We all have heard that breastmilk is the ideal food for an infant. Some even reference breast milk as the "perfect food." Human milk provides a baby with all the nutrients it needs to function and thrive, while the act of breastfeeding provides an abundance of physical, mental, and emotional needs for both mother and child. While this sounds great, the CDC reported that only 1 in 4 infants are exclusively breastfed for the recommended six months. In addition, these lower breastfeeding rates add $3 billion a year in medical costs for mothers and children. In a perfect world, all mothers would breastfeed. But unfortunately, there are many circumstances and situations that prevent successful breastfeeding outcomes. Learning the benefits and understanding some of the causes of discontinued breastfeeding can shed light on the topic and help you in this stage of life.
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Who Should Breastfeed?
Professional medical organizations like The American Academy of Pediatrics recommend exclusive breastfeeding for the first six months of life. As long as the mother and infant are mutually able to breastfeed, it is the standard of care recommendation for optimal nutrition. There are special circumstances in which breastfeeding may not be mutually beneficial, some of which include medications or drugs that the mother may be taking, specific health conditions (example: HIV positive), or chronic illnesses (example: tuberculosis).
Health Benefits of Breastfeeding
Breast milk is the ideal food for infants. Nutritionally it contains fat, proteins, and vitamins in a ratio that perfectly suits a baby's needs for growth and development. Analysis of human milk has revealed that there are adequate amounts of macro- and micronutrients to nourish an infant, and for the most part, these nutrients are resilient even in times when the mother's nutrition is not optimal. A mother's nutrition may not always impact nutritional content, but an undernourished mother may have issues with keeping up with milk supply as the baby grows.
Infant Benefits
An infant's development is supported by breast milk from the initial introduction. Antibodies in human milk help ward off foreign pathogens and support the baby's digestive system as it is an easily digestible source of nutrition. Some key benefits of breastfeeding for your infant include a decreased chance of developing allergies and asthma, fewer ear infections, less diarrhea, reduced respiratory illnesses, fewer trips for medical care, reduced risk for SIDS, and enhanced immune system development. Later in life, breastfeeding has been linked to higher IQ scores, healthy adult weight, and reduced risk of developing Type 2 Diabetes and certain cancers.
Maternal Benefits
Breastfeeding is a great way to bond with your newborn. There are physiological benefits as it inherently promotes more skin-to-skin contact, which has been shown to reduce post-partum depression symptoms in the mother. During breastfeeding, the hormone oxytocin is released, which helps reduce post-partum bleeding from delivery and shrinks the uterus back to its initial size. From a lifestyle standpoint, breastfeeding saves mothers' time and the financial aspect of investing in bottles, formula, and sterilization of parts. In a study looking at body-related changes resulting from breastfeeding, half of the women reported that the act had a positive result on their bodies. This included a return to their pre-pregnancy physique, physical benefits, how they ate, psychological benefits, and overall health benefits. Long-term benefits include a reduced risk of developing osteoporosis, lower rates of high blood pressure, decreased Type 2 Diabetes, and lowered cancer rates (breast, cervical, and ovarian).
Can You Get Pregnant While Breastfeeding?
The short answer is yes. It all depends on where you are in your breastfeeding journey and if your menses has returned. Evidence suggests that the Lactational Amenorrhea Method (LAM), which is a natural way to prevent pregnancy, is 98% effective in you are exclusively breastfeeding, are within the first six months of breastfeeding, and have not yet had a period. In order for LAM to be highly effective, you need to exclusively breastfeed with no more than 4 hours between nursing sessions during the day and no more than 6 hours between sessions at night.
Most women become pregnant while breastfeeding when the child starts depending on solid foods more and is nursing less. This age varies depending on when you introduce solid food and how often you are nursing them. If you conceive while breastfeeding, just know that it is safe to continue as long as there are no pregnancy complications.
Can You Drink Alcohol When Breastfeeding?
Nutritious consumption is important for maintaining milk production. Drinking excessively will not only deplete your nutrients but is harmful to a nursing baby. On the other hand, if a mother wants to enjoy an occasional drink, she can plan it out accordingly so the alcohol is not transferred through the milk to the baby. On average, it takes your body about two hours to metabolize one alcoholic beverage. Once it's metabolized, it will be out of breast milk and not harmful to your child. If two hours is the rule of thumb for one drink, then extrapolate that for two drinks which would be about 4 hours of time needed from drinking to breastfeeding.
