Let's talk bras ( ... important, even though it gets tricky!)

    “_When you find burden in either belief or apparel, cast it off."_ Amelia Bloomer (1818-1894) American suffrage reform, pioneer of the Victorian Dress Reform Movement

Does bra-wearing help breastfeeding?

Unfortunately, wearing a bra for much of the day can increase some women's chances of developing breastfeeding problems. This is because bras can

• Alter the biomechanics of breastfeeding and cause fit and hold problems

• Increase the chances of overhydration of the nipple skin, which makes our nipples less resilient when they're exposed to the stretching and expanding pressures which are a normal part of breastfeeding. You can find out about this here.

• Interfere with the natural vibratiang movements of the breast in relation to gravity, which support lymphatic drainage, particularly in generous breasts. You can find out about lymphatic drainage of the lactating breast here.

• Increase the risk of breast inflammation or mastitis if not fitted well. You can find out about this here.

How can we get around these challenges, living as we do in 21st century cultures which have certain expectations of women around bra-wearing? And also when bra-wearing is necessary for the comfort of many women?

The first step is to be educated about the risks bras pose. Then you can work out what's right for you, living in your own unique and precious body and with your own unique and precious breasts, at the same time as you ensure your bra doesn't interfere with your capacity to enjoy breastfeeding your baby.

On breasts, bras and biomechanics

Bras are a reality of the world we bring our baby into, and there are women who find that wearing a bra much of the time is a necessity, even at night.

But particularly in the early days after giving birth, it makes sense to go without a bra as much as possible.

Our milk-producing glands lie deep to the nipple, areola and skin, mostly in a three-centimetre radius around the base of the nipple. You can find out about this here. We want baby to draw up ust as much of your nipple and breast skin and underlying glandular tissue as possible. You can find out how babies suckle at the breast here.

If we're not careful, bras can interfere with baby's capacity to fill his mouth with as much nipple and breast tissue as posssible. This makes it difficult for breastfeeding to work properly.

There are the two important things to look out for when you're breastfeeding with a bra on.

The material of the bra can encroach on your breast's landing pad, interfering with breastfeeding

Always make sure there is a ten-centimeter-wide landing pad exposed all the way around the nipple and areola, even when you are wearing a bra. You can find out what I mean by the landing pad here.

Bras often encroach on the ten-centimetre diameter circle which the baby needs to have exposed around your nipple so that she can achieve a stable face-breast bury, especially if we are out and trying to be discrete. But if there is any garment or cloth in the way (including part of the bra, baby's bib, or a tucked-in towel), your baby might

• Fuss and pull off

• Cause you pain, or

• Be unable to transfer milk efficiently.

If you wear a singlet or camisole bra, it's usually best to roll the soft cloth cup inwards (instead of pulling it down flat against your torso with the cup area facing outwards). By rolling the material of the cup inwards, into a very tight roll, we can then position the bra material out of the way, tucked up snug where your breast meets your ribcage.

Simply pulling down the soft cup to expose your breast without rolling it inwards, particularly if there is a breast pad or foam pad in it, can leave quite a lot of cloth sitting over your ribs and tummy under the breast. Often there is a light built-in foam pad, under which you've slipped the breast pad. This pulled-down cloth and breast pad can bulk up, making it more difficult for your baby to have a snug rib-cage wrap with good biomechanical angles for the face-breast bury.

For some women, rolling up the cup and garment this way will lift up the landing pad and expose it better. For many it is just a way of getting the excess cloth out of the way.

For more petitely-breasted women, rolling the cup in doesn't work because it interferes with the landing pad. In this case, try pulling the top of the singlet bra down with only a single layer of cloth flattened over your tummy, removing any breast pad.

Bras can alter the shape of your breast's landing pad, interfering with breastfeeding

Sometimes, a bra with its cup unfastened and the material bunched up under the breast shapes the breast into what looks like a narrow firm protruding ledge when you look at the breast side on. This ledge-like shaping of the breast means that the breast falls quite differently to the way it would without a bra. Some women even hope this kind of shape might help the baby. But unfortunately it often causes problems.

