Hi Sara,
Something that isn't addressed in your review is that perceived insufficient
milk can often be a perception rather than a reality or caused by practices
such as restricting breastfeeds or inefficient suckling. Research that has
measured milk consumption when mothers have felt their supply to be "low"
has not found that less milk is consumed then when mothers have thought
their supply to be adequate. Further, normal infant behaviour can be
interpreted as meaning "not enough milk" and it is perhaps for this reason
that women who are associated with breastfeeding support groups are less
likely to believe that they do not have enough milk. This whole area is
complicated by the suggestion that "not enough milk" is perceived as a
socially acceptable reason to wean.
Complex area.
Karleen Gribble
Australia
----- Original Message -----
From: "Sara Whalen" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, October 25, 2006 11:08 AM
Subject: causes of insufficient milk supply
I have been reading with interest the postings regarding the mother who is
having trouble getting her supply of milk started. Being a student and a
bit naïve, I thought that as long as baby was put to breast enough, the
mother’s milk would come in. This is a concerning issue for mothers and
lactation consultants. I have done a bit of research to find out causes
of this problem. I found there are commonly known reasons, and perhaps,
some less understood causes of inadequate milk supply, including obesity
and ovarian cysts.
Marasco. Marmet & Shell (2000) state, between 2-15% of new mothers
are unable to produce enough milk to maintain their baby’s health. They
go on to explain professionally accepted causes for this condition such as
uncontrolled diabetes, low thyroid hormone, pituitary problems,
hemorrhaging and breast surgeries. Hoover, Barbalinardo & Platia (2002)
also give retained placental fragments, magnesium sulfate use, obesity,
anemia, Sheehan’s syndrome, radiation therapy, cigarette smoking, and some
medications as reason for delayed milk supply.
Marasco et al. (2000) looked at women with poly-cystic ovarian
syndrome and their high rates of BF failure. These authors concluded that
these women need to be followed closely, but the reason for BF failure was
not completely understood.
In 2002, Hoover, Barbalinardo & Platia published a case report
stating information on gestational ovarian theca lutein cysts. These
cysts appear during pregnancy and substantially raise the mother’s
testosterone level. The authors relate the hypothesis of the
endocrinologist is the high levels of testosterone had delayed
lactogenesis II (the onset of a substantial milk supply).
Hill, Aldag, Chatterton, and Zinaman (2005) published a study in
the Western Journal of Nursing Research that looked at the correlation of
psychological stress and fatigue and low milk supply in term and pre-term
mothers. The researchers found no correlation between the mother’s
perceived stress and milk volume. Stress has received its share of blame
in low milk supply, so it is good to know that may just be an old wives
tale.
Pathology related to low milk production has been linked to
obesity. A study by Rasmussen and Kjolhede (2004) indicates a link in the
amount of prolactin produced by overweight and obese mothers. Prolactin
levels are significantly below normal at post-partum day 2 and 7 and would
affect lactogenesis II, the authors postulate this is the reason it is
common that overweight/obese mother give up on breast feeding at this time.
It seems to me that hormone production is an important indicator
of BF success. When milk supply is not started in a timely fashion and
other causes have been ruled out. Hormone tests may be the way to go. I
would like comments from you professionals on what you see in your
practice and what your normal course of action is when a mother is having
trouble establishing a supply.
REFERENCES:
Hill, P. Aldag, J. Chatterton, R. and Zinaman, M. (2005) Psychological
distress and milk volume in lactating mothers. Western journal of nursing
research. 27(6): 676-693.
Hoover, Barbalinardo & Platia (2002) Delayed lactogenesis II secondary to
gestational ovarian theca lutein cysts in two normal singleton
pregnancies. Journal of human lactation 18(3):
264-268
Marasco, L. Marmet, C. & Shell, E. (2000) Polycystic ovarian syndrome: A
connection to insufficient mild supply? Journal of human lactation. 16
(2):143-148.
Rasmussen, K. & and Kjolhede, C. (May, 2004) Prepregnant overweight and
obesity diminish the prolactin response to suckling in the first week
postpartum. Pediatrics 113(5): 465-470.
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