The Motherwear Breastfeeding Blog

Wow.

I was reading a textbook on lactation the other day and found this:

It seemed surprising that human milk SIgA antibodies often are directed against just about any bacteria present in the gut.  This was explained when it was discovered that lactogenic hormones important for the development of the mammary glands towards the end of pregnancy directly influence the migration of lymphocytes from the aggregates of lymphocytes in the gut to the mammary glands.  This is called the entero-mammaric link and results in SIgA antibodies in the milk being directed against bacteria in the mother's gut and bacteria arriving there from her upper respiratory tract secretions.

In other words, toward the end of pregnancy, hormones cause lymphocytes in the mothers gut to migrate to the breasts, so that at birth the breasts can start making milk which contains antibodies against the things which the mother's gut already fights.  This was discovered in 1978.  Cool.

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Breastfeeding and codeine.

Last year the FDA raised concerns about use of codeine in nursing mothers, after a two week old infant died of a morphine overdose resulting from maternal intake of codeine (in less than the amount typically prescribed). 

This issue has been in the news again this week after the release of a Canadian study documenting the same hazard.

Codeine is commonly prescribed for postpartum pain, and can be found in Tylenol 3.  When codeine is ingested an enzyme in our bodies metabolizes it into morphine.  Some mothers are "ultra-rapid metabolizers" of codeine, which means that the enzyme in their system more efficiently process codeine into morphine.  For those mothers, the amount of morphine in their milk is many times higher than others, and the concentration can be fatal to breastfed babies.

Some of us are more likely to be ultra-rapid metabolizers of codeine.  Dr. Thomas Hale, of Texas Tech University, and author of the indispensable Medications and Mother's Milk explains on his forum that the incidence ranges from 1% in Caucasians, to 10% in Greeks and Portuguese, to 29% in Ethiopians.  He also notes that at least 7-10% of Caucasians lack the metabolizing enzyme altogether, and cannot metabolize codeine to morphine, and so codeine is ineffective for these individuals.

So, what else could be used for postpartum pain?  Dr. Hale lists alternatives and guidelines for the use of strong pain killers on his forum.  You can also watch a brief FDA video on this topic.

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When breastfeeding causes bad feelings: Dysphoric Milk Ejection Reflex.

Today I'm pleased to bring you an email interview with Alia Macrina Heise.  Alia is a mother of three who lives in the Finger Lakes region of New York.  She is a WIC breastfeeding counselor, a postpartum doula and a certified lactation counselor in private practice.

Alia has been working with a team of physicians and lactation consultants to identify a problem recently termed Dsyphoric Milk Ejection Reflex, or D-MER.  She runs the website, DMER.org.

What is D-MER?

The official definition of D-MER (Dysphoric Milk Ejection Reflex) is a newly recognized condition causing a brief surge of dysphoria, or negative emotions, that peak before the milk ejection reflex, or letdown, in a lactating woman and then dissipates quickly after the milk release.

But put more casually, what a mother with D-MER experiences is a wave of unpleasurable emotion that hits when she begins to breastfeed and then fades a few minutes later. The feeling varies for each D-MER mother to some degree but can include a sinking feeling in her stomach, a feeling of hollowness, anxiety, panic, sadness, restlessness and self disgust. This wave of feelings corresponds with her release of milk, but many mothers don’t make that connection.  There are three reasons for this: Firstly, because the mother also has the feelings with spontaneous releases when she is not breastfeeding; secondly, because not all mothers feel a letdown tingle in their breasts to connect the emotion with letdown and thirdly, because the emotional overload happens just prior to milk release, making it something that is not always easily connected for some mothers.

  

What was your experience with D-MER?

I began experiencing what is now known as D-MER when my third baby was born almost a year ago.  I did not experience the same reaction to letdown with my first two babies. As a lactation counselor it seemed to me that there ought to be information somewhere on such a phenomenon, but I could not find any. I did find however, within about one month’s time, about 100 other mothers who experienced the same thing and they had all thought they were alone in their experience. So I sought out the more qualified lactation professionals to help me investigate D-MER and since then D-MER has gained a large amount of attention and is continuing to gain recognition.

 

How common is D-MER?

It seems that it is more common than anyone would have guessed. We are finding is that this is one of breastfeeding’s best kept secrets. Women have been embarrassed, fearful and self conscious about bringing up the negative emotions they feel while breastfeeding, even to their best friend or mother. This is because there is a strong message that breastfeeding feels 100% pleasurable, even warm and fuzzy, and so a mother who experiences the exact opposite, things like guilt, anger, irritation, hopelessness and dread, feels very much like a “freak” and a “weirdo.”

What is known about the causes of D-MER?

We have come very far in a short amount of time, but we surely haven’t come far enough in terms of knowing what the exact mechanism of D-MER is. We probably know 1000 things or more that aren’t the cause of D-MER and that brings us that much closer to finding out what is.  Oxytocin is involved, but not as the culprit, more as the messenger.  We can know this because mothers experience D-MER before a letdown, probably about the same time oxytocin is being released in the brain. The rest of the puzzle will be figuring out the other parts of the hormonal milieu involved. Prolactin, dopamine, the pituitary, the amygdala and others are all being investigated.

