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-   -   Why isn't there more medical information about BFing? (http://www.diaperswappers.com/forum/showthread.php?t=1526019)

happysmileylady 06-20-2013 06:32 PM

Why isn't there more medical information about BFing?
 
Having encountered supply problems with two of the thee kids I have BFed, I wonder why there seems to be so little real solid medical information on BFing. We know that breastmilk production is triggered by a hormone and that increasing demand increases supply, but why does there seem to be so little beyond that? What levels of hormone are necessary to ensure adequate production? Can hormones be developed as a medication to to help increase hormone leves and supply if demand alone isn't working. We can take hormones to prevent ovulation, there are medications for when the body doesn't make enough other hormones, why not for BFing?

I just feel like right now, the whole thing is just guessing game and it often leaves women feeling like they screwed up, when they struggle with supply. The best an LC can tell them is nurse more, make sure your latch is right and that baby doesn't have a tongue tie. There really seems to be nothing to tell a woman if her body is actually doing what it's supposed to and this assumption that there is pretty much no way that something could be medically wrong.

Is there more research going on in this area that I am not aware of?

islandymama 06-20-2013 07:26 PM

Re: Why isn't there more medical information about BFing?
 
There is more, possibly not enough. There is some great info through the Academy of Breastfeeding Medicine....bfmed.org , and also through ILCA (International Lactation Consultant Association, recently they made their newsletters available to all, don't have a direct link). Sorry for incomplete links but I don't have enough posts, yet.

Just as a disclaimer, I am not an IBCLC, but am a midwife and worked as a breastfeeding counselor with WIC for several years. I also a mother of 3 (soon to be 4) and I have also had breastfeeding difficulties; although I have successfully breastfed exclusively and extended, up to 3.5 years, the first few months is always a struggle for me. My babies are on the breast around the clock and though they are healthy the never achieve that "4 to 6 ounce per week " weight gain. We define our own success.

There are definitely hormonal conditions that can make breastfeeding really difficult. One is insufficient glandular tissue/ hypoplasia which I believe I have to some degree.

Also, PCOS can affect milk supply, as can thyroid conditions. Sometimes mom doesn't know she has a condition. Medications, too.... especially hormonal birth control. Sometimes there might be retained placental fragments and mom's prolactin doesn't kick into full gear because her body hadn't gotten the message the pregnancy is over.

Baby might have a physical abnormality, like a tongue tie, or a labial frenulum (upper lip) that is overlooked and milk transfer can be compromised.

Unfortunately a lot of medical professionals have little training in lactation and abysmal, outdated information... this applies to homebirth midwives and OBs and pediatricians a like in my experience. Many (the latter 2) get the bulk of their breastfeeding info from formula reps, which is just backwards to say the least.

There are medications to help increase milk production and they are used off-label, Domperidone and Reglan. There is some great info on these at lowmilksupply.org .

Ultimately I do believe, in the majority if cases, it really is not a hormonal issue but lactation mismanagement which is probably the reason for those run of the mill "nurse your baby more" answers.... so important and underestimated especially in the hospital. Moms are not educated enough on what's normal, or not, and nurses are given the authority to make snap decisions that can adversely affect milk supply. I have heard these stories so many times, it is frustrating and has brought me to tears more than once. Just like we are told we are inadequate to birth, so it continues, into lactation, parenting, etc...

There is also some very interesting, non medical perhaps but definitely academic information from an anthropologist named Kathleen DeWyttler, I believe... look her up too, she has a website.

Sorry to go on for so long but this is a topic near and dear time, I hope something in this post is helpful for you.

EmilytheStrange 06-20-2013 07:33 PM

There are medications to increase supply. And tons of natural things we know increase supply.

What I recommend to a struggling mom is to get baby weighed before and after a feeding. Find out if there's a real supply issue before assuming so.

With DD, we had issues. Lots of them. And I thought low supply was one. But now I know enough that I'm not sure it was.

By my accounts, women are pushed to the pump too early which affects supply negatively. What women don't realize is that not everyone can pump. So when they don't letdown proper for the pump, a supply issue is suspected.

Women are also given to believe that babies nurse every couple hours. So when baby wants to nurse every hour, a supply issue is suspected.

