Has someone suggested to you that your baby isn't gaining weight as expected and the solution is to get baby to ingest more hindmilk? It has become common knowledge that fat content of milk changes throughout breastfeeding. This is true. Milk doesn't change in each feeding session in the same way...it changes over the course of the day and feeding patterns. The anxiety about whether or not baby is feeding "long enough" to get to the hind milk is not necessary.
Something else that is true is that the longer a baby feeds, the more letdowns occur and more fat is released into the milk from the milk making glands, however...there are some things that need to be pointed out and kept in mind.
Foremilk and hindmilk are not two different kinds of milk. Women do not produce a low fat milk and a high fat milk. It is simply that the first milk a baby receives at the start of a feed is foremilk and the milk after that is hindmilk. The change is gradual It is not based on a percertange of fat content, like skim, 1%, 2% or whole milk that we are used to thinking of. There is no magic time in a feed that changes the fat content or we can see a switch of kind of milk. There is no percentage of fat a baby needs to be able to gain wright. On this note, all the foremilk is not always lower fat than all the hindmilk. Foremilk from one feed might have a higher fat content than hindmilk from the next feed, previous feed or other feeds in the day.
With this all in mind, when there is a weight gain concern, the focus needs to be on increasing intake of milk and looking at the factors that might be impacting intake & not trying to avoid foremilk. Strategies to avoid formal and increase hindmilk consumption are ideas like pumping foremilk before a nursing session, so baby can only access hindmilk or keeping baby on one breast for 15 or 20 or 40 minutes, depending on who is giving the instructions. In fact, sometimes these strategies means the baby is getting even less milk than before. It is the total daily milk intake that determines successful weight gain. We cannot look at one feed as the way it is for all feeds. We need to look at each day and all the breastfeeding sessions combined and then address ways to increase milk intake overall.
If you find yourself in the situation of having an infant that is not gaining as expected, not gaining at all, slowly gaining or losing weight, I suggest a full evaluation with an IBCLC.
I love talking breastfeeding and I really like talking the history of breastfeeding. When people find out I am an International Board Certified Lactation Consultant, they often respond with, “you’re a what?”. As I continue to explain what I do they say “seriously? People have trouble with breastfeeding? How is it that the human race has made it this far if it weren’t for breastfeeding?” Oh, goodness, what era do you want to talk about? I mean there is so much history about how breastfeeding can fail and what resolutions people had for that, depending on the era and the region.
We are part of another era and in the middle of history. I call the time before where we are right now “Before Tongue Tie”. Really, as an IBCLC of just shy of a decade, I had MINIMAL education on tongue ties and their impact on breastfeeding. Like a dismel amount. Then several years ago, I attended a few conferences, online, in person, different geographical locations. Everyone was talking about tongue ties. I said to myself and to others:
“Can we not talk about anything else?”
“There is no way there are this many tongue ties”
“Did we even know anything about breastfeeding until now then, if tongue ties are to blame for everything?”
They had different potential solutions. I come into all of this ready to learn and see if we can address some of the challenges that faced breastfeeding families that didn’t seem to have resolve. Much of what I was learning was that there was hope for these ongoing struggles that my previous education and training didn’t teach about.
I dove in. I recruited other professionals as supports. We networked. We shared experiences. We re-evaluated. We want the best for families.
My job as an IBCLC is not the same as those other supports and professionals but I want to share some of my learnings and reflections. I know tongue ties cause a lot of issues. I will not deny that, but I will say that just “getting it snipped” or getting into a dentist for a laser revision isn’t a guarantee things are going to be resolved.
A really key piece I have acknowledged is how much better babies that are at an appropriate weight recover and catch on to breastfeeding post-revision compared to babies that are underweight or slow gaining, maybe gaining weight a little faster than what is called a slow gainer and who maybe is not getting much concern from anyone but still not growing on “their curve”. Doing a revision on these babies is something I really hesitate to do now and I won’t make a recommendation for revision until resolution has occurred in the weight department. This to me a really good reason to be working with an IBCLC before hand.
