Lesser-Known & Novel Ideas for Increasing Milk Production © 2019

Lesser-known & novel ideas for increasing milk production

When should a mother try nontraditional things? When standard (EBP) therapies aren’t working

I am a co-author of Making More Milk When she wants to know I have no other disclosures of financial what else she can do or other conflicting interests to make. When the mother prefers a © 2019 Lisa Marasco MA, IBCLC, FILCA complementary modality

There may be more than one way to get to your goal What’s your target? Milk Synthesis versus Milk Ejection Overlap- what we don’t understand

Rationale Subluxations can interfere Some problems may with integrity of neuro- hormonal axis at cranial or actually be subluxation vertebral level, interfering blocking of nerves w/placental fx or nerve communication Published case studies of Indications improvement even when Hx of pain, trauma, poor not originally seeking help posture, stress, problems + No other explanation for milk supply

Vallone, S. The Role of Subluxation and Chiropractic Care in Hypolactation. J of Clin Chiro Ped 2007; 8(1-2):518-24. RCT NRCT Text Unpub Case Anec Theory

RCT NRCT Text Unpub Case Anec Theory Wang 2007

276 cases of hypolactation Treatme Extensive literature Single-blind study nt Philosophy SI-1 or sham site for control . Milk formed from Qi & blood 2 courses http://www.steve-woodley.co.uk/

Insufficient milk OUTCOMES SI-1 Tx LI-1 Sham . Pi (spleen) qi xu deficiency: inadequate Cured or markedly 97.8% 24.3% P < .05 Sham Tx effective nutritional, excessive blood loss, poor Cum TCM score higher P < .01 constitution Mammary filling higher P < .01 . Gan (liver) qi stagnation: mental Increased lactation higher P < .01 depression, anxiety Prolactin higher P < .01

Han 2006

- 80 cases of hypolactation randomized to SI-1 tx or LI-1 sham treatment. - Treated once daily x 5, 2 courses total Milk production enhancement Liver Qi and Blood deficiency Liver Qi deficiency - 30/40 in treatment vs 5% sham “cured” - Prolactin higher in treatment group RCT, n=90 <3mos, Treated twice weekly x 3 weeks

Esfahani 2015, Iran GB20 GV16 N=60 mothers,10d-6mo pp, complaining of hypogalactia SI1 (30ml pumped 1 hr after last feed) no other tx. Points: SI1 , LI4, GB21 Self-treated TID x 2-5 min x 12 days Controls: “routine education” Milk measured before, then 2 & 4 wks after intervention SI1

LI4 LI4 GB21

RCT NRCT Text Unpub Case Anec Theory Esfahani 2015, Iran Philosophy Variation of TCM Relaxation, building How it may work Reduction of anxiety

Stimulation of OT via With permission: http://www.vision-unlimited.co.uk reflex points in feet/hands Indications Milk volume higher in treatment group High stress, fear Suspected retained placental tissue

Mirzaie 2018 Pituitary area (PRL/OT): ball of thumb at center of thumb print whorl Breast area (lymphatics of breast, axilla): back of hand* Solar Plexus (relaxation/release tension) palm of hand beneath pads at base of fingers, below middle

Method: Self-treat each area for 5-10 seconds 6x/day prior to pumping *author commentary on back of hand IV trauma causing inhibition on that side

https://www.youtube.com/watch?v=2qiph7AQ_PM

Scoring: Zhou 2009 1. Clinically cured: Met infant needs, no symptoms 2. Markedly effective: Met 2/3 infant needs / ↑ 2 grades Treatment: 3. Effective: Met 1/3 infant needs / ↑ 1 grade  All: AH10 & CO18 4. Ineffective: No change Qi (little milk, soft gland): CO13 & CO4 Outcome Treatment n=58 Control n=58 Gan (little milk, distended, painful): CO12 & T4 Cured 21 (36.2%) 0 Markedly Effective 31 (53.5%) 16 (27.6%)  Breastfeed 8+ times daily Effective 6 (10.3%) 30 (51.7%)  Press 4x daily x 5 Ineffective 0 12 (20.7%) Volume Pre-treat 5.2 +/- 2.5 5.9 +/- 2.7 Outcomes: Volume Post-treat 698.2 +/- 162.6 252.3 +/- 102.8 Volume of milk Volume increment 690.7 +/- 159.2 248.1 +/- 100.4 P <.01 Supplementary feeding Prolactin Pre-treat 1014.5 +/- 20.1 1012.3 +- 19.2 Serum prolactin Prolactin Post-treat 2003.5 +- 34.2 1236.4 +- 22.5 Prolactin increment 990.3 +/- 33.4 218.2 +/- 21.6 P <.01

