Boost the Flow Janice Fyfe, B Comm (Hons)

S How Milk is Made

S : released form the anterior pituitary gland and responsible for the production of

S Oxytocin: Released in response to stimulation of the nipple, released from the posterior pituitary and works on the myoepithelial cells to contract and stimulate let down -AKA “the cuddle ”

S Maturation of Breast Tissue influenced by: S Estrogen, progesterone, insulin, , cortisol, thyroxine, human placental lactogen How Milk is Made

http://www.mhhe.com/socscience/sex/common/ibank/ibank/0036.jpg Reasons for slow flow

S Latch Mechanics Hypothyroidism, etc)

S Tongue tie S Exogenous (OCP, Mirena IUD, Thyroid Meds) S Block Feeding S Placenta Caps S Nipple Shield S Pregnancy S Feeding away from the breast (Bottles, etc)

S Maternal Illness (DM, What we can do to help

S Improve Latch Mechanics

S Tongue &/or lip release

S Ensure all feeds are at the breast

S Galactagogues Galactagogues

S Herbs S Fenugreek (Trigonella foenum-graecum) S Blessed Thistle (Cnicus benedictus) S Goats Rue (Galega officinalis)

S Pharmaceuticals S

S Food S Oats S Moringa Fenugreek: Actions

S Galactagogue S Antirheumatic S Demulcent S Vulnerary S Bitter S Hepatic S Hypoglycemic S Cholagogue S Antispasmodic S Antihyperlipidemic

Fenugreek: Uses

S S Dysmenorrhea

S PCOS S Dyspepsia

S Diabetes S Arthritis S Women with were found to be 2.5x more likely to have had gestational DM1

S Hypercholesterolemia Fenugreek: MOA

S Not fully understood

S Potentially through affecting insulin and blood sugar levels

S Potentially through stimulating sweat gland production: Glands that produce breast milk are similar to sweat glands

S Likely a combination of both

Fenugreek: Dosing

S Capsules (3 Caps TID)

S Tincture S Use of alcohol to extract herbs (or glycerine) S More potent S Various strengths

S Tea

S Not all supplements are the same, different brands may have different strengths and formulations, always check recommended dosing on label

Fenugreek: Side Effects

S Gas

S Diarrhea

S Maple Syrup Odor to sweat and urine

S Allergy Potential: Asteraceae Family S Ragweed, marigolds, daisies, etc

Blessed Thistle: Uses

S Galactagogue

S Diarrhea

S Cough

S Diuretic Blessed Thistle: MOA

S Hormone Normalizer

S Increase Milk Flow

S Insufficient evidence Blessed Thistle: Dosing

S Capsules (3 Caps TID)

S Tincture

S Tea

S Not all supplements are the same, different brands may have different strengths and formulations, always check recommended dosing on label

Blessed Thistle: Side Effects

S May increase stomach acid

S May interact with Antacids

S Allergy warning: Asteraceae Family S Ragweed, marigolds, daisies, etc Goat’s Rue: Actions

S Hypoglycemic

S Galactagogue

S Diuretic

S Diaphoretic

Goat’s Rue: Uses

S PCOS

S Diabetes Mellitus type 2 Goat’s Rue: MOA

S Affects Insulin

S Contains galegin which is a compound from which metformin is derived. Goat’s Rue: Dosing

S Tincture 1-2 mL (1:10 in 45% EtOH)

S Tea Goat’s Rue: Side Effects

S None reported, but same family as fenugreek Domperidone: Uses

S Anti-emetc

S Nausea Domperidone: MOA

S Antagonist

S Competes with Dopamine in the Peripheral Nervous System

When does this physiological Process occur naturally? http://pituitary.ucla.edu/images/site/PRL2.1.jpg http://i249.photobucket.com/albums/gg203/ourphotos99/z-misc/prolactin.jpg Domperidone: Dosing

S Starting breastfeeding dose: 30mg TID

S 40mg TID

S 40 mg QID

S 10mg tablets Domperidone: Side Effects

S abdominal cramps

S dry mouth

S weight gain

S diarrhea

S alteration of menstrual periods, usually stopping them, but also breakthrough bleeding is possible. It is usual when breastfeeding not to have menstrual periods for many months

S Headaches and anxiety (typically only if stopped cold turkey) Stopping Domperidone

S Not recommended until well established on solids

S Reduce by 1 pill per 4-7 days watching to see if there is any drop in milk supply

S If there is a noticeable drop in the milk supply, return to prescribed dose for a minimum of 2 weeks then try dropping 1 pill per day When to use which treatment

S Age of infant

S Time it takes to see an effect

S Mothers preference

S Severity of situation

S What other things have been done thus far Other Herbs

S Hops: Incr serum prolactin

S Alfalfa (Medicago Sativa): often taken in combination

S Fennel (Foeniculum vulgare): diuretic, antiandrogenic, promote milk ejection reflex, reduce inappropriate hair growth in women- why may this be important??