Another really important part to working with an IBCLC is to assessing milk supply. Babies respond to flow and without that flow, they just won’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely or at all. If supply is low, again even with a revision, they just are not happy breastfeeders. Both this scenario and the above one make people say “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Being able to get moms working on supply, which in turn can help the weight gain issue, if it exists, helps ensure that once they get those two factors sorted out, they are ready for revision and have a good foundation to make the revision successful. The pieces fall into place nicely and almost predictably. It also helps me be able to tell a mom a timeline for “when will this all be better”. I can help them set up a plan so they can see a means to an end, rather than “just keep trying, it will click soon”.
There is also maternal pain that is often a concern and should be addressed INDEPENDENTLY of a revision. Sometimes tongue ties cause pain, damage & trauma to mothers breasts and can be resolved with a revision, but ideally more should be done to address this instead of just waiting for things to get better. When we deal with the breast/nipple independently, it makes the revision seem significantly more effective.
Babies can have other factors/stresses affecting and influencing breastfeeding that are often identified by IBCLC’s or professionals who assess physical factors, like Chiropractors or Osteopaths. I also find when we resolve these issues first, or at least start working on them, that things get back on track faster post-revision.
Sometimes I am not consulted until after a procedure for a tongue tie has been performed. When I get called after, I can most certainly still help and we can get past these remaining pieces, it just is in reverse. What I find though, is it is all a lot more stressful for moms and families because they also have a cranky baby and after care exercises to get in, as well as possible pumping & supplementing, and perhaps appointments with the other professionals we work with. I personally think It is better when I can set up a plan in steps with one focus at a time. Once supply and weight is up, it is one less stress, so the family can handle the stress of the aftercare and extra needs of the baby.
I am also aware that some parents would rather not go through a revision at all and this is where my “Before Tongue Tie” experience and knowledge comes in. I say to the parents and myself, “what would we have done BTT?” Are there strategies that would be useful and address the concerns? Sometimes there are solutions that the parents are 100% ok with and will get the baby fed and minimize concerns. Sometimes all of those are tried and the revision conversation might have to happen again. This is where knowing the risks to the situation and knowing what else to watch for is important.
Tongue ties are a topic that people get really excited about from many different perspectives and I don't see that changing for awhile, but I wanted to raise the thought that we are in a place of breastfeeding right now that in the years to come will be a historical recollection. It might be known as something more eloquent than BTT but until then we can recall what it was like BTT.
Earlier this week you might have seen my Facebook Live discussing what I am calling a guise for breastfeeding support. What is really happening when the sponsorship of events is by pump companies or formula companies/pharmaceutical companies.
I want to be *explicitly clear* that this is NOT about individuals. This is not about the idea or execution of such events. This is not about women supporting or not supporting women. This is not about businesses who chose to plan events. This is not about businesses who participate in events. This is fully about the sponsorship by the companies covered by the WHO Code. (and I promise you they all know about the WHO Code and how that impacts their relationships).
So, what is the WHO Code?
The WHO Code is the common wording used to refer to the International Code of Marketing of Breastmilk Substitutes. The Code was adopted by World Health Assembly and UNICEF in 1981. Since that time, a number changes have been made with the Code.
The purpose of the Code is to protect breastfeeding, to protect all mothers and babies, regardless of their desired feeding methods, and to prevent aggressive marketing practices that often interfere with mothers meeting their own breastfeeding goals. Infant formula, feeding bottles, and artificial nipples are the main products that fall within the scope of the Code. Breast pumps are not under the scope of the Code BUT some pump companies violate the code because they market bottles and artificial nipples. Again, the Code only applies to the marketing of these items–it does not affect whether they are sold or used. Confusing, right?
What did I have to say?
Confused? Of course you are!
The Code itself can be confusing, but then try to figure of which companies are WHO code Compliant and which are not is a whole other task. Companies come in and out of compliance all the time. Something that commonly happens is large companies merge, or enter into marketing relationships with each other and they also acquire departments from other companies with buying, selling and trading.
