The human reproductive system is an extremely complex and sensitive system that can function seamlessly in some couples and in other couples it can be extremely challenging. When a pregnancy is not established or obstacles have made becoming pregnant challenging, future nursing issues should be understood and considered The following section will outline some common issues that certain couples may endure and how this can impact nursing, milk supply establishment and other aspects of nursing.
In vitro fertilization (IVF) or intrauterine insemination (IUI) should be discussed as potential obstacles with nursing and milk supply establishment with an obstetrician (Ob/Gyn) or fertility team specialists. Each parent or couple presents with a unique background and reason why fertility treatments were utilized in establishing a pregnancy, which may or may not impact future nursing.
Polycystic ovarian syndrome (PCOS) can impact milk establishment and supply due to hormonal imbalances. Some mother’s with PCOS may have delayed establishment of milk, while other’s may exhibit a normal to oversupply. This syndrome needs to be considered when breastfeeding and discussed in depth with your lactation consultant or primary health care provider. This link can help explain PCOS in greater detail: https://www.breastfeeding.asn.au/bfinfo/polycystic-ovarian-syndrome-and-breastfeeding
Thyroid Disorders, most commonly lower levels or hypothyroid, can negatively impact milk establishment and supply. Thyroid hormone helps stimulate the body to signal and produce milk for the baby. If these hormone levels are below normal, milk supply may not be optimal. Proper diagnosis and treatment through medicine can help regulate these hormone levels and milk supply. Hyperthyroidism or excessive thyroid hormone levels can also effect breastfeeding and the mother’s overall health and needs to be closely monitored during pregnancy. This link will expand on thyroid imbalances and nursing: Thyroid Disorders.
HELLP Syndrome is a rare, but serious medical condition that may be discovered later in a pregnancy. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelets counts. HELLP is often associated with preeclampsia or higher blood pressure in the mother. Mother’s who are placed on medicine to help control their blood pressure can have delayed milk establishment. This may lead to a slower start to nursing for the infant and cause discomfort or pain for the mother as the infant tries to nurse with great frustration or little success.
Insufficient glandular tissue (IGT) or Mammary Hypoplasia (MH) is a condition in which the milk producing ability or capacity of the breast or breasts is compromised. The size of the breast may be smaller, normal or larger, but other key markers are used to try and make the diagnosis. Again, your lactation consultant or health care provider can help better diagnose and provide support if you are suspected of having some degree of these issues.
Some common characteristics that effect a mother with IGT are:
• Widely spaced breasts
• Asymmetric breast size
• Tubular shaped breasts
• No change of breast size during pregnancy or postpartum
Breast reduction surgery or augmentation could have potentially damaged or removed a portion of the milk producing lactocytes, duct work, nerve innervation or blood supply to these areas. Breast reduction, breast lift, certain breast implants and possibly biopsies can disrupt or harm vital nerves or ducts involved in breastfeeding. These surgeries may or may not compromise the ability to produce milk for your baby and a thorough history should be reviewed by your physician and lactation consultant to ensure all possible steps are taken to allow for successful breastfeeding to occur. A history of timing of surgery, technique used for the surgery and any post-operative complications should be noted to better understand the potential obstacles that may present for milk production and breastfeeding.
Keloid Formation history with EITHER parent. Some individuals will have a tendency to form thicker collagen or a denser scar and may form keloids. Keloids form over more involved cuts or incisions and may appear or be present after ear piercings. The reason this question is asked is because some individuals and more genetically prone to heal more densely and this may impact healing of revision site. If either parent has a history of keloid and the child forms a denser scar under the tongue is not necessarily reattachment, but may in fact be a keloid.
Pregnancy and Maternal Postpartum Challenges:
Birthing Practices
Many different birthing practices are utilized in our country and vary from completely natural birth to drug assisted to caesarian section. Some practices can impact or effect milk establishment in the first days and should be considered and understood.
The use of Pitocin to induce labor can lead to fluid retention due to its anti-diuretic effects. This retained fluid can cause edema or soft tissue swelling due to fluid retention. This fluid can be retained in the breast tissue and lead to a feeling of engorgement. The retained fluid can put pressure on the lactocytes and ducts that lead to the nipple and in effect block the flow of milk from the breast to the newborn. Breast that become engorged are typically much more difficult for an infant to latch onto and if they are able to latch, the expression of milk can be compromised due to the swelling on the ducts.
Fluid intake through an intravenous (IV) line in the time leading up to birth can result is fluid transfer to the infant. After birth the birth weight is recorded and may be artificially inflated due to excessive fluid intake through the mother’s IV line. These infant’s may drop in weight in the days following birth and may cause alarm to parent’s or pediatrician’s, but may in fact just be the loss of water weight. Close monitoring by the lactation consultant and physician will help better guide the parent and child.
Excessive loss of blood during birth from the mother can impact milk establishment, too. If this occurs, the body will utilize most of the available calories to help reproduce various blood cells that help deliver oxygen, fight infection and remove waste products from the body. Once the blood levels have started to rebound the milk supply should improve and increase, but again, close monitoring of the mother’s physician is highly recommended.
Both of these articles outline and describe effects of anemia and blood loss on milk establishment:
Henly, S., C. Anderson, M. Avery et al. Anemia and insufficient milk in first-time mothers. Birth 1995; 22(2):86-92.
Willis, C., and V. Livingstone. Infant insufficient milk syndrome associated with maternal postpartum hemorrhage. J Hum Lact 1995; 11(2):123- 26.