IUD’s and Milk Supply

About 6 weeks to 2 months postpartum, your health care provider will bring up the subject of birth control. Even though sex may be the farthest thing from your mind! Your doctor has your mental and physical health in mind when he talks to you about a birth control method. It can be devastating emotionally and physically to get pregnant again before you are ready.

There are many birth control methods that are compatible with breastfeeding and have absolutely zero risk of harming milk production. Condoms and other barrier methods are safe and effective when used appropriately. But these methods are considered “risky” to many doctors because they rely on patient compliance and errors can occur. More and more doctors, therefore, are encouraging new mothers to use an IUD for birth control.

There is a relatively new IUD on the market, that definitely can and does create problems for breastfeeding mothers. It’s called Mirena. The Mirena IUD releases small amounts of synthetic progesterone over time. Progesterone is the hormone that keeps you from lactating during pregnancy. It follows that progesterone, even a small amount, could cause a reduction in milk supply for a breastfeeding mother.

There is no research that I know of to back up this claim. But I have stories from breastfeeding moms.  I would bet that there are many others who didn’t put 2 and 2 together and just believed that their milk ”dried up” all by itself or because they had returned to work. Since the resumption of birth control and going back to work often occur at about the same time, a mom could easily assume that being away from her baby for 8 hours per day is what caused the drop in milk production. So who knows how many mothers quit breastfeeding because of the Mirena? I believe the number is much, much larger than is reported.

Margie called me because her milk supply had plummeted to practically nothing. Her baby could not breastfeed, but she had been pumping since his birth so she has always known exactly how much milk she produced.

After Margie’s milk came in, she was able to pump 4 ounces every 2 hours—with a hand pump! She continued pumping regularly and always had more than her baby could eat. When her baby was 2 months old, her doctor recommended the Mirena IUD. She agreed that it sounded like a good birth control method for her. She noticed a gradual, slight dip in her milk supply within a week. She thought maybe it was because of the hand pump, so she tried a professional grade pump. Her supply continued to decrease, so she rented a hospital grade pump. There was no improvement. A mere six weeks after the IUD was inserted, her milk supply had practically vanished—down to 2 oz per day. She had the IUD removed.

Maggie is now working hard, with my guidance, to increase her milk production. There is no doubt in her mind (or mine) what caused her supply to plummet. It makes me sad that anyone would have to go through what she has gone through. Especially since it was completely avoidable.

So what should you do about birth control? Talk to your doctor about options. Let him know that breastfeeding is important to you and that you want to avoid risking your milk supply. Explore all options—keeping in mind that any birth control method is largely a “back up” method if you are fully breastfeeding and your baby is under 6 months old. . Avoid any birth control method that relies on hormones. Remember that you will be breastfeeding for a relatively short period of time in your child’s life. The Mirena and other hormonal methods may be a good choice for you when your baby is older and is not reliant on your milk for nourishment. Lastly, if you have already instituted birth control that includes hormones, and you are concerned about milk production, please call me for help!

Note: Many breastfeeding mothers use the Mirena IUD with no noticeable effect on breastfeeding. Unfortunately, it’s impossible to predict how an individual mom’s milk supply will react to the introduction of progesterone.

See also, “Breastfeeding and Fertility”   This link will take you to the latest version of my blog and website.  I hope you enjoy the new look!

Guest Post–When Nursing Makes you Sick

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

When a woman thinks of birth and breastfeeding she expects it to be the happiest time of her life. Occasionally, to a mother’s dismay, she finds that breastfeeding brings on new challenges, feelings and experiences. She may experience feelings of pain with breastfeeding, or an unexplainable twist in her gut when her milk lets down. Unable to justify or validate what she is feeling leaves her at a loss and feeling confused. These feelings may be the result of a condition known as D-MER. D-MER stands for Dysmorphic Milk Ejection Reflex and it is treatable.