Then we have to consider who are the "kid" companies and who are the "parents"? Companies who are owned by Code violators are considered the same as their parent company. You really have to dig deep to find out a lot of this info, but if you start goggling different brands of formula, medications, infant supplies, etc you start to see that there are a lot of kid companies and just a few parents. The parent companies, of course, want to keep their smaller companies WHO Code violating record clean so that health care workers who have to adhere to the WHO Code can still have relationships with these companies, while the parent company gains benefits. They can also give items and samples not covered by the WHO Code and maintain compliance. But in the end, they are still violators.
As an IBCLC, I need to educate people about the WHO Code and marketing. What I am encouraging people to do, all across Canada, is to just keep their eyes open a little bit to who is hosting events, who is sponsoring events, what is that relationship like, who is providing the educational piece & decide if the information being given is evidence based and helping mothers meet their breastfeeding goals or if the information might be slanted. You will see a large variety of how these events take place and some will be absolutely ok and some are going to have questionable practices.
This is not about you and it is not about me.
Again, none of this is personal. None of the individuals involved did anything "wrong". It is not an individual issue. This is a nation wide issue. If one baby store is approached to host an event, any baby store could be being asked. If any doula is asked to be at an event, it could've been any doula they approached. If any nurse is involved, it could be any nurse approached, It happens to doctors, chiropractors, pharmacists, or even IBCLC's. It is anybody who is nice and kind and is buying into the idea of hosting an events for moms to offer support and companionship and education. That in itself is a fabulous idea and needs to happen! I will say people are ALLOWED to do this. As an IBCLC, I choose to adhere to the Code so I will not participate I do let people know that if that is breastfeeding matters to someone else in their profession, they can choose to adopt to follow the WHO Code. I am not here to tell anybody how to run their own business. They CAN participate and have relationships like this if they chose to. But I will always protect breastfeeding in my community. True breastfeeding support does not come from WHO Code Violators.
I want this to be heard by everyone because if the doula/nurse/doctor/pharmacist or IBCLC, asked to participate this time walked away, the companies will just go to find another one. This also applies to educational events for professionals so not only do we look down, we have to look up. I want parents to hear this so if they go to an event they can also see who is providing the funding for the event and the information.
Do you remember that time I told you to throw away the Lanolin? (You’re welcome)
I am here again suggesting you keep again breastfeeding old faithful on the shelf! At bare minimum before taking fenugreek to help an unsteady to low supply keep that bottle of fenugreek sealed until some further investigation as to why you might need something to boost supply is started.
We are starting to learn that fenugreek may not actually help a supply but also can be quite harmful for many mothers who are struggling with a low supply, depending on why the supply is low. The very reason supply is low can be a contraindication for use of fenugreek. For your own safety, you need to know the reason for the low supply, before taking fenugreek. Of particular awareness would be mothers with thyroid concerns, PCOS, IGT, diabetes, insulin resistant type health concerns. Women who has just had babies may not aware of or have an official diagnosis because until that time they have been mostly healthy. Sometimes it is not until the stress of a pregnancy and birth and early postpartum has an impact on the body that women start to feel unwell. And they might not even feel unwell, but just not be making a full supply. Producing milk is not a necessary part of living, so if the body has stressors, often production is suppressed. Breastfeeding truly is a time in life where a mother needs to take care of herself in order to be able to take care of the baby.
I think “breastfeeding issues” are sometimes breastfeeding issues but I also think that often time struggling with breastfeeding is just a symptom of something else. Paying attention to your supply as an indiction of something else, might actually help you understand more about your body and its personal needs.
This is not to say there are not good herbal options for supply, because there are. It is matter of knowing what is happening with your supply and body and having a health history taken or worked up, so that the right herbal for each individual can be chosen/suggested. It might just be fenugreek for you. But, there is a good chance there is something better.
Breastfeeding help the way you want it? Or do you think it needs some improving? Now is your opportunity to help by providing feedback.
