Making More Milk Presented by Diana West, BA, IBCLC Making More Milk GET A HEAD START: MAXIMIZING MILK Presented by PRODUCTION Diana West, BA, IBCLC [email protected] CAPABILITY MAXIMIZE MILK PRODUCTION CAPABILITY LUTEAL PHASE DEFECT ! Especially when there is a known risk factor !Not enough progesterone in second half of menstrual cycle " Hormonal problems # PCOS, thyroid, luteal phase defect, insulin resistance, Type I diabetes !Common cause of miscarriage " Hx breast surgery, breast injury/trauma " High risk of infant hypoglycemia !The higher the progesterone levels # Mother is Type I diabetic in pregnancy, the better the milk " Hx of prior milk production problems production is postpartum (Ingram, 1999) POLYCYSTIC OVARIAN LUTEAL PHASE DEFECT SYNDROME (PCOS) ! Many informal reports of progesterone ! Multiple ovarian cysts (Glueck, 2004) supplementation during pregnancy connected to ! Incidence: 4-12% better milk production ! Can cause high levels of ! Case report of woman with LPD (Bodley, 1999) testosterone, estrogen, and insulin " First successful pregnancy, no breast growth, very ! Can cause low progesterone little milk ! Can cause infertility " Second pregnancy, progesterone treatment, milk ! Possible symptoms: " Hirsutism (excess body hair) production normal " Alopecia (balding) " Obesity ! Progesterone inhibits prolactin, so treat only " Masculine characteristics during pregnancy " Insulin resistance " Hypoplasia (insufficient glandular tissue) # Risk factor for low supply Copyright © 2012 by Diana West, BA, IBCLC 1 Making More Milk Presented by Diana West, BA, IBCLC POLYCYSTIC OVARIAN THYROID DYSFUNCTION SYNDROME (PCOS) ! Treatment with Metformin often increases milk ! All three types can reduce milk production production (Gabbay, 2003) " Hyperthyroid " Hypothyroid "Both during pregnancy and after delivery " Postpartum thyroiditis "Safe for baby (Hale, 2010) ! Rat studies give new clues why (Marasco, 2006; Hapon, 2003; Varas, 2002, Varas, 2005) " Reduced milk ejection from oxytocin inhibition " Not inhibited milk synthesis EXPRESS MILK BEFORE HYROID YSFUNCTION T D BABY IS BORN ! Commonly associated with anemia and pp ! Old method rediscovered hemorrhage in Australia " Both risk factors for low supply (Chapman, 2012, Chapman, 2012, Cox, 2006; Cox 2010) ! Need comprehensive (not screening) test (TSH + Total or Free T3 + Total or Free T4) " Practice instituted for hypoglycemic infants of " TSH range for fertility/pregnancy: .5-3.0 or even .5-2.5 (Mandel, 2005) Type I diabetic mothers ! Even borderline cases tend to improve with treatment ! Gentle hand expression ! Monitor closely during pregnancy once or twice a day ! If out of range, test frequently postpartum EXPRESS MILK BEFORE EXPRESS MILK BEFORE BABY IS BORN BABY IS BORN ! Express Milk Before Baby is Born !Many authors " Begin from 34th week of pregnancy " Each day after taking hot shower when breasts are warm recommended " Stop expressing if cramps or contractions for antenatal " Use 1-3 mm or periodontal syringes to draw up expressed colostrum breast care and " Use same syringe for 48 hours, refrigerating in between improved " Freeze syringes in zip-close bag " Bring to hospital to use as supplementation breastfeeding # Defrost under warm running water (Ingelman, 1958; Myles, 1964; Applebaum, 1969; Eiger and Olds, 1973; Messenger, 1983) Copyright © 2012 by Diana West, BA, IBCLC 2 Making More Milk Presented by Diana West, BA, IBCLC EXPRESS MILK BEFORE EXPRESS MILK BEFORE BABY IS BORN BABY IS BORN ! Significant benefits ! Significant benefits "Collected colostrum can be used as " Increases comfort supplementation in touching and handling her "Additional colostrum ! energy for feeding breasts (Llewellyn- "Better feeding $ better milk removal Jones, 1983) "Better milk removal $ more milk " Teaches hand production expression! " Validates mothers’ "May hasten Lactogenesis II need to prepare for breastfeeding EXPRESS MILK BEFORE EXPRESS MILK BEFORE BABY IS BORN BABY IS BORN !Safety concerns !Safety concerns "Preterm labor??? "Preterm labor??? # Prenatal nipple # Many activities are precursors for oxytocin release: stimulation while — Eating expressing colostrum ! Particularly foods with phenyethylamines such as chocolate) can NOT induce — Laughing premature labor — Kissing (Cox, 2010) — Hugging — Masturbation and sexual intercourse ! Oxytocin surges MUCH stronger with orgasm! EXPRESS MILK BEFORE EXPRESS MILK BEFORE BABY IS BORN BABY IS BORN !Safety concerns !Safety concerns "Preterm labor??? "No evidence for causing preterm labor # Cox (2006) reviewed a group of studies in which # Oxytocin surges will pregnant women experienced varying but long only induce labor if periods of nipple stimulation (Di Lieto et al, 1989; Stein there are sufficient et al, 