When to Stop Breastfeeding
Women are advised to exclusively breastfeed for the first 6 months post-partum. This is the most vital time for the baby to get nutrition, acquire antibodies, bond with their mother, and support their gut and immune system. The American Academy of Pediatrics' position statement declares that breastfeeding can continue until two years old and beyond as long as its mutually beneficial for mother and baby.
Causes of Low Milk Supply in Women
Each breastfeeding journey is unique and individualized. While the majority of infants start out breastfeeding in the United States, many do not continue with exclusive breastfeeding past six months due to a myriad of reasons. Many issues can arise that can impact your milk supply. Here are some of the main causes.
Infrequent sessions will signal milk production to decrease. This is a supply and demand process. The more you breastfeed or pump, the more milk will be produced with each session. Rigidly scheduled feedings can also impact production. Feeding on demand allows for regular emptying of the breasts, which can aid in maintaining the milk supply.
Women tend to experience more stress than men, especially during the season of motherhood. Stressing over nourishing your child can negatively impact your milk supply due to stress hormones decreasing oxytocin release which is needed for milk letdown.
Making sure you are consuming enough calories and water for what is necessary to maintain your milk supply is essential. Dehydration is a primary contributor to a drop in milk supply. It's important to remember that electrolyte loss is a part of dehydration. While there is no scientific evidence that electrolyte depletion impacts breast milk supply, understanding the necessity of electrolytes for bodily functions can help solve potential causations.
Endocrine disorders and pre-existing hormone dysfunction conditions can impact your milk supply. Thyroid disorders can negatively impact the hormones prolactin and oxytocin, which both play a role in milk production and secretion. If you have a thyroid condition such as hypothyroidism, monitoring your thyroid function and getting proactive support for breastfeeding is beneficial. PCOS is a hormone imbalance condition that can impact milk production. The thought is that this is linked to estrogen or testosterone dominance, which can throw off prolactin and oxytocin, thus decreasing milk production. Insulin resistance is another component that many women with PCOS have. This can lead to weight gain, which is also known to negatively impact a mother's milk supply.
Sometimes there are anatomical and functional reasons for these issues. This can include flat nipples, infant tongue ties, poor latch or suck reflexes, and changes in feeding patterns. All of these concerns could potentially be rectified by consulting with a lactation consultant.
Lastly, medications can negatively contribute to making and sustaining the milk supply. Hormonal birth control and decongestants containing pseudoephedrine are two categories known to affect milk production.
Functional Medicine Labs to Get to Root Cause of Decreased Milk Production
Functional medicine labs can help you and your practitioner determine the underlying causes for decreased milk production. Below are some of the most helpful labs for this.
Sex Hormones Plus Cortisol
Cortisol is an objective measure of physiological stress. Due to the nature of pregnancy, postpartum, and breastfeeding, some stress is expected. It’s when stress begins to impact your health and activities of daily living that it should be assessed as a contributor to low milk production. A study of 146 exclusively breastfeeding mothers found that there is a negative correlation between excessive stress and breast milk nutrient compositions. This study suggests that, as a society, we should monitor mothers' stress levels for psychological reasons and to support their breastfeeding journey and their infant's nutritional needs.
Thyroid Panel
Endocrine disorders involving thyroid function can impact milk supply. Monitoring this by testing key thyroid makers can determine if this is the cause of low production. A complete thyroid panel is an ideal way to get a full picture. If you have a history of Hashimoto's Disease or Postpartum Thyroiditis is suspected, evaluating thyroid antibodies like Anti-TPO is important.
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Conventional Treatment for Low Milk Supply
If you're working with your gynecologist, pediatrician, or midwife, measures should be in place to support successful breastfeeding and milk supply. Typically the first line of support is a referral to a lactation consultant. They are trained healthcare professionals who can provide guidance, support, and education regarding breastfeeding techniques. Working with a lactation consultant has been shown to greatly improve initiation and rates of breastfeeding.