Newborn babies are dirty business and believe it or not that white substance on newborn babies is good for them and shouldn’t be washed away!
Here are 15 things you might not already know about vernix:
I think we can agree vernix is pretty amazing.
What is a Lactation Consultant, LC, IBCLC?
The term lactation consultant or LC has become the known, accepted title for a professionals with expert knowledge in breastfeeding. They may work with moms and babies to address breastfeeding issues and concerns. They may also teach classes, assist with establishing breastfeeding one on one, and promote and protect breastfeeding through policy, procedure within health care and government.
Origin of the term “Lactation Consultant
The accepted term for “IBCLC” or International Board Certified Lactation Consultant in many geographical areas is "LC" or Lactation Consultant because, as you can see, that term is a mouthful.
“LC” is not trademarked and does not hold the professional standard like “IBCLC” does, so one will occasionally find a practicing LC who is not an IBCLC. Consumers (mothers and families) and other professionals (doulas and doctors) need to be aware of this.
As well, not all those who work as “lactation consultants” in health centres or breastfeeding support centres are IBCLCs. Some employers encourage employees to pursue the credential but don’t mandate it for employment. Many times, nurses with some basic breastfeeding education fill these jobs.
Why is this IBC part so important?
The International Board of Lactation Consultant Examiners (IBCLE) awards the title of International Board Certified Lactation Consultant to only the candidates who meet the comprehensive pathway requirements and pass an international exam. This allows IBLCE to establish the highest standards in lactation and breastfeeding care worldwide and to certify only the individuals who meet these standards.
Breastfeeding alphabet soup
I’d like to explain some of the breastfeeding alphabet soup by using the birthing support alphabet soup, as people seem to relate to that.
All the roles are important, but they provide their own distinct scope, responsibilities, and abilities. They can all work together to provide comprehensive support.
Primary roles of the individual bodies
As you can see, I’ve broken this down into three primary roles.
3. Clinical management
Educators teach you about the normal and expected processes of childbirth and breastfeeding. They typically call themselves childbirth educators and lactation educators.
They teach the normal process of birth and what you can expect when having a baby, as well as encourage and promote breastfeeding.
This information helps you make decisions, helps you know if you are on track, gives you references for getting the birth and breastfeeding relationships you want, and helps answer your questions.
Educators typically teach community classes in group settings.
Support people are typically those who have additional training in supporting mother, baby, and family during crucial times: birth and breastfeeding.
They’re typically doulas and La Leche League (LLL) leaders. Doulas are usually paid professionals, and LLL is a mother-to-mother peer support group. These roles offer the encouragement and motivation you need to get through the processes of birth and breastfeeding.
They are well versed in normal and expected outcomes. They know to watch for red flags to ensure they can guide you further if you have come outside the normal, expected process. Their job is to provide physical and emotional support, encouraging you to ask questions of your caregivers to make sure you’re well informed about what occurs. They have resources and guidelines to reassure you that you’re indeed in the realm of normal, and if things deviate from normal, they can point you in the direction of more resources.
Lastly, we have the clinical management professionals.
These are the folks responsible for the clinical and medical bits of the scenario. They look at the facts and figures, big picture, and red flags to rule in or out the things that are not in the normal and expected category and then make management plans from there. They have the clinical experience of things that fall outside normal and how to manage them.
All of these people have a place in the realm of support and caregiving; what’s important is they know their role and responsibility and respect the others’. Where it becomes problematic is when the client receives something different from what she expected to receive. Sometimes, this occurs because the roles of each provider isn’t clear to her, and she might conclude that one person isn’t performing a role properly. Let’s look at how this might apply to IBCLCs specifically.
In our example, a mother assumes that a breastfeeding educator* is an IBCLC. She notices that despite consulting with the helper, her breastfeeding issue remains unresolved. She decides to seek more help through a La Leche League leader, who determines that the issue is outside her scope and recommends an IBCLC. The mother insists that she already saw an IBCLC, but received no help.
