- Bryna Sampey, IBCLC
Your breast tissue might be an issue. How will you know?
Updated: Jun 23, 2022
Look at your hands. What are they doing? What body part are they touching? Chances are, they're resting on your face or lap. They might be holding your phone or your baby, but chances are, they are NOT touching your chest or breasts.
We know that touching is a weighted subject in today's cultures- and it is reflected cross-culturally that most folks don't touch one another's torsos- as reflected in this article about the research from Oxford University on touching amongst social groups.
Shown in this image from the study, you can see how reluctant most folks are to come into close contact with anything beyond hands & arms.
As a general rule, this serves society pretty well. It's not like you'd want to pick up your morning coffee and find your neighborhood barista giving your boob a friendly squeeze as a means of greeting. But, looking at the numbers for a second, only about 1 in 3 nonpregnant/nonlactating folks practice regular breast self examination (BSE) to look for lumps or cancers. Far fewer folks practice any breast-touching when pregnant or lactating (outside of pumping). Hand Expression is relatively uncommon, too, unless taught by a healthcare provider.
Prenatal breast exams are even less common, unless the expecting parent meets with a lactation consultant prenatally.
Even then, not all lactation consultants offer prenatal breast assessments, many are not taught the skill-- beyond looking for lumps or plugged ducts.
Don't expect to hear much about it at your OB/GYN, either--given that breastfeeding is only even brought up in 1 in 3 care providers' offices prenatally, and then only once or twice in an ambivalent way with questions like "How do you feel about breastfeeding?" or "Do you plan to breastfeed?" Once that box is ticked, it's assumed everything will just...work itself out!
Obviously, it doesn't always do that.
Well, now. Why not?
When the the milk-making tissue begins to develop, changes occur that create a relatively foreign landscape in there. Even if your breasts have been well-traveled by yourself or your partner(s), the map has changed. That's when things get a little problematic. The breasts are tender and swollen, and partner-touching (understandably) decreases. As pregnancy progresses, things change more and more. Areolae darken. Montgomery's glands swell, encircling the nipple with strange bumps. Nipples protrude (or don't). Sensitivity continues to increase. Shooting pains. Pins and needles in the armpits. What if one side grows three sizes larger than the other? What if they don't change much (if at all)? What about leaking colostrum? What if they already aim different directions to begin with, and only turn more and more away from each other? This tectonic shifting on the chest only muddies the waters of what's normal and what's not. As the breast is the only organ that has no medical specialty of its own (who wouldn't want to do their residency in Mammology?) it's even harder to get those answers before baby arrives.
Why worry? Babies come out knowing how to eat!
Babies might be born with feeding instincts called reflexes but parents are not born knowing how to nurse. We, the human animal, learn by watching others do. One only need look to the evolution of the lucrative career as an instagram influencer to know that's true. When we see another person give birth, and watch what they do with their baby and breasts, we can follow. But what if you have never seen anyone give birth? Or what if they didn't breast or chestfeed? What if one doesn't give birth themselves (as in the case of a parent who induces lactation)? All of a sudden, you have to travel this wild, new landscape of breast tissue while also recovering and parenting a brand new baby (or babies)! It seems terribly unfair not to be prepared for this!
Prepared for what? Baby + Boob. Right?
There are so many questions lactation consultants get asked right away, as a parents realizes how tricky breastfeeding can be. How to know what a full breast feels like? How to differentiate fullness from engorgement? How to tell what a plugged duct is or where it might be located? How to know if baby is latched well? How to know if baby is full? Can you nurse with flat nipples? Inverted nipples? Just one inverted nipple (the shy boob)?
And, less common, but still frequent: Why is my armpit swollen? Why is this mole leaking milk? I had surgery on this breast, but it was a long time ago, isn't that okay?
Simply put, most folks aren't well-prepared at all. Even if you took the prenatal classes at the hospital, it's hard to feel prepared. It's not the hospital class's fault, it's just more information than any human can take in-- especially in a three-hour group class in a basement or conference room. The chairs are uncomfortable, the plastic dolls are rigid and unyielding (the opposite of this floppy baby with a huge head that seems so, so fragile), and the slide decks are dated and not terribly helpful for specific situations. They have generally good info, but nothing could prepare you for the real deal.