1990; Curtis et al, 1999) oxytocin receptors in # None of the studies showed significant effects in the middle layer of inducing labor the uterine wall (myometrium) (Blackburn, 2003) Copyright © 2012 by Diana West, BA, IBCLC 3 Making More Milk Presented by Diana West, BA, IBCLC EXPRESS MILK BEFORE EXPRESS MILK BEFORE BABY IS BORN BABY IS BORN ! Safety concerns??? ! Safety concerns??? "No evidence for causing preterm labor "No evidence for causing preterm labor # 2009 pilot study by Forster et al # 2009 study by Ishii "43 women hand expressed 2x/day from —110 women continued breastfeeding week 36 through pregnancy compared to 774 women who did not breastfeed during "No evidence of fetal compromise pregnancy " Despite this, authors recommend antenatal —No statistically significant difference in labor expression should cease until efficacy can be initiation tested in randomized controlled trial (RCT) # An RCT would be unethical (some babies would not receive colostrum) EXPRESS MILK BEFORE EXPRESS MILK BEFORE BABY IS BORN BABY IS BORN !2009 pilot study by Forster et al !Safety concerns "Tandem Nursing is Safe " At 6 weeks pp, 95% were positive # Study of 57 women who had continued to about their experience breastfeed during pregnancy of prenatal milk # Infants born to these mothers were healthy and expression appropriate for gestational age (Moscone and Moore,1993) " They would do it again MAXIMIZE MILK REMOVAL MAXIMIZE MILK REMOVAL TO IN THE CALIBRATE HIGH LACTATION FIRST TWO WEEKS CAPABILITY " Hormonal receptors seem to be established in the breast in first 2-3 weeks in response to milk removal " The more milk that is removed, the higher milk production capability will be for this baby # Calibration process restarts for each baby " Extra milk removal even if only just during this time helps create the highest possible “set point” Copyright © 2012 by Diana West, BA, IBCLC 4 Making More Milk Presented by Diana West, BA, IBCLC HORMONES AND FACILITATE RECEPTORS BREASTFEEDING ! Hormones need receptors ! Delay bathing of mothers and babies as long as possible to act on a target organ " Babies placed on their mothers’ chests immediately after ! Each hormone has its birth with their hands free smear amniotic fluid onto the own receptor breasts as they use their hands and face to find them Hormone (Varendi, 1996; Varendi, 1997) ! There are receptors in Receptor each organ of our body " Smell of amniotic fluid orients to breasts like tracking beacon ! The more receptors, the more effective hormones are " Critical biological sequence # Helps babies cue into their natural latching instincts " Obviously less effective for water births # BUT water birth babies tend to orient more easily to breast "Not enough receptors $ hormones less effective BABY-LED LATCHING SKIN TO SKIN ! A reclined position allow baby to use ! Enhances metabolism of brown adipose tissue breastfeeding reflexes to latch himself (Colson, 2008) $ increase gluconeogenesis and ketogenesis " “Biological Nursing” (Suzanne Colson) $ decreases risk of hypoglycemia requiring " Also known as “Laid Back Breastfeeding” supplementation (Christensson et al 1992) ! Mom leaning back so gravity helps ! Promotes physiologic stability for better feeding (Bauer, 1997; Bier, " NOT fully flat 1996; Bohnhorst, 2001; Cattaneo, 1998; Gaxxolo, 2000; Tornhage, 1998; Whitelaw, 1994 %TIP OF CITATION ICEBURG) ! Gravity holds baby firmly against mom in " Regulates baby’s body temperature (thermoregulation) VENTRAL position Increases blood oxygenation " Stabilizes pulmonary function " Increases baby’s sense of stability & security ! Increases maternal milk supply, breastfeeding duration (Bier, 1996) BABY-LED LATCHING BABY-LED LATCHING !Releases baby’s AND mother’s natural reflexes and instincts ! Snuggle baby high up between mom's breasts !Baby impresses mother with his ! Mother automatically strokes baby’s back competency ! Baby begins woodpecker motion and !Helps improve milk transfer and bobbing down to a breast to self-attach painless latching ! Mother only needs to support, not to guide !Does not require any hands-on ! More info: Baby-Led Breastfeeding video help from lactation helper biologicalnurturing.com !Mother feels more confident Copyright © 2012 by Diana West, BA, IBCLC 5 Making More Milk Presented by Diana West, BA, IBCLC HAND EXPRESS COLOSTRUM HAND EXPRESS COLOSTRUM (IN ADDITION TO NURSING) (IN ADDITION TO NURSING) !Hand expression more effective !2009 study by Dr. Jane Morton and to remove colostrum in first 48 hours Colleagues at Stanford (Ohyama, 2010) " Expressing colostrum at least 6x/day in first 3 days pp Moves thick colostrum more easily through breast increases later milk production by avg 45% (Morton, " Pumps pull fluid into the areola 2009) # Compounds LGII areolar edema