... yet some, like myself, don't?
I've written before about how when I started doing birth work 2 decades ago I rarely saw posterior babies and then about 1997 or so, there was an explosion of babies being born by cesarean because they were persistantly posterior. Those numbers have only increased. It took awhile to figure out what the deal was and many of us attribute it to two things: recliners and SUVs. Positions that put the mom leaning backwards encourages the baby into the posterior position. When we actively help women to remain leaning forward (hips lower than the pelvis, for example), we see far, far fewer posterior babies, long, drawn out labors, and cesareans.
Similar changes have happened with breastfeeding.
Over all these years, I have watched as more and more women are unable to nurse their babies because of inadequate milk supplies. What is going on? One theory being watched and studied is that our ever-more-fat culture is contributing to lactogenesis II (failure to get breastfeeding established due to low or non-existent milk supply). I am at a breastfeeding conference and keep hearing more and more about PCOS, diabetes (I and II), insulin resistance and obesity being attributed to lactogenesis. I first heard about this at this same conference 2 years ago and knew I was on the right track believing there was a connection, but hadn't heard anyone else talking about it until then. Once I had that validation and studies started coming out, the connection seemed obvious.
I have very little actual experience with this, but have been asking CNMs and midwives around the country about their take on all of this. I want to know what they are doing - what meds are working - how to better help a woman who very well might be on the failure side of the equation. (The stats I have seen [I'll put the citations up when I find them at home] are it is about 50/50 success/failure rate for seriously obese moms and women who have been diagnosed with PCOS.)
It seems that Metformin (Glucophage) is the medication of choice. Clomid used to be a first line of defense for infertile women until they realized that PCOS and obesity would be dramatically helped by Metformin. Now, most women beginning infertility work-ups, if anywhere near overweight, are put on Metformin as a regulating and initial step towards conceiving. So, instead of prescribing Reglan and Domperidone as first lines of defense, perhaps Metformin should be on the prescription pad.
I have heard great things about Metformin and milk supply increases. It takes time, sometimes a couple of months, but it usually helps if there are no other organic issues going on.
I have a client right now (she reads and knows I am writing about her), quite obese with her second bout of Lactogenesis. The first time, even with help from the LC, milk production was minimal and mom supplemented using an SNS. This time, armed with reams of information, she ordered Domperidone from out of the country, got the pump primed, had the LC at the ready, hired me as a monitrice and had a beautiful birth where no separation from the mother or baby occurred.
Separate from these issues was postpartum pre-eclampsia (a whole post on its own) and re-hospitalization for a couple of days on magnesium sulphate and one dose of an anti-seizure medication - this happening after both pregnancies (far, far worse after the first child).
So, did the PP Pre-eclampsia cause the Lactogenesis? Or the obesity (and probable PCOS)?
Most research would say the PP Pre-eclampsia didn't help, but the obesity seems to be the actual culprit.
So, after running through the new well-thought out plan she had, she still remains milk deficient. She talked her doctor into prescribing Metformin and initially began 500 mg in the morning and 500 mg at night. Mom emailed me after a week on the meds and was very frustrated and disappointed that it hadn't worked... she was nearly resigned to the fact that she would have to use the SNS as she had with her first. I explained that 1000 mg is a loading dose and that 1500 - 2000 mg seems to be a much better level to have success at. Mind you, I am NOT a doctor, nor can I prescribe meds. These are just my anecdotal and personal experiences I am speaking of. She made the decision to increase her dosage to 1500 mg per day and I also explained that it can take a couple of months - not weeks - to see a change in the milk supply.
Metformin is notorious for causing intestinal disturbances such as diarrhea and gas along with stomach aches. I nearly quit taking it because of the stomach ache I lived with for several months. Once I got past that phase, I began to see a difference in my own blood glucoses and have heard women say similar stories about their own glucoses. Midwives I have spoken with say the threshhold of diarrhea to normal stool seems to be when milk supply increases - if it is going to increase at all. Letting women know there is a period of adjustment for this medication is crucial for compliance and appropriate expectations.
So, in the face of growing research about obesity/fat and lactation failure, could this be one way to get women to comply with proper diets and taking their Metformin? That if they don't, they have a 50/50 chance of an unsuccessful breastfeeding attempt (and the misery that goes along with that)? I don't know if it would have been incentive enough for me to get to a "normal" weight before having kids or to try and diet/change my eating habits postpartum; I am too much of a food addict, lazy, and had zero time to do much of anything but be a mommy all those years ago. I was also in the lucky half that successfully breastfed (several kids, sometimes all at the same time!), so it's hard for to know what my response would have been if I hadn't have been able to nurse that first time.
Would I have cared enough to try? Would I have had enough motivation to explore options as my client has? Would I have used an SNS for a year as my client did and is doing? Would I nurse my child even if no milk were coming out - as my client has done with her first child?
Knowing myself, I don't think so. I don't like saying that, either. I admire my client so much for all she does for her children. Much of the time at her own health's expense. I try to be encouraging and loving and let her know what a phenomenal job she is doing despite the plethora of obstacles she has had thrown in her face (and at her breasts!). I admire her tenacity. I know I wouldn't have had an iota of what she has inside that heart and mind of hers.
I'll let you know how the Metformin works in a couple of months.
Some sites regarding these issues:
Obesity and Lactogenesis II
A slew of articles found here on Pub Med
Diminished prolactin and milk production failure
A great article about Metformin to increase milk production - Lisa Marasco is quoted throughout; she is the woman I heard speak 2 years ago about this very issue - naming the hunch I'd already had (along with many others, apparently!)