When I first started looking into the hows and why’s of our situation I found this article. I have a whole folder in my bookmarks called Breastfeeding Help. Everything from support groups for those who stop, to latch techniques, to what symptoms go with what issues. This one is near the top. It covers a list of potential complications and risk factors that should be grounds for referral to a breastfeeding specialist. It doesn’t totally explain why any of them are potential complications or risk factors for breastfeeding. Some of them, yeah, but others I was left scratching my head. Also, the Google books format is not so easy to read. Maybe I can put it on my Kindle…
Anyhow, to summarize that table
- Cesarean birth
- Labour analgesia
- Theta lutein cysts
- Placental retention
So Cesarean, we know can cause issues for a variety of reasons. Perhaps the baby is not fully neurologically ready for latching, sucking or suck-swallow coordination, perhaps the birth was traumatic, perhaps there was blood loss, perhaps the mother was overhydrated causing edema of the breasts, the artificial detachment of the placenta delaying the lactogenesis II cascade, the pain of the surgery limiting feeding positions, the painkillers and medications. There are a heap of reasons, although with a bit of preemptive education and stubbornness you can get through a lot of them. Not all, but a lot.
Diabetes: I’ve been talking to some diabetic women recently who had issues breastfeeding their previous children. From what I’ve read the baby can have issues managing blood sugar after birth, this leads to reduced nursing effectiveness, being pushed to top up (which leads to other things, like nipple confusion). On top of that, there are potential issues with hormone cascades being out of whack causing milk delay. Again, some avoidable complications with a lot of education and support beforehand.
Labour analgesia: I mentioned in the Childbirth Interventions post how some doses and forms of epidural had negative implications for breastfeeding. In addition, opiates are known to make babies drowsy. Drowsiness can lead to poor sucking, poor latching technique, which in turn can cause excess weight loss.
Obesity: This was one that stumped me. I knew extra fatty tissue could cause issues with the female reproductive cycle. After all, why would IVF places want you to be below a certain BMI for services? I’ve gotten into online arguments where others called such practices fat discrimination (I’m at least 50lbs overweight now and have been 150 lbs overweight in the past, so not really on my agenda there) because I knew it was a risk factor for infertility but I couldn’t back up why. But I finally figured it out. Fat stores fat soluble hormones. Fat soluble hormones are estrogen, testosterone and similar. For infertility those excess retained hormones can throw things out of whack. For lactation when you have a baby your body expects to undergo a rapid hormone cascade and the hormones stored in your tissues can delay that cascade leading to later onset of milk production. Obesity can also be a result of several underlying causes that have their own contraindications. In addition of course, obesity can mask other conditions such as PCOS and thyroid disorders which have their own risk factors.
PCOS: I’ve outlined this one before (I think?) but my basic understanding of it is thus: The link between PCOS and BF difficulties is usually in one of two ways. For one you have early onset PCOS and due to hormonal imbalances your breast tissue does not develop properly in puberty. For the other you have later (post puberty) PCOS onset and the hormonal profile either inhibits milk production (this can be an issue if you tend toward androgen dominance) or causes your breasts not to develop properly during pregnancy. About 25-30% of women with PCOS may have milk production issues and another 30% will have overproduction (with the last 3rd being more or less normal).
PCOS sufferers often suffer from insulin resistance. Insulin resistance often goes hand in hand with androgen dominance. High androgens can prevent the progesterone (which grows breast tissue both in first trimester and with every monthly cycle) from doing it’s job. Also, excess fatty tissue (which we know can go with PCOS) holds onto hormones which in high enough concentrations can disrupt things (as above).
Theta lutein cysts are testosterone producing cysts. As we know androgens such as testosterone can inhibit the lastogenesis cascade and milk production.
Placental retention keeps the progesterone and estrogen levels high preventing the lactogenesis cascade (by the way, here is an excellent article on that) and decreasing milk production.
Stress: This is an odd one, and I haven’t found much speculating on the mechanism of this. Stress can inhibit let down in the lactating mother, but there are several documented cases of intense stresses near to childbirth that cause the mother to simply not lactate. Cases where women lose other children their houses or similar and deliver their new child and simply fail to lactate. I’d personally be inclined to extend that to those who had mentally traumatic birthing experiences, but it’s hard to know if the trauma needs to be before labour begins or if once the hormonal cascade of labour is begun then things are on a different schedule. Of course, it may be hard to find a traumatic labour where blood loss was not an issue. And of course this, like all of these potential complications, is not standard across all women.