Complex Medical Issues in the Lactating Parent

Breastfeeding parents who are navigating autoimmune disorders of inflammation such as lupus, and rheumatoid arthritis face unique challenges. This presentation will look at the lived experiences, limited research, and express challenges of these parents including the most common and debilitating symptoms for the prenatal and post partum periods, and ways these conditions can affect mammary gland development or interfere with lactogenesis stages. Also covered will be how managing the symptoms of these disorders affects the stress of recovery and breastfeeding or pumping goals, what methods of support can be offered and areas for future clinical improvement and advocacy.

Dysphoric milk ejection reflex (D-MER), is not a new phenomenon. In the past, it was almost like Voldemort, the Problem That Must Not Be Named. But for over 10 years now, it has had a name and been brought into daylight. Though still not widely known or understood by many, the hypothesis of the mechanism and possible sustainable solutions are becoming better documented all the time. D-MER has been the subject of two case studies, one case series, and a qualitative research study. Two other studies as also in process at this time.

Mothers with D-MER feel, as a reflexive response with every single milk release, a wave of negative emotions ranging (depending on severity) from homesickness to hopelessness and despair, perhaps even anger and suicidal ideation. These emotions dissipate shortly after milk release and reoccur with the start of every MER, whether with breastfeeding, expressing or with spontaneous releases. Many sufferers keep the problem to themselves preferring the weaning of their baby to being incorrectly labeled as depressed or victims of abuse. Upon experiencing D-MER mothers are initially convinced the problem is physiological and not psychological, and they are correct.

As both a lactation consultant and a sufferer of D-MER, I first named and identified D-MER over 10 years ago. Now, through the case studies that have been done, collaboration with other medical and breastfeeding care providers, and the collection of information from the anecdotal reports from over 1,000 mothers, there is now a foundation of understanding of D-MER. Though the evidence base for D-MER is still mainly unestablished at this time, there are many professionals always working to bring evidenced-based information to the study of human lactation. This is exactly what the slow work and understanding of D-MER is about; the process of bringing new information into the light for further research and understanding.

In the PowerPoint presentation that I have to present, I discuss how D-MER presents, its tell-tale manifestation, and its spectrum and intensities. The presentation also explains the currently proposed mechanism of the MER anomaly, how health care providers can identify a mother it D-MER and how to help and support mothers with the condition.

Background: Higher intensity and longer duration of breastfeeding is associated with protection against type 2 diabetes development. While exclusive breastfeeding is optimal, women with gestational diabetes mellitus (GDM) have lower exclusive breastfeeding rates than non-diabetic women. While women with GDM have expressed that they feel that their milk “comes in” late, there is limited biochemical validation of their perception and a lack of information regarding the difference in metabolite composition of colostrum which may influence the transition to lactogenesis II. Methods: Researchers conducted a prospective case-control pilot study involving the comparison of metabolite concentrations and maternal perception of milk “coming in” between postpartum women with GDM and without GDM. Results: There were lower concentrations of lactose and citrate, metabolites that indicate transition to lactogenesis II, in colostrum samples of women with GDM compared to non-diabetic women. Furthermore, a higher proportion of women with GDM reported a perceived delay in their milk “coming in.” Conclusions: Lower levels of lactose and citrate in the colostrum samples of women with GDM compared to those without GDM indicate delayed lactogenesis II with GDM which may suggest a biological mechanism associated with lower breastfeeding rates among women with GDM. Additionally, maternal perception of delayed lactogenesis II among women with GDM appears to be validated by biomarkers. The implications for practice relate to lactation support in the early postpartum period among women with GDM.

Breast cancer is the most frequent malignant tumor during reproductive age. Around 1/10000 nursing mothers are diagnosed with breast cancer every year. In this rare and difficult situation, patients and healthcare providers should be knowledgeable about the prognostic and practical implications of such an event. Chemotherapy may pass into the milk and breastfeeding is usually contraindicated during chemotherapy. Weaning should be gradual, to avoid breast inflammation and mastitis. A thorough psychological support should be given to the nursing mother to help her into the oncological trajectory.
On the other hand, the number of young breast cancer survivors is increasing and more and more patients enquire about the possibility of subsequent pregnancies and breastfeeding. The breast treated with conservative surgery and subsequent radiation is less responsive to hormonal stimulation, with reduced glandular hyperplasia and hypertrophy. Milk production is usually decreased in the previously affected breast and surgery may affect duct integrity. Nonetheless, each breast has the capability to self regulate milk production according to the baby’s suckling habits, and many evidences support the notion that one breast is enough. Specific education programs should focus on adequate baby positioning, correct latching and reinforcement of the advantages of on demand breastfeeding. Data from our group demonstrate the feasibility of breastfeeding after breast cancer, but qualified lactation counseling to support patients and caregivers is needed.

Many breastfeeding/chestfeeding parents seeking to grow their families through Assisted Reproductive Therapies (ART), including IVF will be faced with limited or conflicting information and challenging decisions. When they turn to lactation professional for support it’s important that the receive knowledgeable and compassionate care. This presentation will equip lactation professionals with an understanding of not only the various therapies, procedures, and medications, by the mental and emotional aspects that breastfeeding/chestfeeding families may experience in their fertility journey.

Mast Cell diseases are rare but still underdiagnosed. Even among specialists, there is a lack of consensus on terminology, diagnostic techniques and even diagnostic criteria. Clinically, mast cell diseases manifest in divergent ways. Triggers, symptoms, management and treatments differ widely from patient to patient. To date, there is no cure, just palliative management of this chronic, sometimes life-threatening condition. Because of this, there is a poor understanding of Mast Cell-related issues in the broader medical community, particularly in the realms of pregnancy, birth and lactation.
This webinar will provide participants with a general overview and understanding of the various types of Mast Cell Diseases including Mast Cell Activation Syndrome (MCAS), Mast Cell Activation Disease (MCAD) and Mastocytosis. Participants will learn how to put this knowledge into practice to provide their Mast Cell clients with specialized, empathetic, and supportive care. It will discuss how to provide patient-centered care, the importance of coordinated care and the crucial role lactation specialists play within their client’s multidisciplinary health care team. It will examine Mast Cell treatments that are compatible with lactation.
Additionally, light will shed on approaches lactation specialists can utilize to empower their clients with the tools needed to establish and maintain the breastfeeding relationship desired, including helping clients manage their parenting and breastfeeding expectations given the limitations imposed by their disease.