S Anise: helpful to boost flow help with “colic/gassiness”

S Nettle (Urtica dioica): Often used in combination

S Shatavari (Asparagus racemosus): very commonly used in India- Lactare. Useful for infertility Other Herbs

S Milk Thistle (Silybum marianum): Not to be confused with Blessed Thistle

S Dill Seed (Anethum graveolens): part of the recipe for gripe water

S Borage Oil: Contains GLA (gamma-linoleic acid) which may increase the creaminess of the milk

S Dandelion: Diuretic

S Chasteberry (Vitex Agnus-Castus): Hormone normalizer. Maybe helpful in boosting prolactin, but only in just the right amount

Other Pharmaceuticals

S : Dopamine Anatgonist in the CNS S Side Effects: Tremor, bradykinesia S Used for upper GI issues (GERD, chemo induced nausea)

S S S Increases Prolactin Releasing Hormone from the hypothalamus

S Chloropromazine S Antipsychotic S Blocks Dopamine receptors

S Oxytocin S Intranasal administration S 3-5 fold increase in breastmilk production S No longer available

These are NOT used in the clinic and are only included for purpose of completeness of presentation to illustrate how breast milk production can be increased through different pathways in the body

Foods

S Oats (Avena sativa)

S Moringa

S Barley

S Pumpkin

S Sunflower

S Sesame Seeds

S Ginger Vasospasm AKA Mammillary Constriction Syndrome (MCS)

S Vasospasm: What is it?

S Spasm of the blood vessels in the breast due to a suboptimal latch which can be exacerbated by cold

S Raynaud’s phenomenon

S Tends to occur after feeds or toward the end of the feed &/or when the nipples are exposed to cold after being warm (after being in baby’s mouth, after shower) Vasospasm

http://www.japi.org/may_2010/images/ra_fig_01.jpg Vasospasm: Symptoms

S Burning Pain in breast

S Throbbing pain in breast

S Sharp shooting pain

S Blanched nipple

S Purple nipple

http:// royaltimes.net/wp-content/uploads/2013/11/A-woman-with-chest-pain.jpg Vasospasm: Symptoms

http://i.ytimg.com/vi/F3ZHhX3X04I/hqdefault.jpg Candida?

S Often misdiagnosed as Candida

S Are there white patches on inside of baby’s cheeks?

S Rash around breast?

S Rash on Baby’s Bum?

S Often prescribed antifungals before coming to clinic… did they work? Treatment: Vasospasm Protocol

Fix the latch!

S Cover- no air drying! S Olive oil to massage into the nipple S Massage S APNO S Stretch

Treatment: Vasospasm Protocol

http://media-cache- ec0.pinimg.com/736x/60/e3/69/60e369a676191a28ff966f0ac1612bbe.jpg Treatment: Vasospasm Protocol

http://www.34-menopause-symptoms.com/pics/breast-submenu.jpg Treatment: Vasospasm Protocol

http://www.naasphysiotherapy.ie/uploadedfiles/pagepics/pecs%20stretch.p ng In more severe cases

S Vitamin B6 Complex 100mg bid

S Warm compresses

S Magnesium

S Nifedipine 30mg for two weeks References

1. http://www.medscape.com/viewarticle/825625

2. http://www.webmd.com/vitamins-supplements/ingredientmono-94- BLESSED%20THISTLE.aspx?activeIngredientId=94&activeIngredientNam e=BLESSED%20THISTLE

3. Gabay, . Galactagogues: Medications that induce . J Hum Lact. 2002 Aug;18(3):274-9.

4. West, Diana. Marasco, Lisa. The breastfeeding mothers guide to Making more milk. The McGraw Hill Companies, USA. 2009

5. Romm, Aviva. Botanical Medicine for Womens Health. Churchill Livingstone, Missouri. 2010