*this person could also be staff at a breastfeeding clinic or nurse who comes to her home
This example is typical, and it hurts all support people. The educator gets a bad rep because she didn’t help. The LLL leader is helpless because the needs were outside her scope. The IBCLC profession gets a bad rep because the client misunderstood the different roles and expectations.
Clients need to know clearly what their expectations are and who can best meet those expectations based on role, scope, and experience. I want to be asked and welcome being asked these questions! I want you to go and look at the IBLCE website to see what IBCLC's are all about and verify I am indeed and IBCLC and see what scope and standards are laid in place for my profession. I welcome the same questions about being a doula! I would love to see a blog about midwives and how they are different from doulas and childbirth educators (wink, wink, nudge, nudge midwives).
All breastfeeding and lactation professionals have a responsibility to work together to ensure mothers have accurate information, so they can receive the support and encouragement they need as efficiently and as quickly as possible.
Breastfeeding pressure, postpartum depression & supports for new families. What is happening with todays mothers?
This week husband of Florence Leung released an emotional statement about postpartum anxiety & depression after losing his wife two months ago. He also commented about the pressure to breastfeed in the same comments. I commend him for speaking up, being brave, being seen, wanting to improve other peoples situations & for encouraging all new moms experiencing low mood or anxiety or depression to seek help. He added that these mothers are not alone and that they are not bad mothers. I agree and know he is correct. I don't believe there are bad mothers. I know mothers feel alone and isolated. Too many mothers feel this way. They are alone but not alone at the same time. When we pull in the breastfeeding component it gets super confusing and conflicting and very, very emotional. There are so many versions of how breastfeeding plays into postpartum anxiety and depression. Part of it is emotional and the feeling part of our brains and body and some of it is biological and chemically controlled in our brains and bodies (hormones are so complex). Some of this is controllable, in the sense that we can just change our outlook and start to feel better, and much of it less controllable and sort it feels like it is happening TO the mother. It really feels like a loss of control.
It is true that all over the place, in so many places new and expecting parents are visiting, there are posters and flyers and brochures and people encouraging breastfeeding and exclusive breast-feeding. This recommendation is world wide and comes from the World Health Organization. While I agree with all the benefits of breastfeeding, as most people would, it is NOT enough to just give benefits. In fact, it is dangerous to encourage and promote breastfeeding & yet not be able to follow through with the support needed. Breastfeeding is significantly more complex than the two-dimensional vision posters make it out to be. Most women are certainly not relating to the mothers on the photos of the breastfeeding books. You know, the mothers who have perfect skin, no bags under their eyes, pristine hair and makeup looking like they have zero cares in the world…beyond oxytocin highs.There needs to be support for the mothers that can breastfeed "easily" so they succeed. We also must meet the needs of and support the mothers in which breastfeeding is not going to work "easily" or perhaps not at all….and all the unique, complex cases in between this. Blanket statements are harmful, on all sides.
Supports for new families are getting less and less available and the resources we do have are not always adequately trained and skilled to handle the cases they have presented to them. For every mother who feels judged because she could breastfeed, but doesn't want to, there is another mother who is feeling judged because she wanted to breastfeed, but did not meet her goal. There are mothers who celebrate being told their babies need to be supplemented and welcome supplementation. There are mothers who are devastated when they are given the same news. We need to learn how to support all kinds of mothers and all kinds of scenarios. We have to be prepared for that to take more than 5 minutes in the doctors office.
Let's look at one way this all gets blurry. There are the mothers with babies who are not sleeping well but the mother has been reassured that this is just how breastfeed babies are. I don't believe that to always be the case…sometimes babies are not sleeping because they are hungry…breastfeeding is not working in that case, not for anyone. Mothers and babies need to sleep. Feeding endlessly for days and weeks is not healthy for anyone. The issue then becomes "exhaustion due to breast-feeding" weeks later, when breast-feeding issues could have been addressed, resulting in more sleep. Beyond that, families need support people to come in and do practical stuff, like care for a baby so mothers can nap, feed themselves, go for a walk. That doesn't mean breast-feeding needs to be discontinued, it just has to be understood and managed. Other examples would be a woman in so much pain from breastfeeding. Who wants to torture themselves 10 times a day. That is a breakdown waiting to happen. Again, lets get to the source as soon as we can. Get to the resolution so the mother can be pain free. There are so many options for that.
