Holistic Babies London
When science meets holistic therapies
19. Jan, 2021
Low Milk Supply & babies who struggle to gain weight Part 2
Anatomical Issues:
Baby is small: small/ premature babies lack cheek padding; therefore, it is harder for them to maintain the latch, suck for long enough, not fall asleep feeding.
Try:
The koala hold is beneficial with small babies- also great with twins:
Applying pressure on the cheeks with your fingers: attach the baby at the breast/ bottle, as the baby starts sucking, with your thumb and index, gently squeeze the cheeks to help the baby suck and draw up milk.
Torticollis: with the medicalisation of birth, more and more babies suffer from torticollis.
A way to assess if it is torticollis:
- the baby is always (or very often) looking/ sleeping with the head turn in one direction.
- the baby "prefers" one breast versus the other and one nipple may be damaged while the other is perfectly fine.
A sore neck means there is a shortening of the neck muscles; this makes it painful for the baby to extend her neck, leading to a "preferred" breast.
The tension exerted on the neck leads to a shortening/ compression of the hypoglossal nerve, leading to a restriction in tongue movement, which can be misdiagnosed with tongue-tie.
How can you help your baby with a sore neck:
Start with the cradle position on the breast the baby "likes", then once that breast is empty, glide the baby across to the other breast. This way, the neck will be protected until the muscle eventually stretch and the nipple heals.
- Cranio-osteopathy shows very beneficial and results with an improved latch can be usually seen after about 3 days post-treatment.
- Tummy time: the baby must stretch her neck, which will help release the muscles.
- Bath: warm water helps with tight muscles
- Baby massage: can be combined with tummy time, gently rub the neck and shoulders of the baby.
- Cheek brushing: this will force the baby to turn her head to the side. She doesn't usually use and stretch the neck muscle gently.
Tongue-tie:
This is a tricky topic as tongue-tie is often under or misdiagnosed, and there is a general lack of skills in identifying tongue-ties.
- Not all tongue-ties lead to poor feeding, some babies with tongue-tie feed perfectly fine.
- While some tongue-ties are apparent, they are not diagnosed by looking in the baby's mouth! It takes an oral examination by someone who was trained accordingly to assess for tongue-tie.
- High palate is often associated with a tongue-tie, however, if your baby was born via ventouse or forceps, the traction applied to the head, and the elongation of the soft bones can also lead to a high palate.
- Your baby may stick her tongue out yet have a tongue-tie.
- The tongue is white (and it is not thrush) and remains white even hours post feeds. Because of the tongue's restrictive lift and the high palate (a result of the tongue not lifting high enough in utero to shape the palate), the milk coating is not scrapped from the tongue.
If your baby is:
1) struggling to feed
2)is very gassy/ reflux
3) you have sore nipples
4) there is a thick white coating on the tongue
5) Your baby's tongue has a lily pad shape or even a small dip at the end of the tongue.
It could be a tongue-tie.
In doubt, seek a referral from your midwife or breastfeeding professional to see someone in the NHS or privately.
Katherine Fisher is wonderful and very skilled with tongue-tie and frenotomy.
She has a lot of useful information about tongue-tie on her website.
Unless the professional you meet is a tongue-tie practitioner (and has trained and is qualified to perform tongue-tie division of frenotomy), they are not allowed to diagnosed tongue-tie (this include your GP, paediatrician, midwife, health visitor and even your IBCLC). They can only suspect a tongue-tie and refer you accordingly.
Breast anatomy:
Very few women are unable to breastfeed for anatomical reasons. Those reasons can be:
- Mastectomy (however some women feed with only one breast!)
- A double mastectomy.
- Breast reduction surgery (however partial breastfeeding might be possible).
- Some breast augmentation surgery(depending on how/ where the breasts implants were inserted, breastfeeding might still be possible).
- Hypoplasia (insufficient glandular tissue).
Hypoplasia Insufficient glandular tissue):
The anatomy of the breasts in the case of hypoplasia is very typical. The breasts have a wide gap between them, they are tubular, asymmetrical and the nipples quite large: Hypoplasia | La Leche League International (llli.org)
Inverted nipples:
Not all cases of nipple inversion are real inversion.
Test: if the nipple erects, even in the slightest, to the touch/ reacts to cold, this is not an actual case of inverted nipple, just flat nipples that will improve over time.