RCT NRCT Text Unpub Case Anec Theory

Mother Issues- nerve blockages or pituitary Baby Issues- Used with permission from The Upledger Institute, With permission: http://www.vision-unlimited.co.uk improve poor www.upledger.com. Copyright 2002. All rights reserved stimulation sucking

RCT NRCT Text Unpub Case Anec Theory

Pregnancy suckling Hypothesis: Massage will decrease stress and anxiety and stimulate lactation N= 220: 100 massage vs 120 “routine care” **First back massage within 2 hrs of birth for 4 times per day x 3 days Japanese Thumb pressure on either side of spine, neck to buttocks for 15 min. massage Assessed fullness afterwards and fed baby, pre- & post-weights.

Conclusion: “Back massage has a positive effect on lactation”

Patel, U., & Gedam, D. (2013). Effect Of Back Massage On Lactation Among Postnatal Mother. International Journal Of Medical And Research Jan-Mar.

RCT NRCT Text Unpub Case Anec Theory

“This mode of treatment, a physiologic one, would be devoid of the adverse effects of the pharmaceutical therapeutic agents, and can be considered to aid in Rationale: Colostrum initiating and maintaining adequate lactation.” removal may stimulate more activity Menezes, R. (2008). Is indulging in sexual activity a potential mode of treatment for hypogalactia? Medical hypotheses, 71, 808-823. Lamba, S., Chopra, S., & Negi, M. (2016). Effect of Antenatal Breast Milk Expression at Term Pregnancy to Improve Post Natal Lactational Performance. J Brody, S., & Kruger, T. H. (2006). The post-orgasmic Obstet Gynaecol India, 66(1), 30-34. doi:10.1007/s13224-014-0648-7 prolactin increase following intercourse is greater than Singh, G., Chouhan, R., & Kidhu, K. (2009). Effect of antenatal expression of following masturbation and suggests greater satiety. Biol breast milk at term in reducing breast feeding failures. MJAFI(65), 131-133. Psychol, 71(3), 312-315.

Singh Lambda 2016 2009 RCT India: N= 200 mothers 37wks gestation Exp Group 1- express at least once daily for 5 min Measured: “Time to initiation of lactation when no top-up was required”

“Daily antenatal breast milk expression after 37 completed weeks of pregnancy significantly reduced the time for Conclusion: “significantly improves postpartum lactation by early establishing full breast feeding and reduced breast feeding establishment of plentiful milk secretion” failures.

Harnessing the Mind Harnessing the Mind… Visualization

How it may work: Milk Milk Stimulate oxytocin ejection synthesis release for MER

Visualization: Harnessing the mind… Hypnotherapy Overcoming tetraplegia RCT NRCT Text Unpub Case Anec Theory

Cowley 2005- Psychogenic and How it may work: pharmacologic induction of the let-down Reduce stress inhibition of MER reflex can facilitate breastfeeding by tetraplegic women Indications: - Unrelieved anxiety - When mother is 3 case studies not reassured by evidence Jonas 2008: “oxytocin…contributes to the control of prolactin release”

With permission: http://www.vision-unlimited.co.uk RCT NRCT Text Unpub Case Anec Theory

hypnotherapy Relaxation/imagery study RCT NRCT Text Unpub Case Anec Theory Feher 1989 RCT Mothers of preterm infants 3-5d postpartum 20 min relaxation & imagery tape before pumping for 1 wk Final test expression 1wk Avg use once a day Pincus: original class to reduce stress for pp mothers, but they came back reporting more milk Experimental group 63% higher than controls - Increase irrespective of real or perceived IMS Dose-response increase: mean 57ml <5x vs - Developed self-hypnosis techniques & “White Light” script 112ml for >10x

Pincus, L. How hypnosis can help increase breast milk production. Medela Roundup 1996; 13(3):5. Response so great, may have also affected PRL

 33 moms of preterm infants N=28 RCT

 Listened to music of choice while  Milk volume change non-significant pumping  Too many variables, ie frequency,  No differences between music and breastfeeding before pumping silence

Keith RCT: N=162 NICU mothers Group A: Standard support Group B: Verbal protocol + music Group C: Verbal protocol + music + images of her baby Group D: Verbal protocol only

Pump 8x 10 min x 12 days

Keith, et al. (2012). The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk- produced by mothers of premature and critically ill infants. Adv Neonatal Care, 12(2), 112-119. Colliver, A. A. (2015). The Effect of Music Listening on Relaxation Level and Volume of Breast Milk Pumped by Mothers of Infants in the Neonatal Intensive Care Unit. (Masters), University of Kentucky. Retrieved from http://uknowledge.uky.edu/music_etds/39