We know about postpartum blues and depression and how common it is. We also know that for many women it is so bad they are taking their own lives. It is horribly, horribly sad and devastating. I don't believe it is about mothers breastfeeding or not. I believe it is about support, or lack there of, about misunderstanding babies and mothers, about isolation and healthcare systems that seem to be set up for failure and not success, it is about misunderstanding what the Baby Friendly Initiative is and what it was intended to do and how it is supposed to work.
We can do better. We need to do better. Lives matter and are being lost.
"Low supply", "over supply", "overactive let down", "supply and demand", "slow gaining infant", "no weight gain" & the role of the baby in these phenomena!
The landscape of breastfeeding discussions has changed. I have been in breastfeeding conversations now, actively, for 12 years. The conversations I am having now do not resemble the conversations I have had in the past. I cringe now when I think about many of those conversations, knowing what I know now. What is that saying? When we know better, we do better…YES, yes we do.
One of the primary changes to the conversation is that we no longer can look solely at what is happening with the mother of the breastfeeding dyads, but we are looking at the baby also. I don’t mean positioning. I don’t mean skin-to-skin. I don’t mean early and often feeding. I mean, just as in how we look at a mothers ability to produce milk, we need to look at the babies ability to extract that milk. We know production of milk is primarily about supply and demand. Demand needs to be present first; this is the baby. Expulsion of the placenta stimulates the start of milk production & then the baby needs to drive it from there. If we are seeing something not working as expected, we need to assess both mother and baby. Often what appears as not working is “mom hasn't started to produce, her milk is not in yet, she just can’t produce milk or she cannot produce enough”. However, we then also say, and I am sure you have heard this, that very few women truly do not produce milk or produce lower amounts of milk. We use completely contradicting statements, loosely, but they are taken as hard, fast truths. Or we will say, “No, no, you are making enough for your baby. Of course, you are making perfect milk for your baby. Your body knows what your baby needs. Some babies are just slender. That is how breastfeed babies are. They feed all the time. They are slender. Babies on formula weigh more. Don't worry about it. Just keep feeding," Or have you heard about the mothers being told their breastmilk is made of water. They just don’t make “cream” like their friends. How confusing!
When the new growth charts came out, we expected to prove some of these theories .The new charts were based on breastfed babies, internationally, in favourable living environments. There is lots of history to read on the development of the WHO growth charts. In short, people expected to see breastfed babies being slender and slower gaining and waited to be able to say, “we, told you so”. Well, the laugh was on us. The new charts show that under favourable environments and feeding conditions, breastfed babies do weigh more than their formula fed counterparts and on the new charts breastfeeding concerns show up even sooner than previously. For example, it is common at a 4 month check up to see a baby on the old chart to not be gaining on the curve anymore. Now, with the new growth charts, that same baby would show up with less than ideal growth earlier, perhaps at 3 or 4 weeks. Growth failure was being seen as a normal negative deviation and being missed! It appeared almost as if advocates of breastfeeding were trying to downplay growth failure, because they so truly believed breastfeeding is the way to feed an infant and didn’t want to admit when it wasn’t working. I was fascinated by the charts and wanted to know why the data spread that way. (That could be my former career as a Medical Laboratory Technologist shining through).