Does D-MER go away?

It can self-correct, but that varies from mother to mother. For mothers with mild D-MER it is likely to self-correct around the third month. For severe D-MER it often won’t self correct until well after the first year, or sometimes not until weaning.

Where can mothers get more information about D-MER?
D-MER.org is the largest source for D-MER support at this time, as D-MER is still gaining recognition.  Not only does it contain comprehensive information about D-MER, but it has quotes from other mothers, informational handouts available for download, a forum dedicated to D-MER, a survey for mothers who have experienced D-MER to take to help with the investigation of D-MER, and a lot more.

Recent breastfeeding news.

Catching up on lots of breastfeeding in the news this week:

• Breastfeeding protects babies from breast cancer as adults, though not for first-born women.
• Breastfeeding reduces risk of mother developing rheumatoid arthritis by half
• Washington Post covers difficulties implementing D.C.'s new workplace pumping law
• Extended breastfeeding discussed on the BBC (video)
• FDA recalls Mommy's Bliss nipple cream
• Study finds breastfeeding increases intelligence scores
• Popular brand of organic formula is made with cane sugar, raising concerns (though breastmilk is barely mentioned)
• FDA announces a new system for rating the safety of medications during breastfeeding and pregnancy

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And now a message from 1914.

I was just reading The Nursing Mother's Guide to Weaning, which has an interesting introductory section on the age of weaning through history.  This quote put the poster in context:

"...by 1915 [the recommended age of weaning] had declined to seven to eight months.  Several trends coincided, moreover, to make many women wean earlier than recommended and others fail at breastfeeding or never even attempt it.  First, women spent more time away from home; while the Industrial Revolution sent poor women into factories, some wealthy women entered professions, and even more joined volunteer organizations...At the same time, the extreme prudishness of Victorian culture made public breastfeeding inconceivable...

Thanks to Amanda for this one!

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Nursing mothers get bad information at the pharmacy counter.

Last year a study proved something many of us have found out the hard way:  much of the information nursing mothers get at the pharmacy counter is inaccurate.  According to the Massachusetts Breastfeeding Coalition:

The study's authors examined the safety information used by two large retail pharmacy chains on the East Coast, looking at 14 commonly-prescribed medications. For 75 percent of drugs that are considered unequivocally safe for breastfeeding, pharmacies were inappropriately advising mothers to stop nursing.

"We were surprised by the results, when we looked at all the resources systematically," said lead author, Monica Akus, PharmD, a pharmacist at Cambridge Health Alliance and Assistant Professor of Pharmacy at University of Rhode Island. Several well-respected sources used out of date information, most commonly resulting in inappropriate advice to stop breastfeeding. "As pharmacists, our training in drugs and lactation is often limited, so it's critical to spread the word to other pharmacists. Our knowledge is only as good as our resources," notes Akus.

The authors consider two resources to be the most reliable:

• LactMed, is a website run by the National Institutes of Health which you can use to look up medications and their impact on breastfeeding.
• Medications and Mothers Milk, by Dr. Thomas Hale (2008 edition coming out soon).  I use this book a lot and find its "L1 to L5" scale of rating drugs very helpful. 

Have you received bad information at the pharmacy counter?  Were you told that a medication was unsafe when it wasn't, or safe when it was unsafe?  Tell us about it below.

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Breastfeeding reduces mothers' risk of metabolic syndrome.

A study just published in the American Journal of Obstetrics & Gynecology reports that breastfeeding is associated with a decrease in risk for metabolic syndrome in mothers. 

What's metabolic syndrome?  According the American Heart Association, it's a combination of factors including abdominal obesity, high cholesterol, elevated blood pressure, insulin resistance, high inflammatory state.  These factors significantly increase the risk of heart attack and Type II diabetes.

The findings also showed that the duration of lactation was associated with significance of the risk reduction.  It also found that this reduction waned after the fourth child. 

Medwire News reports:

[Out of the 2,516 participants,] there were 536 (21.3 percent) cases of metabolic syndrome, with rates among women who breastfed of 18.3 percent, compared with 26.7 percent among those who did not.

After adjusting for age, current smoking, parity, ethnicity, socioeconomic status, study site, physical activity, caloric intake, and high school body mass index, women who breastfed were 23 percent less likely to develop the metabolic syndrome than those who did not.

The researchers also report that the duration of lactation was significantly associated with the metabolic syndrome, with the risk decreasing by 20 percent for each year of lactation.

In a way this isn't too surprising, given that previous studies have shown that breastfeeding is associated with lower levels of several of the components of metabolic syndrome.  I've written before about the effect breastfeeding has on reducing the risk of heart attack, and controlling levels of cholesterol, insulin, and weight.

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I donated milk for this research.

A few years ago, when we were living in California, I donated milk for this research, which was being conducted through UC Berkeley and UC Davis.  I pumped at work, and then met the researcher on a street corner outside of the State Capitol building - we both joked that it felt like a drug deal!