But neither mean that. I think supply issues are commonly blamed for misunderstanding nursing.

And growth spurts are not taught about enough so moms are like 'baby nursed 5 hours and then drank 2oz formula - I have a supply issue! When it's not. It's a growth spurt. Or cluster feeding. Or something else completely normal.

I was a victim of too little info with DD. I know how it works.

I know that's going beyond what you said but those are thoughts. There are medications to help women with low supply. I don't know if they're hormonal, per se but they have side effects just like the hormones that cause us to ovulate or not.

happysmileylady 06-20-2013 07:39 PM

Re: Why isn't there more medical information about BFing?
 
Well I am finished nursing for good so I am not really looking for anything specific. Just kind of generally wondering.

Are there any blood tests to tell a mother what her prolactin levels are? I was aware of the meds used off label, but are there any in research and development to be used on label?

Honestly, I think that the constant line of 'mamas don't have enough information and support' might be starting to do more harm than good. It's often leaves many mamas who ARE trying and are getting support and seeing IBCLCs and such a bi lost. And I think it leaves mamas who have to return to work feeling like any problems they have are because they are working and not keeping baby tied to them 24/7.

I wonder how much is 'mamas are misinformed' and how much is 'mamas don't have enough info because there just isn't enough info out there.'

islandymama 06-20-2013 08:02 PM

Re: Why isn't there more medical information about BFing?
 
Yes you can test your prolactin but it does fluctuate throughout the day. My opinion is that as a mommy you are always going to be subjected to that mommy guilt.... we naturally compare ourselves to others and are too much, not enough, etc.

I don't really follow what you said about the line about misinformation, etc doing more harm than good exactly.... for me this is not a line but an observation from years of experience both personal and professional. We really don't have a culture of breastfeeding support as a whole.

For me, giving and receiving the right information at the right time makes all the difference ( or the opposite is also true...)

You should never feel like less, or a failure, especially when you have made a decision to educate, explore your options, and try.... like I said, what I have learned is "define your own success".

I once met a mom who had a breast reduction and desperately wanted to breastfeed. She saw an IBCLC and was not transferring anything measureable. Mom was really hurting and feeling like a failure when we first met. Guess what? Baby did not mind and continued to nurse after each bottle, happily for many months. He had no idea that breastfeeding had anything to do with milk production and really that is only the tip of the iceberg. Breastfeeding goes way deeper than how much milk you make and doesn't make or break you as a mother.

BSWmama 06-20-2013 09:06 PM

Re: Why isn't there more medical information about BFing?
 
Quote:

Originally Posted by happysmileylady (Post 16695572)
Well I am finished nursing for good so I am not really looking for anything specific. Just kind of generally wondering.

Are there any blood tests to tell a mother what her prolactin levels are? I was aware of the meds used off label, but are there any in research and development to be used on label?

Honestly, I think that the constant line of 'mamas don't have enough information and support' might be starting to do more harm than good. It's often leaves many mamas who ARE trying and are getting support and seeing IBCLCs and such a bi lost. And I think it leaves mamas who have to return to work feeling like any problems they have are because they are working and not keeping baby tied to them 24/7.

I wonder how much is 'mamas are misinformed' and how much is 'mamas don't have enough info because there just isn't enough info out there.'

I know what you mean by this as a mom who struggled with supply with my first, and now probably my second child. I can't claim I did everything perfectly, but I had a natural birth, got baby to the breast immediately, soon took Reglan and Fenugreek and Blessed Thistle, I did breast compressions, I pumped after feeding, I drank a lot of water, some beer, I ate plenty of calories, I nursed around the clock, coslept night and day. I saw lactation consultants at the hospital numerous times, had before/after feed weigh-ins, I called LLL leaders. I read A LOT, and cried A LOT. Ultimately, I was able to EBF my son but it was an uphill battle and weight gain was always somewhat an issue. All that that I got from LLL and lactation consultants was, "Well, have you tried this or that?" I felt that they had already judged that I was a total idiot who had "mismanaged" the breastfeeding relationship (and I guess perhaps I had but I was trying sooo hard and reading and obsessing) and I was seriously at a loss, having indeed tried all that already...

islandymama 06-20-2013 09:59 PM

Re: Why isn't there more medical information about BFing?
 
