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From:
Carol Chamblin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 8 Sep 2002 11:06:42 EDT
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I have to add my 2 cents here to Lisa Marasco's great synopsis about the
prolactin receptors, etc.  My twist on this subject is relevant to postpartum
depression/mood disorders.  There are different theories regarding the
physiology and hormonal influence on the occurance of PPD.  These findings
parallel everything that's being stated regarding the breast function in
lactation.  One finding is that the neurotransmitters of the brain are not
receiving adequate amounts of oxytocin.  When nonlactating rats were given
adequate amounts of oxytocin, they exhibited maternal behaviors.  When
lactating rats were made to have reduced levels, they did not exhibit
appropriate maternal reactions to their young.  Since studies on the
lactating human mammal are not ethical, meaning we cannot diminish oxytocin
levels and see what happens to maternal behaviors, we need to do the next
best thing and study other lactating mammals.  These findings are deemed to
be fairly relevant to the course of hormonal levels in humans.  Furthermore,
studies demonstrate a correlation between prolactin levels and the occurence
of postpartum depression (PPD).  Moms with symptoms of PPD have been found to
have reduced levels of availability of prolactin.  Common reasons we may be
instrumental in meeting the needs of this woman may be to consult with her
about her low milk supply issues.  Her low prolactin levels may have resulted
purely physiologically (a hormonal imbalance) and she very likely may have
had a history of infertility, which is why it is important to get a thorough
history and to be putting all of the pieces of the puzzle together as we
conduct our consult.  Or, as we know, her low prolactin level resulted from
breastfeeding difficulties, namely poor latch-on, and spiraled into low milk
volumes.  These are some of the reasons I strongly advocate that lactation
consultants thoroughly understand postpartum depression/mood disorders and
how to effectively screen these women and make appropriate referrals.  The
literature reflects the onset of these hormonal imbalances and physiological
shifts to take place within the first 2 weeks postpartum.  Who do you think
potentially sees these women at this time?  Most likely she has already had
the baby to the pediatrician and her visit to the OB is not until 4-6 weeks
postpartum (at least in the U.S.).  Yes, you got it!  It may be us who are
consulting with this new mom and can counsel her effectively so that her
needs are addressed and support provided for her.  Furthermore, the
literature demonstrates a decreased incidence of symptoms of PPD in
subsequent births when a plan has been established involving appropriate
support.  We can make a great impact on the lives of these women.  The
influence of the cortisol levels are also documented in the literature about
PPD.  These are a few of the reasons for lactation consultants to be highly
knowledgeable about PPD.  The occurence of PPD is directly linked to the
outcome of her breastfeeding.  One last finding I have to share, and then I
promise I'll stop.  One study used a reliable and valid tool to measure level
of fatigue postpartum.  The findings reflected a correlation between fatigue
on day 7 postpartum and the onset of PPD on day 28 postpartum.  And, you're
going to love this one!  The findings demonstrated no greater fatigue for
breastfeeding moms as for bottle-feeding moms.  That squashes the theory that
breastfeeding is too tiring for mom and so she needs to wean.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
Geneva, Il

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