman, and even different between babies for the same mother.² When the fit and hold is not right, the nipple is pulled in different directions – by the baby’s mouth, by gravity or by the hand as the woman lifts or shapes her breast. As well as causing pain and nipple damage for the mother, this obstructs the ducts discussed earlier.

Breast tissue drag pulls the nipple out of its natural shape and therefore obstructs milk flow. This can almost be conceptualised as drinking through a straw with a kink in it – although in this case it is more like ten straws, and three are kinked. Very little, if any, milk will flow through the kinked straw and so the milk will back up. The baby is not able to take all the milk in the breast. For some women who have a very generous supply this won’t matter, as the other ducts will contain sufficient milk to satisfy her baby’s needs, but for some women this will mean her baby will be hungry or unsettled. Over time the milk that is not being removed can cause inflammation, leading to pain or even mastitis. But also of concern, when milk is not removed from the breast the woman’s body learns that the baby doesn’t need that milk, and starts producing less. Fortunately this can be addressed by eliminating breast tissue drag.³

A thorough breast feeding assessment by a clinician skilled in fit and hold adjustment is often all that is needed to avoid this vicious cycle of breast tissue drag, pain, inefficient milk transfer and unhappy mums and babies. Once fit and hold are optimised inflammation will heal, pain will resolve and supply will regulate. Any breastfeeding parent with concerns around nipple or breast pain, unsettled infant behaviour or insufficient weight gain should seek an early review and support.

Dr Lauren Wilson
General Practitioner
The Brisbane Possums Clinic
10 Park Terrace, Sherwood QLD 4075
+61 490 044 948

References

1. Ramsay DE, Kent JC, Hartmann RA & Hartman PE (2005).  Anatomy of the lactating human breast redefined with ultrasound imaging. Journal of Anatomy. 2005; 206: 525–534
2. Douglas P, Keogh R. Gestalt Breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017; 33: 509-518
3. Australian Breastfeeding Association.  Breastfeeding FAQs.  March 2019