Quote:

Originally Posted by BSWmama (Post 16695798)
I know what you mean by this as a mom who struggled with supply with my first, and now probably my second child. I can't claim I did everything perfectly, but I had a natural birth, got baby to the breast immediately, soon took Reglan and Fenugreek and Blessed Thistle, I did breast compressions, I pumped after feeding, I drank a lot of water, some beer, I ate plenty of calories, I nursed around the clock, coslept night and day. I saw lactation consultants at the hospital numerous times, had before/after feed weigh-ins, I called LLL leaders. I read A LOT, and cried A LOT. Ultimately, I was able to EBF my son but it was an uphill battle and weight gain was always somewhat an issue. All that that I got from LLL and lactation consultants was, "Well, have you tried this or that?" I felt that they had already judged that I was a total idiot who had "mismanaged" the breastfeeding relationship (and I guess perhaps I had but I was trying sooo hard and reading and obsessing) and I was seriously at a loss, having indeed tried all that already...

That sounds a lot like my breastfeeding experience with my first, minus the Reglan. My baby did not get back to her birth weight until over a month and only after I began formula supplementation. I smelled like curry powder from all of the Fenugreek, not to mention Goat's Rue and Brewer's yeast. I nursed around the clock and pumped (usually drops, nothing measureable) with a hospital grade pump. I supplemented at the breast with an SNS. I was a huge ball of stress, depressed, and vould not understand my body's failure. After some time I just couldn't deal, and seeing no increase, stopped pumping and using the SNS. I supplemented after nursing with formula in a bottle. One day I stopped the formula, I didn't consult my midwife, the IBCLC or the pediatrician. By weight alone she was failure to thrive but met or exceeded her milestones, I did intro. solids early, probably too early, but I didn't kn8w better back then. I EBF my second, she did a little better but wss still under the norm, and small even at a year and two years, She nursed 3.5 years. My third is a similar story but I stopped stressing. I was really lucky to be able to bring her to work with me so she was able to nurse on demand ( I would never be able to pump frequently enough to work and maintain a supply). I never mentioned our low weight gain to any of the IBCLCs I worked with.

As mentioned in a previous post I have "self diagnosed" myself as having insuffucient glandular tissue. I have all of the physical signs and I feel that because we build milk making tissue with each subsequent pregnancy I have done a little better each time, not to mentinm my conscious decision not to stress myself as long as my babies are healthy.

Bayasmomma 06-21-2013 01:08 AM

Re: Why isn't there more medical information about BFing?
 
Quote:

Originally Posted by islandymama (Post 16695924)
That sounds a lot like my breastfeeding experience with my first, minus the Reglan. My baby did not get back to her birth weight until over a month and only after I began formula supplementation. I smelled like curry powder from all of the Fenugreek, not to mention Goat's Rue and Brewer's yeast. I nursed around the clock and pumped (usually drops, nothing measureable) with a hospital grade pump. I supplemented at the breast with an SNS. I was a huge ball of stress, depressed, and vould not understand my body's failure. After some time I just couldn't deal, and seeing no increase, stopped pumping and using the SNS. I supplemented after nursing with formula in a bottle. One day I stopped the formula, I didn't consult my midwife, the IBCLC or the pediatrician. By weight alone she was failure to thrive but met or exceeded her milestones, I did intro. solids early, probably too early, but I didn't kn8w better back then. I EBF my second, she did a little better but wss still under the norm, and small even at a year and two years, She nursed 3.5 years. My third is a similar story but I stopped stressing. I was really lucky to be able to bring her to work with me so she was able to nurse on demand ( I would never be able to pump frequently enough to work and maintain a supply). I never mentioned our low weight gain to any of the IBCLCs I worked with.

As mentioned in a previous post I have "self diagnosed" myself as having insuffucient glandular tissue. I have all of the physical signs and I feel that because we build milk making tissue with each subsequent pregnancy I have done a little better each time, not to mentinm my conscious decision not to stress myself as long as my babies are healthy.

Quote:

Originally Posted by BSWmama (Post 16695798)
I know what you mean by this as a mom who struggled with supply with my first, and now probably my second child. I can't claim I did everything perfectly, but I had a natural birth, got baby to the breast immediately, soon took Reglan and Fenugreek and Blessed Thistle, I did breast compressions, I pumped after feeding, I drank a lot of water, some beer, I ate plenty of calories, I nursed around the clock, coslept night and day. I saw lactation consultants at the hospital numerous times, had before/after feed weigh-ins, I called LLL leaders. I read A LOT, and cried A LOT. Ultimately, I was able to EBF my son but it was an uphill battle and weight gain was always somewhat an issue. All that that I got from LLL and lactation consultants was, "Well, have you tried this or that?" I felt that they had already judged that I was a total idiot who had "mismanaged" the breastfeeding relationship (and I guess perhaps I had but I was trying sooo hard and reading and obsessing) and I was seriously at a loss, having indeed tried all that already...

OMG you guys are my new BFFs. I'm going through all the same stuff now. My first DD was probably mismanaged because I hadn't received enough information. We nursed around the clock but on the 6th day she had been on my breast for EIGHT hours straight. It was 4 am and I hadn't slept in days. I decided one 2 oz bottle so that we could get a little sleep would be alright (OT but WHY do all the OBs put formula in every new mom's home so its easily accessible in their moment of weakness???) We did ok supplementing tiny bits here and there until one night I got her down, went to bed and we woke up 10 hours later with raging mastitis. The mastitis shut off supply in that breast and I couldn't keep up with only the other side. When giving my history to the LC I mentioned that first formula night she just looked at me like I was an idiot and said "well, why didn't you just put her back to your breast?" Like that thought must not have occurred to me. We did all the supplements, pumps and Reglan which tipped me into such depression I couldn't stand it anymore. She was formula fed by 2 months.

Now DD number 2- I did SO much research, watched videos, read books. We started out great, I set up shop in my chair and expected round the clock nursing, milk came in at a crazy volume. I put about 30 oz in the freezer in the first 2 weeks. Then it dropped into oblivion. I took fenugreek and brewers yeast, I went to a herbalist and had fresh tea made up with everything she could put in there, I made cookies, drank so much water I thought I would puke, ate boxes and boxes of oatmeal, upped my iron intake. LO continued with a whopping 1 oz per week weight gain. She was tiny, gaunt, fell off the charts, didn't interact at all- only ate, slept and cried. We nursed at least 18 hours a day. I EBF until 6 weeks when she started peeing a rusty blood color from the dehydration. I just kept remembering that first LC telling me to put her back on, which I did. I went every week to a lactation weigh in and was told to keep it up. Then that same LC, again, looked at me like I was an idiot and asked why I wasn't feeding my baby (meaning formula this time.) I got a second opinion from a nicer lady and she told me I needed to start offering a bottle after every feed which made her start refusing the breast so now we are SNS feeding...And yet I'm still told its probably all in my head and if I just make sure my latch is always perfect and drink enough water my body will rise to the occasion.

I'm probably just misinformed.

islandymama 06-21-2013 09:22 AM

Re: Why isn't there more medical information about BFing?
 
Quote:

Originally Posted by Bayasmomma (Post 16696162)
OMG you guys are my new BFFs. I'm going through all the same stuff now. My first DD was probably mismanaged because I hadn't received enough information. We nursed around the clock but on the 6th day she had been on my breast for EIGHT hours straight. It was 4 am and I hadn't slept in days. I decided one 2 oz bottle so that we could get a little sleep would be alright (OT but WHY do all the OBs put formula in every new mom's home so its easily accessible in their moment of weakness???) We did ok supplementing tiny bits here and there until one night I got her down, went to bed and we woke up 10 hours later with raging mastitis. The mastitis shut off supply in that breast and I couldn't keep up with only the other side. When giving my history to the LC I mentioned that first formula night she just looked at me like I was an idiot and said "well, why didn't you just put her back to your breast?" Like that thought must not have occurred to me. We did all the supplements, pumps and Reglan which tipped me into such depression I couldn't stand it anymore. She was formula fed by 2 months.