Group A: Standard support Group B: Verbal protocol + music Group C: Verbal protocol + music Group A: Standard support + images of her baby Group B: Verbal protocol + music Group D: Verbal protocol only Group C: Verbal protocol + music + images of her baby Group D: Verbal protocol only Mothers in experimental groups produced significantly more milk; some impact on milk fat

Yoga

Relaxation

Courtesy of the Behavioral Medicine Research and Training Foundation

N= 7 Arm  Two sessions on separate days movements  Duration of expression  Time to milk ejection  Amount of milk produced Feijs et al. (2013). Design for Relaxation during Milk Expression Using Biofeedback. RCT NRCT Text Unpub Case Anec Theory

N=177 babies Research: Soyková-Pachnerová, E., Brutar, V., Golová, Prep: Fresh placenta B., & Zvolská, E. (1954). Placenta as a Lactagogon. ground, dried, powdered, Gynecologic and Obstetric Investigation, 138(6), 617-627. encapsulated

Timing: Day of delivery 210 women controlled case study Dosage: 10 grains 29 (13.8%) negative result (~600mg) TID x 11 days 181 (86.2%) positive result

117 (55.7%) 65 (30.5%) Conclusion: The maternal ingestion of desiccated placenta “good” “very good” produces on increase in the rate of growth and growth capacity of the breast-fed infants above that normally occurring.

Based on TCM, placental specialists recommend general dose of 2 x 550 mg Dosage? Raw? (size 00) capsules up to 3 times daily Cooked? -Maffaccini 2015 Started when? For how Dehydrated from long? raw or cooked & pulverized?

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes- Wikipedia

RCT NRCT Text Research Case Anec Theory

Shackleton, M., Vaillant, F., Simpson, K. J., Stingl, J., Smyth, G. K., Asselin-Labat, M. L., Visvader, J. E. (2006). Generation of a functional mammary gland from a single stem cell. Nature, 439(7072), 84-88. RCT NRCT Text Unpub Case Anec Theory

Low Level Laser therapy

Wang, Q., Qiao, H., & Bai, J. (2012). [Low Measurement ∆ Serum ∆ Milk ∆ Protein ∆ Fat ∆ Milk points PRL lactose production frequency ultrasound promotes lactation in Study group: lactating rats]. Nan Fang Yi Ke Da Xue Xue Bao, Enrollment: Laser No sig diff No sig diff No sig diff No sig diff ? 32(5), 730-733. Supplement-dependent Enrollment: No sig diff No sig diff No sig diff No sig diff ? primips (3-6 bottles daily Placebo in the first month) Laser- 3 wks post- ↑ highly ↑ highly ↑ highly ↑ highly ? intervention significant significant significant significant p<.001 p<.001 p<.001 p<.001

Treatment: 12 sessions Placebo- 3 wks Non-sig diff Non-sig diff Non-sig Non-sig ? over 3 weeks post-intervention (P>.05) (P>.05) diff diff (P>.05) (P>.05) Laser- 3 mos post- ↑ highly ↑ highly ↑ highly ↑ highly ? intervention significant significant significant significant N=20: Laser p<.001 p<.001 p<.001 p<.001

RCT NRCT Text Unpub Case Anec Animal Placebo- 3 mos Non-sig diff Signif diff Non-sig Non-sig ? N=20: Placebo post-intervention (P>.05) (P<.01) diff diff (Sham tx) (P>.05) (P>.05) Mammary glands “irradiated” at (40 kHz, 0.26 W/cm2) El Taweel, et al. (2017). Effect of low level laser therapy of the breasts http://mumsmilk.com.au/low-level-laser-therapy/ starting day 2 for 7 days- Sham, 5 min, 10 min on milk production and composition in supplement-dependent mothers. “Increased acinar (alveolar) gland expansion & number…”

Urtica urens Homeopathics RCT NRCT Text Unpub Case Anecdote Lactuca virosa Based on the Law of Similars, or Ignatia “like treats like.” Counter-intuitive Galega to western thought. Classical approach takes in-depth Dulcamara constitutional history and chooses one Causticum remedy only Agnus castus Remedies are diluted until no measurable amount of source remains: 6x, 12x, 6c, Helonias 12c, 30c, 200c, L & M dilution/potencies HOMEOPATHICS Ricinus communis Typically used short term, ~ 3 days more commonly used for Calcarea carbonica Best results when prescribed by low milk supply… practitioner rather than self-diagnosis Silicea Rescue Remedy

Rescue Remedy

When milk is present but not flowing and mother is stressed from pain, fear of pain, etc.  Use 4 drops sublingually before nursing or pumping to facilitate milk ejection.  Can have a slight sedative effect