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CAM Region 3 Meeting Notes on Breastfeeding from Ami Burnham


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An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.


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



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