Tuesday, July 26, 2016

Deciphering the Lactation Curve


What can a lactation consultant learn from the diary industry?

According to Lisa Marasco, MA, IBCLC, FILCA, the diary industry can provide a different prospect of milk production and help healthcare professionals decipher the lactation curve.

The concept of a lactation curve is well known in the dairy industry, but not in the human lactation world. When we look at milk production in the paradigm of this curve, we begin to understand the underlying drivers of milk production and why some women’s production seems more resilient than others.

At a recent SDCBC general meeting, Marasco explored the factors involved in the curve, the concept of persistency, and the importance of what happens in the beginning to long-term calibration. 

Marasco made an analogy between the lactation trajectory and the rocket forces: the trajectory is a path followed by a projectile flying or an object moving under the action of a given force. And our goal is long term maintenance of sufficient milk production.

Marasco introduced her famous milk supply equation inspired by the dairy industry to explain the key factors which make an ideal “trajectory” and allow moms to make enough milk:
Sufficient lactation tissue
+ Intact nerve pathways and ducts
+Adequate hormones and hormone receptors
+Adequately frequent, effective milk removal and simulation
=Good milk production

Marasco further explained what each piece of the equation means, so that her fellow lactation consultants can use it to solve milk supply mystery for the moms they work with.

Sufficient lactation tissue: This is the question whether the mother has “the right size of the rocket to do the job,” said Marasco. Some women have less glandular tissue than others, and as a result produce less milk. However this is not a question of breast size, but of the amount of milk making structures inside the breast.

Intact nerve pathways and ducts: If the mom had a breast injury or a breast surgery, she may have sustained damage to her milk ducts and/or nerves. Both are key to milk production.

Adequate hormones and hormones receptors: An often overlooked source of milk supply problems, adequate hormones are another part of the milk supply equation. Conditions such as PCOS, anemia, thyroid problems and postpartum hemorrhage can affect mom’s hormone levels and may cause problems with milk supply.

Adequately frequent, effective milk removal and stimulation: This part of the equation is at the heart of many breastfeeding problems.

  • Adequately frequent: Frequently empty of mom’s breasts signals her body to maintain a good level of milk production. In dairy industry is regular pump. In human lactation world it’s effective baby suck. "Mom may owns the equipment, but babies drive the supply!" said Marasco. What does adequately frequent mean? Generally it means 8 to 12 feedings in 24 hours, but some babies who don’t remove much milk at feedings require even more feedings. Pacifiers can mask feeding cues, so consistent use of them can reduce feeding frequency and lower milk supply. 
  • Effective milk removal: Removing a significant amount of milk at each feeding also signals mom’s body to maintain good milk production. But a baby who has a poor latch, is sleepy, s refusing the breast, has an anatomical barrier (such as tongue tie or eldest palate) to effective milk removal, or is otherwise unable to remove enough milk, will make it difficult to establish and maintain and adequate milk supply. Milk removal also occurs with a breast pump, so pumping problems can also results in lower milk supply. 

Fortunately, there are steps lactation consultants can take to remedy many of the causes of low milk supply. For measures to take to increase milk supply, Marasco recommend the Morton Maximizing Production video. This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.

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