When your breast is contoured into a narrow ledge like this, it is more difficult for baby to achieve a lovely symmetrical face-breast bury, because her lower cheek can't bury in to your breast properly. This too can result in fussy behaviour, poor milk transfer, or nipple pain.

Bras can make your nipples look too much to the front, interfering with breastfeeding

Sometimes, firm bras which are designed to enhance cleavage can push a woman's breast and nipple too much towards the midline. You can read about the diverse directions nipples look when the breast is falling naturally in response to gravity here.

Depending on where your nipple naturally falls, your bra might push your nipple towards the middle of your chest so that your nipple is now looking more to the front. Your breast tissue to the outside of the nipple becomes more mounded up. In this situation, your baby

• Might have difficulty achieving the slight tilt-back of the neck required for relaxed breastfeeding

• Is more likely to fuss and pull off because the airflow through her nose is blocked off. Her nostrils are more likely to bury too deeply into the mounded-up breast tissue off to the side of your nipple (even when you have a newborn and are holding her in high tight rib-cage wrap)

• Is more likely to accidentally drag your nipple and breast tissue off to the side (again even with the best possible rib-cage wrap, if you have a newborn).

Often when your breast is allowed to fall naturally, without a bra, these problems disappear.

Does your breast fall a long way to the side without a bra?

Sometimes, particularly when a woman has a very generous breast, her nipple falls very much off to the side of her body.

A woman in this situation might find that she is leaning towards that side herself when breastfeeding, as she tries to see what is going on for the baby, but this accidentally causes her breast to fall even further in that direction, worsening problems. If baby needs to feed by following the breast off to the side and 'around the corner', with some forward bending or flexion of his neck, it becomes very difficult to drink and he will tend to fuss and pull off.

Sometimes a woman in this situation finds that a bra which has a strap to firmly support the outer part of her breast prevents the breast and nipple falling too far to the side.

In this situation, some women use their upper arm to support the breast and hold it so that the nipple stops falling off to the side. To begin with, you might use your opposite hand to tuck the breast forward and then bring your upper arm in to support it in that position. This immediately limits what you can do with your forearm, which is your lever for creating micromovements and getting rid of breast tissue drag, but women experiment with these ideas and compromise and find something that works.

Do your nipples look downwards without a bra?

With a very generous breast and nipples that look downwards, you might again find that the support of a bra is helpful - though it's often the case that a bra still doesn't stop the nipple looking downward.

This is when using a facecloth rolled up very tightly can be helpful. Sometimes, a woman with very generous breasts needs two facecloths rolled up together. You can find out how to do this here.

You can find out about fit and hold strategies to experiment with when you have a generous breast here.

Bras trap moisture and overhydrate the nipple epidermis, increasing the risk of nipple pain and damage

Bras are a kind of occlusive dressing, despite our best efforts to create breathable fabrics. Inside the bra, we are likely to find

• Increased skin temperature

• Increased carbon dioxide levels

• Decreased oxygen levels

• Increased humidity, and

• Increased acidity,

compared to the breast and nipple-areolar complex skin that is not enclosed in a bra.

These changes predispose to nipple skin overhydration and moisture-associated skin damage, which increases risk of a crack in the epidermis.

Breast pads also absorb and hold moisture (mostly milk and also sweat). This further predisposes to nipple epithelial overhydration and moisture-associated skin damage, which increases risk of epithelial fracture.

You can find out about bras here.

Bras eliminate the deep vibrations which are part of the mechanical effects of gravity

The bra restricts breast movement in relation to gravity. Many women wear bras for exactly this reason.

But especially in generous-breasted women, the downside to this is that the weight of the breast inside the bra may compress lymphatic vasculature, limiting the natural lymphatic movement from the nipple area into the draining nodes. The breastpad also contains the regular leaking of moisture (milk) from the nipple and soaks it up and retains it, causing nipple hydration.

This is why in a generously breasted woman, it can make sense sometimes to gently use the palms of her hands to move her own breasts around, even though usually there usually isn't a role of therapeutic breast massage in lactation. You can find out about this here and here.

Recommended resources

A short history of the bra