About the same time I started looking at breast-feeding failure with my new set of lenses; the lenses that looked at mom and baby, not just a mother seemingly making too little milk, with pain or maybe without pain, with a screaming baby or maybe a sleepy baby, maybe a baby gaining weight but seemingly hungry all the time, maybe a baby with slow weight but seemingly content. I wanted to know more about all the babies & was learning more about babies. (What you seek you shall receive) I was introduced to the idea that babies cannot always function at the breast well, and therefore, the demand is not put on the mothers supply. Without demand, there is no supply! But can’t a mother just offer the breast more, get into bed for 24 hours for a breast-feeding vacation, do skin-to-skin, put baby in a wrap and walk and feed as baby needs and get that supply up? That is exactly what I was taught. Mom just needed to try harder and get supply up, drink more water, rest, take some fenugreek, drink lactation tea and eat lactation cookies. But, you know what? That wasn’t always working. Not with the cases I was seeing.
If the baby cannot function fully at the breast no amount of time at the breast is going to drive supply. At the same time, we also learnt the breast doesn’t function like we thought it did. The new science tells us we make more milk by emptying the breast more, NOT by letting it get full and empty every 4 hours. Hold on, what? But babies don’t like when the breast isn't full, they scream and protest or fall asleep. They are happy when it is full, let-downs come easy and milk leaks into their mouths. We now understand this all as a compensation for babies inability to function and realize that this routine of feeding can, in fact, cause (secondary) low milk supply down the weeks of feeding. If we address the babies issues, we can have proper feeding, proper demand and proper long term supply. We are starting to make progress with this and changing the idea of low supply.
What i am not seeing is a change is how we see the idea of oversupply or overactive let down. If the idea of low supply is often being perceived incorrectly should we not consider the idea of overactive let down or oversupply isn't a true phenomena either? Could oversupply also point back to the baby? Is this another function consideration? I certainly think so. I would like to ask that we consider the let down and supply as normal flow, but, too fast for that particular infant. The infant, for varying reasons (and an assessment would be needed to determine the reason) is having a hard time controlling the flow of the milk. They choke, cough, sputter, leak milk, etc. They might have fast feeds, gain well and seem to adapt to this "overactive let down". As time goes on, supply decreases (we respond saying milk supply is now regulated as nothing was wrong anyway) and soon, the same mom with overactive let down, is saying she has low supply. WHY? Because the baby could not feed correctly from the beginning. They had difficulty at the breast, relied on that fast letdown and now without correct feeding behaviours, just like the low supply moms I talk about above, the demand is not there and so the supply goes down.
Something else we now know, that we used to say the opposite of, is that a hungry baby will cry and a content baby cannot be hungry, Regardless of weight gain plateauing on the curve, being slow gaining, so long as baby seemed content, no one worried. What we know how is that as milk supply goes down, appetite of the baby goes down. That appetite is the demand we need! So without the demand, we again will have no supply. This is quite a different tale than has been told in history!
Let's keep chatting! If you think you need some hep navigating your breast-feeding I am happy to book a time to see you and your little one.
Yes, I am a doula and many doulas offer placenta encapsulating as an additional service. I am not one of those doulas. I am a doula that is happy to refer that job out. Why? There are so many more evidence based things I can do to help new mothers that relate to most of the reasons why they are considering placenta encapsulating. There is simply not enough evidence for me to feel that this is how I would like to spend my time instead of doing the other things I can be doing for clients.
One of the primary reasons women consider encapsulating their placentas is anecdotal information that it can aid in appropriate milk supply. As an IBCLC, of course, I think milk supply is very significant. One of the driving factors of good production is good breastfeeding, early and often. This helps lay the foundation for the days and weeks to come. Breastfeeding, in fact, is one of the reasons I became a doula. We know that better birth experiences also aid in better breastfeeding. I wanted to support as many families as i could through the whole experience, rather than coming in after the birth and trying to catch up. Being there right away at birth and returning within 18-24 hours to see how things are progressing really helps get things off to a good start. Early identification of any potential roadblocks and removing them as soon as possible can make a big improvement to how breast-feeding starts off.
There are so many reasons for milk supply being low. If as an IBCLC, we identify a supply issue and a suspect cause, knowing the mechanisms of some of the remedies available helps us know what to recommend to help resolve the issue. Ee do not yet know the mechanism of how placentas work to assist in lactation, if they even do. If we identify a supply risk, there are many more evidence based recommendations that can be made that we know with much more certainty should help the situation.