When avenues of naturally increasing milk supply have been exhausted with no success, there are options for pharmaceutical intervention. Metoclopramide and domperidone are two drugs used off-label to increase milk supply. These are dopamine antagonist drugs, which means they block dopamine D2 receptors. Targets for blockage are the anterior pituitary gland, where prolactin is released from. Normally, dopamine would inhibit prolactin release, but with metoclopramide or domperidone, dopamine would not interfere at the anterior pituitary, and therefore prolactin secretion will increase. Determining if this is an option for you should include the risks, benefits, and alternatives to care. It’s advisable that you consult with your primary care doctor before considering these drugs.
Functional Medicine Treatment for Increased Breastmilk Production Naturally
Functional medicine can help mothers increase breast milk production naturally. Below are some of the most beneficial treatments.
Foods to Increase Milk Supply
Eating a well-balanced diet with extra calories is essential for milk production. Women that are breastfeeding should include good sources of protein, dairy, beans, a variety of fruits and vegetables, and legumes in their diet in order to get a variety of necessary vitamins and minerals. Foods that will specifically increase milk supply include sesame seed, alfalfa, oatmeal, leafy green vegetables, garlic, and onions.
Supplements to Increase Breast Milk Production
In addition to a healthy diet, supplements can help increase breast milk production.
Herbal Galactagogues for Milk Production
Galactagogues are substances that stimulate milk production. Some herbal extracts have these properties and can aid in increasing milk supply. Some commonly utilized herbals are Fenugreek, Blessed Thistle, Alfalfa, and Goat's Rue. Fenugreek is one of the most widely used herbal remedies to improve milk production. A meta-analysis of five studies looking at the effectiveness of Fenugreek as a galactagogue revealed that it significantly increased milk production in comparison to a placebo. The recommended dose is 3.5-6 grams per day unless you consult a lactation specialist or herbalist who can provide an individualized recommendation.
Possibly Beneficial Natural Supplements
There is limited scientific evidence on supplements and their ability to increase milk supply. With that being said, historically brewer's yeast (Saccharomyces cerevisiae) has been used to support a mother's milk supply. Fennel is another plant that is traditionally used as a galactagogue.
Hydration with Electrolyte
Staying hydrated while breastfeeding is key to the successful supply and energy needed. Breast milk requires around 25 oz of water a day. In order to maintain this and your own personal needs, on average, you should be consuming 128 ounces of water per day, with a goal of drinking a glass of water each time your baby is nursing. Adjusting to motherhood and breastfeeding can be challenging, and sometimes you may forget to do simple things like staying hydrated. Dehydration can also throw off your electrolyte balance. To optimally support your hydration, it would be beneficial to include an electrolyte replacement or add natural electrolytes like pure coconut water or Himalayan sea salt to your water.
Complementary and Alternative Medicine To Aid in Breastfeeding
Certain complementary and alternative medicine (CAM) treatments can successfully aid breastfeeding. Below are some of the most evidence-based CAM treatments.
Lactation Consultant
Working with a healthcare professional trained to support you in your breastfeeding journey is highly recommended. Finding a certified lactation consultant through your primary healthcare provider or by searching in the International Lactation Consultant Association (ILCA) would be a good starting place.
Chiropractic
Many chiropractic offices focus on mother and baby care. For mothers, chiropractors are trained to assess your neck, back, and shoulders, all of which may need support during this huge transition into a daily activity it’s not used to. Working with a skilled chiropractor can optimize your breastfeeding journey, from encouraging proper nursing posture to providing nervous system support and spinal manipulation.
Relaxation Techniques
Breastfeeding can be stressful and challenging. As you and your baby are getting to know each other, you may also be battling exhaustion and trying to keep up your milk supply. All of this can cause tension and frustration. Incorporating some relaxation techniques, such as yoga or meditation, can help induce a feeling of calmness and be a tool to assist you in managing the stress that may be associated with breastfeeding. If you are able to step away and take some time for yourself, a postpartum massage can be very beneficial.
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Summary
The benefits of breastfeeding are undeniable. With that being said, understanding the ins and outs of breastfeeding and the challenges that many mothers endure is necessary. Education, access to support, and an integrative medicine approach to breastfeeding could help increase breastfeeding success rates. Most importantly, mothers need community and to feel supported in this process regardless of the outcome.
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