Breastfeeding with a Spinal Cord Injury: Mothers with Disabilities

Being a first-time mother in the world of parenting with a disability may bring about an unsettling number of challenges to overcome; one of which is the process of breastfeeding. In the vast body of knowledge that is the internet, there are limited sources that explore breastfeeding for mothers with a spinal cord injury (SCI). Because of this, you may find it difficult to gather all the information that you need to begin this challenging, yet exciting chapter in your journey as a person with a disability.

This blog aims to collect and summarize the currently available information on breastfeeding for mothers with spinal cord injuries.

Although the goal is to answer the most frequent concerns for mothers with a disability, it is important to contact your health service provider, as well as acquaintances with similar experiences who can enlighten you on their journey.

Breastfeeding Challenges

Breastfeeding is a challenging task for all women with and without SCI. However, additional concerns can arise for mothers with a disability depending on the level of injury, with injuries higher up in the spine leading to more difficulties with breastfeeding. With the proper guidance and resources, these concerns can be addressed.

Common challenges for both women with and without SCI
- Difficulty Latching:
  - In the first few weeks postpartum, it is common for most women to face some difficulty in having their newborn latch properly onto the breast for breastfeeding.
- Infection:
  - Throughout their breastfeeding journey, multiple women may develop an infection/swelling of their breast due to conditions such as clogged ducts or mastitis.
Additional challenges for women with SCI:
- Limited milk production:
  - Women with spinal cord injuries above T5 can have complications with the milk-let down reflex, leading to difficulties with milk production. This is reflex that is triggered by the baby suckling on the nipple. However, SCIs can alter sensation in the nipple, affecting the mother’s ability to produce milk and ensure their baby has a good latch. If you are experiencing these issues, physicians recommend using a mirror or having a partner to check for proper latching of the baby. They also recommend observing your baby’s rate of suckling which should increase during feeding to appear as if they are swallowing. You can also check for marks on the nipple post-feeding which suggest proper latching.
- Difficulty positioning your baby for latching:
  - If you have an SCI above T1, a cervical injury or tetraplegia, you can experience reduced strength and mobility of the upper limbs and trunk. This can affect your ability to position your baby for a good latch, which can further impact milk production due to less suckling stimulation of the nipple. Reduced arm and hand function can also make it challenging to manually push milk from your breast and can lead to clogged ducts or mastitis. However, physicians recommend certain positions and equipment that could be of aid for this concern (see Figure 1).
- Autonomic Dysreflexia (AD):
  - Another common and often disregarded complication of a spinal cord injury is Autonomic Dysreflexia. AD is an exaggerated autonomic nervous system reaction which leads to dangerous spikes in heart rate and blood pressure. Women with SCIs at or above T4 have been documented to have episodes of AD triggered by stimulation of the nipples during breastfeeding. These spikes in blood pressure can make it difficult to breastfeed and must be monitored to prevent damage to internal tissues. If you experience episodes of AD during breastfeeding, several recommendations could be of help as discussed below.

Overcoming these challenges:

Limited Milk Production:

To improve some of the concerns that arise with limited milk production, some of

the following tips may be helpful:

Supplemental Nursing System (SNS):
- If you are experiencing trouble producing enough breastmilk, you can supplement your baby using SNS. This requires you to place the end of a tube into a formula bottle and the other end onto the breast. The baby can latch onto the breast and receive milk from the tube, which can be donated or from formula.

Breast pump:
- If you have some hand function or someone who can provide their help, you can manually push milk from your breast directly into the baby’s mouth. You can also use a breast pump to express milk into a baby bottle that you can then use to feed your baby.

Alternating between breastfeeding and baby bottle:
- You can try a combination of breastfeeding and formula to compensate for the limited milk production. This way you can still engaging in the bonding experience that is breastfeeding while providing sufficient milk through a supplement.

Difficulty Latching/Positioning:

Some of the following resources and positions can help with ensuring a good latch

for your baby during breastfeeding:

Figure 1: Breastfeeding position for improved latching

Wedges and Pillows:
- You can use wedges and pillows to help in stabilizing your body and trunk on the bed or wheelchair as you breastfeed. You can also place it as leg support which can help with reducing blood pressure and spasms.
Carriers:
- This includes harnesses and slings. They can help to position your baby for latching and can keep them up-right to prevent reflux after feeding.
Wheelchair modifications:
- Different modifications can help to improve trunk support and positioning when breastfeeding. For example, you can adjust the angle of the backrest and use a chest strap to keep your body upright for holding the baby. You can also widen the chair space to fit the baby inside during breastfeeding.

High and Low Blood Pressure Concerns:

If you experience symptoms of AD, discontinue breastfeeding until blood pressure goes back to normal.
- Have an accessible blood pressure cuff to ensure normal blood pressure before resuming breastfeeding.
You can decreased blood pressure due to prolonged sitting while breastfeeding which can lead to dizziness and light-headedness. It is recommended to elevate your legs and change your body position to horizontal after some time.
Discuss with a physician your risk of developing AD and what other measures you can take to prevent these episodes or subside them.

Other common concerns:

Clogged Milk Ducts and Mastitis:

Clogged milk ducts can occur when you are unable to sufficiently drain milk from your breasts. This can lead to painful swelling in the breast tissue and difficulty expressing milk. Mastitis can also occur with prolonged clogging of the milk ducts or when the breasts are overly full.
- Having an SCI can increase the risk of developing clogged ducts and/or mastitis due to decreased mobility or upper limb function. Here are some tips to help prevent clogged milk ducts and/or mastitis:
  - Allow your baby to latch for as long as possible to help drain milk from the breasts.
  - When your baby is unable to latch, pump your breasts on a schedule that is well-suited to you.
  - Wear a supportive bra that isn’t overly tight to prevent blocking the milk ducts.
  - If swelling develops in your breasts, you can use hot and cold compresses to alleviate it.
  - Be aware that you can have an AD episode from the pain of mastitis or clogged ducts.

Using SCI medications during breastfeeding:

Some common medications taken by individuals with SCIs can permeate into breast milk, and the effects of most of these medications on babies is not known. Therefore, consult your healthcare provider before taking any medications during breastfeeding.
For creams to apply directly to the nipple area, use water-soluble gels instead of ointments. Ointments could expose the baby to paraffins.
When using medications, always observe your baby for any unusual side effects including reactions to a medication, sedation or irritability.

Bonding with baby when breastfeeding is challenging:

Because breastfeeding can be challenging for many mothers with SCIs, you may be concerned that this will affect your ability to form an attachment with your baby. Although your breastfeeding journey may be difficult, there are other ways in which you can help foster a connection:
- Hold and cuddle your child on bare skin as often as you can. Skin-to-skin contact has important health benefits for you and the baby, including hormone release, body temperature regulation, breathing and heart rate.
- Speak with your baby and make eye contact with them often. This helps them connect with your voice and recognize your face.
- Be there when they cry. This way they learn that you are attentive to their needs and create a stronger bond.

Available resources:

Here are a list of other resources and links that you can access to gather more information on many of the important topics discussed in this blog: