We’ve talked about how PCOS and insulin resistance can affect lactation and milk production before but let’s explore this a bit more.
There is a disproportionate incidence of diabetes among ethnic groups.
Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%).
This, of course, is not the only disparity found in lactation among different ethnic groups.
However, insulin resistance plays an important role in the physiological barriers to successful feeding as well as the perception or expectation of failure.
PCOS is a syndrome and the combination of symptoms is unique in each case, making identification more challenging. Many people never receive a formal diagnosis.
Symptoms can include:
•Raised levels of insulin (that can lead to excessive weight gain)
•Raised levels of androgens hormones (that can lead to acne and growth of unwanted hair)
•Irregular menses, ovarian cysts
•Increased risk of developing diabetes
•Underdevelopment of breast glandular tissue – not size
Medical conditions related to insulin resistance create additional challenges to lactation. Insulin resistance may delay Lactogenesis II – which is the milk transition from colostrum to mature milk and copious volume increase – this may be delayed by up to a week.
Some people with IR may never make enough milk to meet all the needs of their infant because of the role insulin plays in milk production and glandular growth during pregnancy, however, we do not know in advance that a person with diabetes will have insufficient supply.
Our focus should be on best practices to support these parents in the optimal outcomes for milk production and healthy infant feeding. We can do this by supporting nutrition which does not focus on weight alone, through offering medication therapy if indicated during pregnancy, by increasing access to lactation care both in-patient and after discharge, and increasing access to human donor milk for supplementation.
As providers we can also learn more about non-medication supports for managing milk supply which can include:
• Frequent milk removal using hands-on techniques
• Learning about which herbs to use or avoid
• Avoiding pacifiers and bottles, instead focusing on skin-to-skin and using at breast supplement tools
• The use of donor milk until milk production is established
• Frequent visits with an IBCLC in the first week after delivery
• Supporting in-home care
• Using Peer Support programs to encourage parents and monitor the need for medical intervention
With support, education, and provider support parents with PCOS can chestfeed successfully!
Manual therapies like chiropractic, osteopathic manipulation (these first 2 are most likely to be covered by your insurance), cranial sacral therapy (focuses on the head/neck/shoulders only), physiotherapy, and many more!
The practitioner and their skill set is an important factor in deciding which type to go with along with the areas your baby needs treated, your IBCLC or pediatrician should help you determine which will be right for your baby.
2. Oral motor exercises
These gentle exercises are meant to address compensations and work toward function. They are done in the mouth and on the face and may include other body movements. Unlike bodywork, these exercises are done daily by the parents as directed by your IBCLC. Some providers call this Suck Training.
3. Managing the feeding plan
This is evaluated and organized by your IBCLC. The feeding plan balances the need of the infant and parent and works toward feeding goals.
Your IBCLC will manage your feeding plan according to your goals and to get the bet outcomes for you. This can include counseling on pumping, feeding positions and techniques, supporting milk supply, and referring to other providers.
*these first 3 components are part of your pre and post release plan*
4. An effective release
Scissors or laser …it doesn’t matter as long as your provider is skilled and performs a full release to allow the tongue and/or other tissue to move normally. The release allows for movement while bodywork, oral motor training, and feeding plan management work together to get to normal function.
5. Wound care
Sometimes called stretches or exercises these are targeted on the site which was released (the diamond shape under the tongue). Wound care is necessary for posterior releases to prevent reattachment and aid in the tissue healing correctly.
Sometimes your provider will suggest oral motor exercises along with the wound care. Your IBCLC will suggest additional, customized oral motor training in addition to these.
Without all 5 components your baby may not achieve full functionality. Your IBCLC should be able to guide you through this process and make referrals to skilled providers as needed.
What to Expect After a Tongue Tie Release (Frenotomy)
- When appropriate anesthetic is used, the procedure is generally not painful but it is irritating to be swaddled and have the mouth held open for the procedure. Your baby may be a little fussy after but can be soothed with skin-to-skin and a feeding.
- Baby may initially feed very well but about 5-6 hours later they may be quite fussy and difficult to console. When adults get the procedure done, they report that they experience muscle fatigue which is quite uncomfortable. Try not to use a pacifier and instead to offer skin-to-skin and other forms of soothing. Smaller, closer spaced feeds may work better temporarily.
- Work with baby’s skills and abilities. We aren’t trying to challenge their feeding during healing. Latch and hold your baby the way that works best for them.
- Feeding starts to improve over time as the tongue strengthens and other muscles which have been compensating start to relax.
The suck training exercises (oral motor work) recommended are very important in this process of “teaching” your baby how to use their newly released tongue and to address areas of tightness and weakness.
- After about 4-5 days the wound will start to contract and feel tight again. Many parents worry that this is reattachment. Continuing your gentle wound care is important to keep these tissues soft.
- Stretches should be done quickly and gently. I don’t recommend doing them before feeds to avoid associations with feeding. If you practice the stretches on yourself and your baby before the procedure it will increase your confidence and skill.
- Effective and comfortable feeding requires a lot more than just a tongue which can fully move and function. It also requires that baby isn’t experiencing pain or discomfort anywhere else. Bodywork helps baby find full function through gentle manipulations. This can include pediatric chiropractic, osteopathic manipulation, cranial sacral therapy, or other types of bodywork. Ask your provider or IBCLC for referrals to providers who are experienced working with infants.
- At home, you can support your baby with movement, massage, and at-home care like Tummy Time.
- A visit with your IBCLC about 2-5 days after the procedure is important to check on the wound healing and to adjust your suck training and bodywork instructions.
August 15-21 is Asian American Native Hawaiian and Pacific Islander Breastfeeding Week! This year’s theme is Telling Our Own Stories. Elevating Our Voices. Organized by the Asian & Pacific Islander Breastfeeding Task Force, the week is a great time to listen and learn from AANHPI families, community members, and lactation support providers; and celebrate and share resources.
August 16, at 1 p.m. E.T. join 1,000 Days and the National WIC Association for the next live panel discussion. This week’s topic is AANHPI Breastfeeding, moderated by Darlena Birch, with presenters Wendy Fung and Pauline Sakamoto.
The second week of August marks the acknowledgement and celebration of indigenous parents and their chestfeeding experience!
This article from LLLI explains why we call out this group of people specifically.
This year’s theme is Strengthening Our Traditions from Birth and Beyond. Organized by the Indigenous Milk Medicine Collective.
Wow! It was so amazing to see you all and celebrate the special relationship we share with our babies and community!
Choline is an essential nutrient during pregnancy and lactation but only 15% of us are getting the recommended daily amount.
So what is it and why do we need it?
Choline is one of the many B Vitamins we need. B4, to be exact.
Choline is a key nutrient for fetal brain development and protection. Choline supports brain development, memory, and learning —and protects us from infections. When we think about brain development during fetal growth we often think about folate (which is also very important!) but choline plays an important role in neural tube development.
During pregnancy choline protects us from serious complications.
Choline is required for maintaining normal levels of homocysteine:
Elevated homocysteine levels during pregnancy have been associated with complications like: preeclampsia, miscarriage, placental abruption, intrauterine growth restrictions (IUGR) , venous thrombosis, and cardiovascular related complications.
Adequate choline during pregnancy can also protect us from cholestasis which is a common complicating during pregnancy and postpartum.
Choline can also be used to reduce risks and prevent mastitis. It is one of the components of lecithin.
Choline RDA During pregnancy 450 mg/day During lactation 550 mg/day
Choline is a naturally occurring amino acid found in egg yolks, liver, animal meat, beans, milk, some vegetables, as well as in human breast milk.
Amount of Choline Per Serving of Food:
- Beef Liver (3 oz): 356 mg
- Egg, hard boiled: 147 mg
- Beef top round (3 oz) : 117 mg
- Soybeans, roasted (½ cup): 107 mg
- Chicken breasts (3 oz) 72 mg
- Beef, ground (3 oz): 72 mg
- Fish, cod and salmon (3 oz): 71 mg
- Broccoli (1 cup): 63 mg
- Green Peas (1 cup): 47.5 mg
- Navy Beans (½ cup): 41 mg
- Milk (8 oz): 40 mg
If you are considering supplementing your diet with choline look for products containing phosphatidylcholine.
“The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first six months. We support continued breastfeeding after solid foods are introduced as long as you and your baby desire, for 2 years or beyond.”
The new recommendations bring the AAP in line with the World Health Organization, UNICEF, The American Academy of Family Physicians, and so many more health organizations!
This article from Healthy Children explains the recommendations and highlights the need for skilled lactation support. It also addresses the structural barriers to meeting these feeding goals.
You can read the official statement titled “Breastfeeding and the Use of Human Milk” here.