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CAM Region 3 Meeting Notes on Breastfeeding from Ami Burnham

CAM Region 3 Meeting Notes from Ami Burnham
April 16, 2010

o At 28wks, do breast questions & physcal exam: breast changes in pregnancy? Presence
of colostrum? Maternal concerns about breasts/BF?
o Lend “Baby Led Breastfeeding” video at 36 wks

LOW MILK SUPPLY
• MATERNAL CAUSES
o Basic physiology: insufficient glandular tissue
§ Herbs: Goats Rue (promotes glandular tissue) & Fenugreek
(Neither are safe in pregnancy, but can be started immediately PP)
o PCOS
§ expect low milk supply
§ Herbs: Goats Rue & Fenugreek
Breast Reductions
o
§ ask mom about amount of nipple sensation? Low sensation generally
means low oxytocin response (poor letdown), oxytocin nose spray can
help encourage letdown
§ Expect flatter nipples
§ Body image issues: why did they get reduction?
§ Book: Defining Your Own Success, BFAR.com
§ Herbs: Goats Rue & Fenugreek
o Breast Augmentations
§ where was implant put in? through nipple = more damage
§ Ideal: no nipple removed, implant placed behind muscle
§ Expect more engorgement and pain, flatter nipples
§ Why did they get augmentation? Want to know if they got it b/c they had
classic low glandular tissue breasts

o Assess maternal desire to BF, psycho-social Hx
o Be aware of OUR expectations as MWs about BF, don’t make moms feel guilty,
respect their limits and expectations
o Prolactin
§ Domperidone only works with Prolactin levels below 50-75 ng
• Compounding pharmacy on Irving will make it (need an OB or
Ped Rx)
• Not for use with Hx of heart arrhythmias
• Most common SA: HAs lasting 2d
• Hale classification L1
• Much less damaging potential SA than Reglan
• Same as Motillium in Canada, can be ordered online (10-20 mg 3-
4x/d)
• Prolactin levels must be drawn, draw 2-3 hrs after nursing
• Start to try to wean mom off after 3-4wks, some moms will be able
to maintain supply, some will need to stay on throughout lactation
§ Prolactin levels are also affected by Progesterone, so no mirena or minipill
until 3mos PP

o Low Supply
§ IUI and IVF for hormonal issues linked to low milk supply
§ Older primips may have low milk supply
§ Blood Loss
§ Hypothyroid
o Draw labs if Hx of thyroid issues or low supply issues
o Draw TSH and T4, at 6wks or if low supply
§ Intrapartum Pitocin overloads oxytocin receptors, so no physiologic
massive PP oxytocin surge, causes delayed milk production
§ Methergine causes definite delayed milk production, stays in body 6d
after dosing, NO METHERGINE unless necessary, use misoprostol first!
o Causes long term milk supply issues (several weeks)
§ To determine daily supply: pump every hour (pump until she stops
dripping then 2 additional minutes) for 4 hours, take average of amount of
hours 3-4, then multiply by 24=how much milk mom makes in 24 hours
o Ideally mom should make 2-2.5 oz/lb of babe body weight per
24 hours (10lb baby needs 20-25oz/d to day to gain oz/day)
§ Applies for up to 12 wks PP

§

BABY CAUSES
o NOTHING GOES IN BABY’S MOUTH until after first latch to avoid oral
aversion
§ No digital palate/exams unless indicated
§ Minimal suctioning, only prn
Avoid telling mom that babe should nurse q2-3h, say minimum 8 feeds in 24 hrs, with
some long stretches & some cluster feeds
o Takes most babes avg 30-45min per feed to get sufficient milk
o Concentrate on one breast, 2nd breast if babe still hungry
o To keep feeding active, compress breast throughout feeding (1-2 seconds per
compression) which increases milk release and increases fat content of milk

§

o Supplementation
o Bottle Feeding, Cup Feeding, Spoon Feeding all preferred to finger or syringe
o Bottle Feeding
§ Use Nook nipple
§ Breast Flow nipple: double nipple, makes babe suck harder, more similar to
breast
o Ideal Formula: Baby’s Only (says for Toddlers only on label, but ideal for NB)
§ Start with Cow’s milk formulas, avoid soy
§ Add fish oils if desired (not necessary with mixed feeding)
§ DHA from algae is being used in formulas, which is not bioavailable to NB
o Maternal Diet
o Good Healthy diet, small frequent meals are ideal
o Higher fat foods don’t make milk richer
o Milk is the ONLY food that could cause NB allergy (b/c of protein in milk, not
lactose)
§ More varied diets for mom causes wider palate for infant/child

o Big shifts in maternal blood sugar can impact supply
o Drink appropriate amount of water, but avoid overhydrating (dilutes hormonal effect)
o Avoid caffeine in high amounts if low supply is an issue, otherwise caffeine doesn’t
transfer to milk easily
o Alcohol
§ 1 dose of alcohol (1 beer, 1 glass of wine, one shot of liquor) goes into milk
within 30min, out of milk within 2-3h
§ All types of alcohol goes into milk equally
§ If mom feels “drunk”, there’s alcohol in milk
§ Only pump and dump if mom NEEDS to pump for engorgement within 2-3h
after drinking
§ Dark beers (hops) don’t increase supply
§ Babies learn flavor of alcohol through milk, and flavors babies taste in milk
are flavors they like later in life
§ Babies drink less milk when there’s alcohol in it
§ Family Hx of Breast CA: avoid alcohol with lactation b/c synergistic effect of
increased prolactin and alcohol increases risk of CA
o Nipple Shield
o Use for high palate, posterior tongue ties, damaged nipples, flat/inverted nipples
o Babes can transfer as much milk, it just takes them longer
o Mastitis
o Gentle nipple wash with baby soap 2-3x/d
o Use antibiotic ointment on nipple 2-3x/d until lesions healed, S/Sx clear up
o Newest research shows that yeast cannot grow within ductal tissue, so most cases of
thrush are actually bacterial infections, antibiotics more appropriate

o Raynaud’s
o High dose omegas
o CalMag
o B6 250mg for 4 days then 25mg/d from then on
o Keeping nipples warm, cotton or wool pads, lily pads, hot water bottles
o Extreme cases can take nifedipine with low side effects, usually resolves after a short
course, safe for baby, mom may have slight HA
o Avoid nipple trauma, which can aggravate it