Tips:
- Roll the nipple between thumb and index before the feed
- Use an ice cube to bring out the nipple or stand without a top on in front of your open fridge/ freezer (do not do this however if you suffer from Raynaud syndrome)
- Use a pump and pump for a few minutes many times a day (or in pregnancy).
- Nipple nudge.
True inverted nipple:
- The connective tissue does not allow for the nipple to erect.
- This is the only case when I use nipple shields.
Hormones and exercise:
In the case of women who had no supply issues but suddenly noticed a reduction in supply, the following should be explored:
- Hormones: contraceptive pill (including the "breastfeeding friendly" progesterone) can reduce supply.
From Kelly Mom Website (evidence-based lactation information):
Progestin-only contraceptives come in several different forms:
· progestin-only pill (POP), also called the "mini-pill."
· birth control injection (Depo-Provera)
· progesterone-releasing IUD (Mirena, Skyla)
· birth control implant (Implanon, Nexplanon)
Most mothers, progestin-only forms of contraception do not cause problems with milk supply if started after the 6th-8th week postpartum and if given at normal doses. However, there are many reports (most anecdotal but nevertheless worth paying attention to) that some women do experience supply problems with these pills, so if you choose this method, you still need to proceed with some caution.
If you're interested in one of the longer-lasting progestin-only forms of birth control (the Depo-Provera injection lasts at least 12 weeks, but effects may be seen up to a year; the progesterone-releasing IUDs and implant last 3-5 years), it is recommended that you do a trial of progestin-only pills (mini-pill) for a month or more before deciding on the longer-term form of birth control. If you find that you are among the women whose supply drops significantly due to progestin-only birth control, you can simply discontinue the pills – rather than struggling with low milk supply for several months until the injection wears off or you get the implant or IUD removed.
Do note that the progesterone-releasing IUD delivers its hormone directly to the lining of the uterus, which only leads to a slight increase in progesterone levels in the bloodstream (much lower than that found with the progesterone-only pill). As a result, there is much less chance of side effects from the progesterone than from the injection or mini pill.
- Return of period/ ovulation: many women note a drop-in supply with their period returning, usually once solid food has been introduced (or if formula is introduced compromising lactation amenorrhea).
Milk composition: At higher doses than normal, this type of pill can affect the content of breastmilk. At these higher doses it has been shown to decrease the protein/nitrogen and lactose content of the milk. At regular doses, this does not seem to be as likely."
Tips:
- skin to skin even with older babies,
- bathing/ sleeping topless together.
- Calcium- magnesium supplement (together not separately): 500mg Calcium + 250mg Magnesium however a higher dosage of 1500 mg of Calcium and 700 mg of Magnesium work better, (always check with your doctor or pharmacist if this is suitable for you).
Exercise:
- Moderate exercise does not impact on lactation; however, upper body weightlifting and arm workout have been linked with an increase in block milk ducts.
Galactagogues to boost supply:
I do not easily recommend galactagogues as many come with side effects that are not negligible. Most supply issues will be resolved with working on attachment and positioning and lots of skin to skin.
However, if all has been implemented and you continue to struggle with supply, galactagogues can be recommended.
Please be aware that even herbal galactagogues' come with contraindications and side effects, which must be assessed before recommending.
For more evidence-based info on galactagogues:
In some cases, I suggest that you see the GP and discuss prescribing Domperidone (Motilium) if you do not have a medical history of cardiac issues.
Paediatrician and breastfeeding Guru, Dr Jack Newman prescribes a much higher dosage for a more extended period.
In the case of prematurity/ twins, Domperidone can be useful.
It has to be a case by case assessment with a letter from a breastfeeding specialist or IBCLC explaining the current actions taken and the reason why Domperidone might be the right treatment.
Most UK GPs are reluctant to prescribe and will not prescribe for a more extended period than 2 weeks. In these 2 weeks, you should be well supported with attachment and positioning and express your milk to maximise supply.
Mental Healh:
A baby whose weight is a concern puts a great deal of worry and anxiety upon mothers (and partner) and can have a lasting effect on the feeding.
I often meet mothers whose baby has struggled in the early days but is now completely fine and thriving, continuing to wake up their baby and push feeds beyond what the baby wants.
Issues with breastfeeding can disempower a mother and increase her risks of postnatal depression (while a good breastfeeding experience diminishes the chances of postnatal depression).
If you feel anxious, down, tearful, have low mood, struggle to bond with your baby, or, overall, feel overwhelmed, please speak to your GP, midwife, health visitor, or breastfeeding professional.