I will also state that I and other IBCLC colleagues have witnessed mothers with supply issues that resolve after they stop taking placenta capsules. Again, this speaks to us not knowing the mechanisms behind how a placenta might aid or impact lactation.
In the end, my skill set as an IBCLC is of much more value than the time I would spend processing a placenta, in my opinion.
I do also have some personal hesitations that I wish for people to consider. I am not saying that they need to decide not to encapsulate after the considerations but just that they consider the points.
When we discuss postpartum mood imbalances & disorders we need to look at a larger picture than just a placenta. We see many mothers of multiples who state they did not consume their placenta after baby #1 but did after baby #2 and felt better emotionally than the first time. However, did they review the other differences? Baby #1 we often know little to nothing about what the experience of mothering will really be like, we go at it alone, we are not very confident in what we already know and we hesitate to seek out much information. Often baby #1 was a longer labour and longer pushing stage. Going from no baby to a baby, no sleep, constant physical and emotional demands from the infant, plus ones own recovery can be overwhelming. Baby #2, labour might be drastically different, maybe this time more supported, a shorter labour, easier pushing, the lack of sleep one gets with a newborn in the house is not as much as a surprise and there is much more understanding of normal newborn behaviours. Maybe the second time she had a doula, the same lady who encapsulated the placenta for her, and also provided postpartum supports, like helping with baby care so she could nap or helped with dishes and laundry so mom can rest, put up her feet and just focus on breastfeeding. Having some healthy meals with nutritional elements similar to a placenta might be a more regular occurrence the second time.
Speaking of nutrients; sometimes it is said that mammals consume their own placentas, so why wouldn’t humans? Some theories are that mammals do it for safety; that in the wild the smell of afterbirth would draw predators near and the mother & the newly born were vulnerable and at risk, so for safety, the mother would quickly consume the placenta. There are also some theories that a mother would be hungry and in the wild food is scarce. Their own placenta vs nothing was the best they could get so it could be considered a last resort for a nutritional deficient animal. We no longer live in the wild and food scarcity is not as prevalent. In this day and age, most humans don’t look at their placenta and see their next meal or have a desire to consume it. Even in the wild, they consume it mostly in one sitting and not small amounts over days and weeks like the placenta encapsulation community recommends now. Even with diminished nutrition in food sources, we can purchase vitamins and foods enhanced with vitamins, which could provide the same effects. There is a study I am aware of that is not yet completed and it does show that the mothers consuming their placentas do have higher hemoglobins at 6 weeks postpartum. However, it has also been commented that there is a chance that the families that have the available monetary funds to pay for placenta encapsulation services, also have the monetary resources to purchases better quality and quantity of foods. The cost of the placenta encapsulations has not been covered for the study. It is a control that needs to be considered.
As a former Medical Laboratory Technologist who worked in manufacturing of blood and blood products, I also worry about an appropriate environment to encapsulate and I do have concerns about infection control. I know that might be over-reactive but as someone who had to do quality control, sterility checks and saw the process of recalls, I think safety and specifications are important. I mean, after all, the placenta might be contaminated with poop. Even a small amount of bacteria can cause a big tummy ache. I say that more tongue in cheek than anything, but it is a thought. There is equipment needed to encapsulate and I am just not 100% that the risk of cross contamination is not there. Now, I am not an encapsulator and maybe there are steps in place to account for that risk. I am unsure about that. I am just saying, for me, it is something to think about. In the lab, in food processing, in other areas where contamination is a risk, sterility checks and quality control is what keeps stuff “clean and safe” and where recalls start, if they are needed. Just because you made the organ does not mean it cannot hurt you if bacteria is at play.
After all that, we do know that placebo effect can be strong and powerful. I am happy to accept placebo effect if you are and I am happy to refer you to a local placenta encapsulator if your desire is to encapsulate your placenta.