Dear Liz & all:
According to everything taught in the accreditation process of LLL Leaders (please refer to pgs. 18, 19 & especially top of 20 of the Breastfeeding Answer Book third revised edition)...there has been ongoing studies of the effects of milk removal and replacement basically since we learned it affects a supply long term. (specifically DeCaravalho 1983 & Daly 1993)
To sum this up, lactocyte cells have prolactin receptors (please forgive me as I am NO SCIENTIST - it's intriguing but still a professional scientist, I am not!!) and in the early weeks when milk is frequently removed from the breasts these sites fill with prolactin (the milk making hormone) OR when milk is not removed frequently & effectively these receptor sites fill up with progesterone!!! These sites filling up with progesterone is a bad thing!!!...as we all know progesterone & estrogen levels should stay at a minimum during lactogenesis II and III (and I say LIII because how many of us have received calls from moms who are freaking out about their supply & come to find out...they are or are about to have their "cycle") because these hormones (in significant quantities) affect milk production...
Let us not forget about FIL (feedback inhibitor of lactation)...this is the reason we say that an empty breast fills quicker than a half full one. During LIII milk synthesis works off an autocrine (locally controlled i.e. breast) system as opposed to the endocrine system (during early pp period)
In this, we've discovered frequent & effective milk removal (by whatever means is feasible for the mother i.e. baby, hand or pump) in the early weeks.....leads us to see that her supply is plentiful in the later months.
So, to answer any questions, in my opinion...yes, if you have a mother whose experiencing significant fullness in the early hours, days, weeks, yes, she needs to remove that milk so she has more in months to come!! Again this is where most mothers need to have education about no supplementing, frequent feeds etc. I know I'm "preaching to the choir" here...but you get my point.
I hope that makes sense...as I'm sitting here trying to type this and visit with a 3 year old who's enjoying "The Incredibles" :) and studying pathogenic microbiology...busy busy busy!!
Someone please correct me if I'm wrong in anything that I've said, I'm not NEARLY as experienced as most of you :)
Joy Kahler
LLL of Wyoming, USA
ps...if anyone hasn't noticed, I email just like I speak...rapidly and (hopefully not too) randomly!!! :)
Liz Brooks <[log in to unmask]> wrote:
So, what are you all telling the mothers who come to you, *weeks* after birth, with what you've figured out is low supply due to inadequate milk removal in the early days?
These moms are often at their wits' end. There has been a blur of feeds-at-breast, and pump use, and supplementation, and weight checks, and weeping babies and weeping moms. As the IBCLC, I'm now suggesting *regular* and *systematic* removal of milk (that darned pump!!) -- lots of skin-to-skin -- and information about herbs or medicinals to boost supply. Often by this stage of the game the moms are overwhelmed by the demands of "getting back to normal" (whatever that means), Dad/partner is back at work; toddlers are tearing through the house, etc etc
And every single one of these moms asks me: when will I see more milk?
Hence my query. I can "soothe and encourage" with the best of them, but I'm haunted by the thought that the majority of receptors in their breast tissue are too far involuted to make this labor-intensive care plan plausible. Am I off my rocker here? I never make promises, and I never-say-never ... but I also believe mothers are entitled to the dignity of a realistic picture of what the future holds.
So -- what is the realistic picture that *you* paint with moms like this?
Liz Brooks, JD, IBCLCWyndmoor, PA, USA
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