Experience is the best teacher, isn't it?
SO many parents are told they'll get the hang of it after a magic number of weeks. 1, 2, 6, 8, 12... sure. It WILL get easier! But what about right now? When there's pain, bleeding, cracking, engorgement, and a hungry hangry baby?! That's when the anticipatory guidance could have come in handy.
Rewind back to pregnancy, and imagine you had a breast exam from a competent professional trained in lactation. Imagine they had noticed you had an inverted nipple and showed you some specific latching techniques- given you links to videos you could save for later, when latching was hard. Imagine they had noticed something odd about your breast shape and figured out that you had markers for IGT (insufficient glandular tissue) and counseled you about supplement choices you might want to make in case you don't make enough milk to meet baby's needs. Introduced to you an SNS system before you were postpartum and sleep deprived so that you could figure out how it works, in case you wanted to supplement at your nipple instead of with a bottle? Or, had counseled you on which bottles work well with babies who are also breast or chestfeeding so that you could maximize your baby's milk intake?
All of these situations happen really regularly. Maybe as you read this, you see something familiar. It's because it's incredibly common practice to just assume all will be well with lactation until proven otherwise. As if we had no information with which to peer behind the boob-colored curtain! There are so many ways we can assess breasts before it comes time to put them to use for feeding.
Why didn't anyone tell me?
There are a million reasons why we don't spend more time on actual helpful preparation for lactation before baby, but a lot of them stem from the reluctance to touch ourselves. That sort of touching is viewed as intimate.
One of the biggest reasons for not doing a prenatal breast exam is not lack of adequate knowledge, but concerns that it is too intimate for most patients. While true, no one wants to strip down to to their skivvies in the office, the long-term benefit of information gained prenatally is well-worth enduring the short-term discomfort and chill of the exam. And it IS short-term! When done well, a breast exam takes just under a minute. Maybe two, if things are complicated, or the breasts are very large. With that simple tool, your provider could offer you a ton of individualized information by which you could prepare for breast/chestfeeding and feel more confident heading into birth and the early postpartum period.
Cool. So then I'll be an expert?
There will still be fumbling, of course. You can read a hundred books about riding a bike, but until you get on the thing, you'll have no real idea how it's done. It's a lot of physical learning that takes a lot of awkward time. However, you'll have a much better idea how to massage your breasts, how to hand express, how to work a plugged duct out, and how to increase the flow as baby gets impatient before a side is quite emptied. And, did you know, your breasts have special receptors that respond to touching in the first 48h after you give birth?
Other cool facts about hands & boobs:
The more you massage (with frequent breastfeeding), the better your milk production.
Hand expressing for 5 min on each side after feeds in the first 48h can improve your long term milk supply.
Hand expressed milk has a higher fat content than pumped milk.
Gentle lymphatic massage before feeds can relieve engorgement and help baby get more colostrum in the early days.
There are special types of massage that can relieve pain associated with breastfeeding (called "Mammary Constriction Syndrome").
Hand expression skills can help maintain a working parent's supply if a pump part is forgotten at home.
Hand expression & massage can help prevent (and relieve) plugged ducts and mastitis.
Can I just DIY this?
Hand expression and breast massage don't come naturally, though. They're skills that have to be taught and practiced. You can self-teach via internet videos, but for your own specific anatomy, and a competent breast evaluation, you should consider seeking out a professional who is trained in prenatal-specific breast examination. We aren't looking for cancer, we are helping you map out this new territory your baby will want to call home.
Bryna Sampey, IBCLC is a lactation consultant with lots of experience serving families and educating parents and providers. Second to boobs & babies, her passion is education of families in an engaging, inclusive way. Lots of boob jokes aside, she really wants to make sure parents are equipped with solid, evidence-based information to use when they make their most important decisions.