The Appropriate Use of Breast Massage

On a recent trip to China, I was made aware of billboard size posters in public areas, including railroad stations, advertising a service to new mothers called “Cui Ru Shi.” What they were advertising to the postpartum mother was the care of traditional lactation “consultants” who would provide routine intensive hour-long breast massage that ostensibly would help the mother “make milk or push the milk out.” On investigation I found out that these “consultants” were neither medical nor nursing personnel nor certified lactation consultants, but rather lay individuals whose sole purpose was to provide routine breast massage irrespective of presence of engorgement and or mastitis. I was struck by the aggressive advertising of this procedure that has as its basis the message that such massage is needed, routinely, by all mothers who wish to breastfeed. No less was the concern that the service was being provided by nonmedical individuals in a business and profit-making model. Surely not a model of unbiased evidence-based care practices.

In contrast, the proper role and technique of breast massage in breastfeeding management is discussed by Witt et al. in this month's issue. ¹ The authors emphasize that mothers should be taught appropriate gentle focused breast massage as a self-management technique for minimizing breast engorgement and possible secondary mastitis. In their opinion the critical period for such education is the outpatient setting in the days immediately after discharge from the hospital when the risk of breast engorgement is real. The authors also emphasize that the massage should be gentle with specific pattern and direction. Such balanced and measured advice for self-management is surely in contrast to the commercialization of massage by “consultants” that is taking place in China.

The continuing problem of in-hospital supplementation of breastfeeding with formula in the immediate postpartum period continues to be a major problem despite the 10 steps and the baby-friendly hospital initiative and clear pronouncements of AAP and ABM protocols. These data collected in a well-designed prospective study by Boban and Zakarija-Grković ² confirmed that, by far most, supplementation cannot be justified for medical reasons. .They found that most common maternal reasons for supplementing were “lack of milk” (49.8%), a “crying baby” (35.5%), “cesarean section” (11.5%), newborn weight loss (10.6%), and sore nipples (10.1%). Of all the given reasons, only 24.6% were categorized as being medically acceptable. Although this study was performed in Croatia, the results reflect a worldwide phenomenon that needs to be more seriously addressed. The most recent survey of feeding practices in the United States noted that more than 17% of infants receive formula supplementation in the first 2 years of life. ³

One need only quote from the categorical statements of the AAP and ABM to be reminded what should be standard hospital practices: “Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.” ⁴ “Before any supplementary feedings are begun, it is important that a formal evaluation of each mother–baby dyad, including a direct observation of breastfeeding, is completed.” ⁵

Clearly we all have more work to do. Possibly reframing our hospital policies and practices as Mother-Baby Friendly will create a mindset that will address the issue more globally.