From what I recall, the researchers took my milk, infected it with HIV, and then conducted the flash pasteurization method you see in the video.  They knew at that point that this method would kill the HIV, but were testing to see how much of the nutrition remained stable in the milk after the pasteurization. 

Many of you probably know about the complex issue of HIV and breastfeeding in the developing world.  Breastfeeding is a key route of transmission of HIV, but for women living in areas with unclean water supplies, not breastfeeding is an even more dangerous proposition.  The risk of death in the early months of life from diarrhea and other infections is considered greater than risk of HIV infection.  For that reason, the World Health Organization and UNICEF recommends not breastfeeding only "when replacement feeding is acceptable, feasible, affordable, sustainable and safe."  A key appears to be exclusive breastfeeding, as recent studies have confirmed.  One theory is that the use of supplements creates tiny fissures in the baby's gastrointestinal tract, which allow the HIV virus to enter the baby's system via breastmilk.   

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The wonders of breastmilk: Cancer therapy and source of stem cells.

A couple of articles in the past week have highlighted the amazing properties of breastmilk. 

One, a nightly news segment from Texas, shows how increased demand for donor milk has left some cancer patients unable to obtain it.  But the parts that got me a little choked up were interviews with a cancer survivor and the mother of a premature baby born at 2 lbs.  Some comments are below, but it's really worth watching this clip.

[Dr. Don] Bauer had a cancerous tumor in his right vocal chord, severe enough to cut off his airway. Surgeons removed it, leaving him with a hole in his neck to talk and breathe.

"So I was bent on getting better. No matter what," he said, wiping his eyes.  But he didn't get better.

Bauer lost 35 pounds in one week, and his diabetes made recovery almost impossible. Then he discovered a new remedy: a mother's breast milk.

"It's just a boost of energy, and it's not like drinking an energy drink or a couple cups of quick coffee, but a slow process of feeling good," he said...

Dr. June Meymand runs a cancer center and says breast milk protects her patients' healthy cells, while killing the cancer at same time.

"What actually causes the damage to the body will be carried out through the intestine and will not become active," she said.

The second is a report from Australia documenting the presence of stem cells in breastmilk.  I remember reading a discussion of this in an article in 2006, in which breastmilk stem cells were described as "an important but so far unappreciated live, functional component of breast milk."  Looks like they're getting their due now:

[Dr. Mark Kregan and] his team cultured cells from human breast milk and found a population that tested positive for the stem cell marker, nestin. Further analysis showed that a side population of the stem cells were of multiple lineages with the potential to differentiate into multiple cell types. This means the cells could potentially be “reprogrammed” to form many types of human tissue...

“We have shown these cells have all the physical characteristics of stem cells. What we will do next is to see if they behave like stem cells,” he says.

If so, they promise to provide researchers with an entirely ethical means of harvesting stem cells for research without the debate that has dogged the harvesting of cells from embryos.

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How to choose a nursing necklace.

Today I'm happy to share some thoughts from Raelynn (shown to the left), owner of Mommy and Me nursing necklaces, and creator of some beautiful designs, on choosing a nursing necklace.  If you'd like to create your own, check out Angela's post for instructions.  At the bottom I've posted a picture of my old nursing necklace, which is a great reminder of those days.

The twisting, the pinching, the pull -- ouch!  How in the world can you alleviate the hair pulling and distracted twisting of a nursing baby?  Nursing necklaces can be a great solution.

Whether you're in the market for a bright, whimsical design or you'd rather go with something a little more subdued and stylish, there is something out there for everyone.  After making nursing necklaces for over three years, here are some recommendations I'd offer when you're ready to give one a try:

1.  Safety first.  You're probably feeling as though you can't take one more scratch, but it's important to buy something that will do its job and won't pose a choking hazard.  Make sure you are purchasing from a reputable company that has a proven track record and has invested the time and thought into their safety features and designs.  Look for their safety information, read through their purchase policies, and try to find a company that offers a breakage guarantee.

2.  Invest in quality.  Most moms are on a budget and are drawn to lower prices.  However, most nursing necklaces offered at cheaper prices use weaker beads and won't give you an all-around bang for your buck.  Try to find a retailer who makes an effort to offer good prices but also doesn't skimp when it comes to necklace composition and safety.  Compare photos from various vendors, really look at the nitty-gritty parts of the necklaces.  Invest in safety and functionality. 

3.  Consider your needs.  Depending on your baby's age and personality, you may need a totally different nursing necklace than me.  Do you have a gripper or a pincher?  A grabber or a twiddler?  Watch your baby while he nurses.  What does he do with his hands?  If your baby is a gripper or grabber, some of the more elegant, fixed-pendant designs may work for you, but if you have an extreme twiddler on your hands, you may want to look for a necklace that has moveable, engaging beads and will really keep him busy.  Plus, it's really great for tactile development! 

Whether you purchase a stylish Mommy Inspired Design or a playful Baby Inspired Design, wear it proudly!  Even after your nursing relationship has ended, your necklace can serve as a special reminder of that time you two shared.  Good luck on your search! 

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