D-MER is caused by a drop in dopamine activity when oxytocin rises which creates a feeling of dysphoria in the mother (D-Mer.org). It is a physiological disorder, not a mental disorder. To understand D-MER better I have interviewed Renee Beebe, IBCLC. Renee Beebe is an International Board Certified Lactation Consultant who works with mothers who may be exhibiting symptoms of D-MER.

A mother asked Renee the following questions:

Q. “Dear Renee, when I nurse my baby I feel nauseated and a dull ache. What is causing this pain and what can I do about it?”

A. Renee’s answer is “First of all let me assure you that you are not causing this situation.  It can be very disturbing to a mother to feel sick, sad or otherwise uncomfortable when breastfeeding or pumping.  After all, breastfeeding is supposed to be pleasant, right?  Various hormones increase and drop dramatically during the process of breastfeeding–particularly during the milk ejection reflex (commonly known as the let down).  Most mothers feel wonderful when the milk ejection reflex or MER occurs.  A few mothers, however, feel awful.  The good news is, the nausea or sad feelings usually dissipate after the MER is finished and it usually dissipates over time during the course of breastfeeding.  Some mothers may need to be on medication temporarily until the condition improves.  Others may find relief with breathing exercises or other coping methods”.  Please see www.d-mer.org for more information and support. You are not alone!

Q: How can I reach Renee Beebe, M. Ed., IBCLC for help if I think I may have D-MER?

A. “Mothers may call or email if they’d like support.  Most mothers call because it ensures I can answer them sooner.  I would encourage women to call before they have the baby to make a connection.  After the baby is born, if things aren’t going absolutely smoothly, call as soon as possible.  I can usually see mothers within 24 hours.  Often the same day.  I take calls 7 days/week till 9 pm.” Renee can be reached at 206-356-7252 or you can go to her website  http://www.second9months.com/.  This entire blog is now located at my new website!

Q. What is an IBCLC?

A. The International Board of Lactation Consultant Examiners (IBLCE) is the certifying body for lactation consultants.  It is the only certification available.  The exam is given once a year all over the world on the same day.  A lactation consultant should have the letters IBCLC after her name.  That is the only way you can ensure that she has achieved this minimum competency required by IBLCE.  The terms “breastfeeding specialist,” “lactation educator,” or “lactation specialist” really don’t mean much.  Usually those people have taken some valuable coursework, but don’t have the clinical hours required to actually sit for and pass the certifying exam.

Q. How did you become a lactation consultant?

A. After the birth of my first baby, I became involved with La Leche League for support.  where I was living at the time, breastfeeding was not the norm and La Leche League provided me with mommy wisdom and role models.  Soon I was helping other mothers and became a La Leche League Leader myself.   It was clear I had found my calling!  6 years later I had accumulated enough “helping” hours (2500!) to become certified as a lactation consultant.  I first took and passed the certifying exam in 1997.  I’ve been working as a lactation consultant ever since.

If you are experiencing negative feelings, pain, or nausea when you nurse your baby please know that you are not alone. Conditions such as D-MER are not caused by the mother. They are physiological in nature and beyond your control. Treatment is available for mothers with D-MER. Please visit www.D-MER.org for more information.

Written by Trina Baggett, Certified Birth Doula and Childbirth Educator.  www.atranquiljourney.com

Tongue Tie: More than “Just” a Breastfeeding Problem

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

Let’s assume for a moment that breastfeeding is not important. That the oral development that breastfeeding provides is inconsequential. We will ignore, for just a moment, the fact that the act of breastfeeding helps develop the baby’s jaw, his facial muscles and properly shapes the palate to make room for his future teeth. We’ll ignore all of that so that I can give you a few other reasons to agree to have your baby’s frenulum clipped. Just in case the possibility of pain free, effective breastfeeding is not a good enough reason for you.