Now DD number 2- I did SO much research, watched videos, read books. We started out great, I set up shop in my chair and expected round the clock nursing, milk came in at a crazy volume. I put about 30 oz in the freezer in the first 2 weeks. Then it dropped into oblivion. I took fenugreek and brewers yeast, I went to a herbalist and had fresh tea made up with everything she could put in there, I made cookies, drank so much water I thought I would puke, ate boxes and boxes of oatmeal, upped my iron intake. LO continued with a whopping 1 oz per week weight gain. She was tiny, gaunt, fell off the charts, didn't interact at all- only ate, slept and cried. We nursed at least 18 hours a day. I EBF until 6 weeks when she started peeing a rusty blood color from the dehydration. I just kept remembering that first LC telling me to put her back on, which I did. I went every week to a lactation weigh in and was told to keep it up. Then that same LC, again, looked at me like I was an idiot and asked why I wasn't feeding my baby (meaning formula this time.) I got a second opinion from a nicer lady and she told me I needed to start offering a bottle after every feed which made her start refusing the breast so now we are SNS feeding...And yet I'm still told its probably all in my head and if I just make sure my latch is always perfect and drink enough water my body will rise to the occasion.

I'm probably just misinformed.

A good IBCLC will tell you that the first rule is to feed the baby.You don't sacrifice baby's health for the sake of breastfeeding. Sounds like you did everything in your power to make your breastfeeding relationship work.

I learned from one IBCLC this breastfeeding equation: Baby + mom = breastfeeding. Sounds simple but that's the way it works. If breastfeeding is not working out either something is going on with mom, or baby, or both.

Mom: Feeding baby enough/ stimulating milk production... esp. In the early days. Hormone issues? Breast surgeries? PP hemorrhage? Underdeveloped breasts? Medications? Any could affect breastfeeding.

Baby: Latch. Sufficient milk transfer? Mom can be making tons of milk, if baby is unable to transfer mom's supply will drop eventually. Tongue or upper lip tie? Some of the most impeding ties can be the least obvious. Does baby have another health issue, I.e. allergies, reaction to what mom is eating? Silent GERD?

PS: I know feeding baby enough was not your issue! It was never mine either, however it is super common and you always start with the most obvious first. Shames on your LC for not looking past that! However I think a lot of hospital IBCLCs are very overworked, some are not really into lactation but RNs who tacked on the credential for professional development, and some have them their for show. Best to find a dedicated IBCLC if you can who doed it for passion's sakes.... if you can.

Zoethink 06-22-2013 08:40 AM

Re: Why isn't there more medical information about BFing?
 
This is SUCH an important question!! I am struggling with supply for the second time and NO ONE has ever tried to diagnose the problem, other than giving me behavioral things to try (pumping more, taking herbs, hydration, etc.)

First time around every circumstance was against us: traumatic cesarean, blood transfusion (me), separation for the first 24 hours, and then a 2 week NICU stay, and therefore a very late start to BFing, IUGR (small, but otherwise healthy), PPD, possible thyroid issue.

I pumped around the clock for four months and never got more than half an ounce per time. I did breast compressions while nursing until I got carpal tunnel syndrome. I took lots of herbs and ate oatmeal every day. I was so stressed out by the regimen that I had to give up finally because I was missing out on enjoying my baby!

This time everything was perfect: Perfectly healthy mom, wonderful, natural, full term VBAC, baby was a healthy size, immediately put to the breast. I nursed constantly for 3 and a half weeks. I ate and drank and rested well. (I was the happiest I had been in a long time!) and then baby lost weight!?!

We started supplementing and it has gone down hill since then. I chose to take a different tack this time; I concentrated on my nutrition and rest. I nursed baby as often as she would come to the breast and offered to nurse in between those times. I did take herbs and pump sparingly. I know there are other things I could have done, but my goal was to avoid the stress of what I had gone through last time, because I know that impacted my supply. And I can't help thinking, "it can't be this hard! We did not survive as a species if breastfeeding was this difficult and requires this much intervention!"

My mom (who BFed four kiddos, the last until he was four years old) kept telling me, "just keep breastfeeding. You don't need to supplement. You (her first) were tiny! But you were healthy."

Islandymama, it sounds like you took my mom's advice!:giggle:

I just didn't have the courage because I didn't want to get in trouble with my very proactive and overseeing pediatrician who I ran to at the first sign of trouble. I will totally do things differently if there is a next time, but I just wish I knew what is going on! And it isn't exactly clear who to ask. :cry:


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