The reason I’m being just a bit sarcastic is because there are plenty of health care professionals out there who do not “believe in” freeing a tongue tied baby’s tongue “just” so he can breastfeed. “After all,” they say, “..you can just feed your baby pumped milk or formula from a bottle.”

Let’s say you are pondering that question yourself. And you don’t want to put your baby through even a second of pain—however minor—if you don’t have to. And, up until the moment your lactation consultant told you your baby is tongue tied, you’d never heard of such a thing. Why should your baby have a frenotomy (clipping the frenulum) when it’s only going to help with breastfeeding and breastfeeding is such a short time in your baby’s life? I’ll tell you why. Because freeing the tongue with a quick clip now may help your baby avoid health problems in childhood and even into adulthood.

The tongue is a very strong muscle and that frenulum is an inelastic cord that is constantly pulling on the floor of the mouth and/or the lower gum ridge (called the alveolar ridge) when the tongue tries to move normally. Without normal tongue movements the oral cavity does not develop properly and since one body part is connected to the other, problems can occur in the rest of the body as well. Here are some effects of tongue tie that are not breastfeeding related.

• Ineffective oral hygiene
• Tooth decay
• Crowding of teeth—especially lower teeth
• Orthodontia
• Lisps and other speech impairments
• Excess saliva production–frenulum pulls salivary glans to unnatural position.
• Fatigue with speaking
• Shame, embarrassment with speaking
• High, arched or “bubble” palate
• Choking
• Reflux
• Snoring
• Sleep apnea
• Headaches

So now you know. If your baby is tongue tied and you have been wondering if a frenotomy is “just” for breastfeeding, wonder no more. Your baby will thank you some day!  

See also, “My Baby is Tongue Tied?”

My Baby is Tongue Tied?

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

“My lactation consultant told me my baby is tongue tied and she needs to get her frenulum clipped so she can breastfeed. What is a frenulum? Why does my baby need this procedure?”

The frenulum is a (usually) thin, fibrous band that connects the underside of the tongue to the floor of the mouth. The mere existence of a lingual (tongue) frenulum is not an indicator of a problem. The important thing is whether the frenulum restricts the movement of the tongue in a way that interferes with its normal functions.  If it does, your baby has a condition known as tongue tie or ankyloglossia.

One of the vital roles of the tongue for a baby is for feeding. Your baby depends on her tongue for creating a vacuum, sustaining a vacuum, moving the milk to the back of her mouth and swallowing. These things are important whether a baby is breastfeeding or bottle feeding. But when a baby is breastfeeding, the function of the tongue is more critical because incorrect tongue movement/placement equals sore nipples for mommy!

How do you know if your baby is tongue tied? Take a minute to observe your baby with this questions in mind:

• Does your baby have a hard time latching on?
• Do your nipples looked creased or flattened after breastfeeding?
• When your baby cries, does the center of his tongue look “’stuck” to the floor of his mouth with just the edges curling up?
• When your baby sucks on your finger, do you feel the lower gums either constantly or intermittently?
• Does your baby seemed stressed with a fast flow of milk?
• Do feedings take a long time? Or is baby feeding very frequently and never seems satisfied?
• Does your baby have symptoms of reflux?

If the answer to any of these questions is yes, Your baby may be tongue tied! Check with an experienced lactation consultant to be sure. She will examine the baby—paying particular attention to assessment of tongue function. She will also observe the baby feeding. After a thorough evaluation, the lactation consultant may recommend that the baby have the frenulum clipped.

The clipping—called a frenotomy—is usually performed by a doctor or dentist. The doctor will assess tongue function, may observe a feeding or ask you detailed questions about feeding. You should be given instructions to stretch your baby’s tongue periodically after the procedure to ensure that it heals properly. Sometimes a topical anesthetic is used, but not always. The pain the baby experiences is mild and brief (similar to biting your tongue) and bleeding is minimal. After this very quick procedure (it literally takes about 1 second!) most mothers and babies notice an immediate difference in breastfeeding.