Wednesday, December 11, 2013

Battlestar Galactagogue: On Fenugreek and Other Products for Perfect Production

Pop Quiz: Assuming physiological normalcy for both mother and infant, a healthy milk supply depends on:
a) Making sure mom goes through a batch of lactation cookies at least once a week.
b) Getting the best tincture from a health food store.
c) Drinking 4 cups of breastfeeding tea blends every day.
d) Obtaining a prescription for Domperidone.
e) None of the fracking above.
Following on my recent theme of nursing support in the age of social media, breastfeeding support products are more easily available than ever before. How is this going for us?  Have we, with all our good intentions in making galactagogue products more widely available, contributed to the (apparently growing) perception that mothers can't have a normal milk supply without teas, tinctures, cookies, and pills?

First off, what is a galactagogue?

Defined: Ga·lac·ta·gogue: gəˈlaktəˌgäg/ noun. 1.a food or drug that promotes or increases the flow of a mother's milk.  Common and popular herbal  options include blessed thistle, fennel, and the most famous reindeer of all: Fenugreek.  Drop into any mom's forum, and you'll see that every thread discussing supply will inevitably include recommendations for various galactagogues, in drug (i.e. Reglan or Domperidone), food (oatmeal for all), and herbal forms, fenugreek being by far the most well-known.

A brief stroll down the aisle at New Seasons, a local Whole Foods-like company in the Portland area, revealed these options:

So, here I go with another post in which I preface with a disclaimer and close with a hedging qualification. Let me be clear: There is nothing at all wrong with galactagogue use when needed! I cannot stress this enough. Part of the very reason we have such a diverse array of options for galactagogues in the first place is because women in vastly different cultures in a variety of ecosystems all over the world have sought them out and passed them down through generations.

The world is very different now - so many undeniable improvements, and yet the matter of marketing as a major force in our collective psyches is a critical one. Let's think about this: how does formula marketing actually function? The most effective formula marketing depends on insidiously undermining women's confidence (I discussed this here and then illustrated it here, a la Mad Men). Is the promotion of galactagogues as something lots and lots of women are likely to need really that different, purely psychologically speaking?

It IS different in some crucial ways because it's not artificial infant milk, of course, and ever moreso because it's not as though well-intentioned companies like Motherlove are engaging in underhanded tactics like slipping samples into gift bags of hospitals. And they possess nowhere near the financial oomph that massive corporations like Abbott wield. My point is not their intention, but the effects on us as a community of mothers. What overall effect does the promotion of galactagogues (whether from professionals, peers, or by the company itself) have on attitudes toward breastfeeding? We collectively need to ask ourselves if this is helpful.

Boiling it down, is it helpful for us to have so many mothers believing that A) they cannot produce a normal supply without purchasing and consuming a product or products, even really high-quality ones? Again, taking a peek into any peer support forum is guaranteed to provide multiple examples of galactagogue recommendations flowing as freely as an uninhibited milk ejection reflex. And possibly even more damaging, is it B) helpful for mothers with genuine low supply to be taking them (haphazardly in many instances, i.e. all-fenugreek-all-the-time) without addressing or even identifying the underlying issues?

And as one learns more about herbal galactagogues in particular, you can't help but notice that most herbs function by supporting the health of the mother, working with whatever underlying condition may have caused or contributed to her low supply in the first place (many of the most effective galactagogues work primarily on the digestive system, for example, the very core of maternal health). Low supply doesn't just happen randomly to moms who are unlucky; there is always a reason. But just as with the matter of breastfeeding advice in general, the most critical point is to tailor the plan to each dyad, and to use when NEEDED.

Again I find myself on the horns of a dilemma. I am truly glad and grateful that a variety of galactagogues are so readily available when mothers need them, and often in such good quality and variety. And yet. I want to discuss all of the above, with pros, peers, moms, and companies too, but I also want to convey this bottom line:

Moms, you do not have to take galactagogues Just Because. Not as a preventative measure, not even "just in case."

So say we all.*

P.S. Yes, I am hereby claiming the Battlestar Galactagogue name as my very own, especially if I decide to create my own herbal blends as part of my future practice. I CONTAIN MULTITUDES.

P.P.S. Aside from galactagogues, there are many other 'helpful' products being marketed to breastfeeding mothers which have a very much related effect, as corporations recognize this category of mothers as a largely untapped group and try to figure out how to profit off of them. (This sounds terribly cynical, I realize.) Take the recent Milkscreen products as merely one example.  Since I like to drop in on Babies R Us et al once in a while to keep in touch with the latest products that are widely available - and thus the marketing moms are being exposed to -  I may address these other products in a follow-up post.

*Not actually speaking for all. Just geeking.

Monday, November 11, 2013

Help Me To Help You: The Promise and Pitfalls of Peer Support in Social Media

Macierzyństwo, 1905 by Stanisław Wyspiański

This is quite the time to be a new breastfeeding mom. Support for breastfeeding has never been more abundantly available, especially when it comes to social media forms of it. There are multitudes of message boards, there are blog followings with regular, lively discussions, there are lactation support websites with many different specialties - and then there's the juggernaut (you see what I did there) that is Facebook, of course. Breastfeeding discussions come up regularly on fan pages for various bloggers and organizations, but the liveliest action by far is in the groups, whether open, closed, or secret. I have no idea if anyone has ever tried to get a ballpark idea of how many Facebook breastfeeding-related groups there are, but there have to be hundreds if not thousands.

So this is great, right? It's what we've always strived for, yes? Nursing moms helping one another, spreading positive promotion of breastfeeding, cheering each other on by the dozens, this is living the dream. In many, many ways, absolutely yes! But in some other ways, well . . . it gets complicated.

I'm part of quite a number of different groups and boards, some of them breastfeeding specific, others more about parenting in general. I witness and sometimes participate in breastfeeding-related threads on a daily basis, and have been doing so for years. You know that saying "The more you know, the more you realize you don't know?" The deeper I've gotten into my lactation science program at school, the quieter I've gotten on those threads. Note my long period of radio silence on this very blog; it's definitely related. Partly due to being absurdly overcommitted, fer sher, but part of it is also due to a growing realization of my own limits.

In the boards and the groups and the pages, within any given breastfeeding thread, there's an ever-variable mixture of totally great advice, utterly terrible advice, and advice that could maybe, possibly, perhaps be good - IF we had a hell of a lot more information about the mother and baby at hand. All this comes with a liberal serving of emotional support- never something to be discounted; at times it is what the mother needs more than anything.  And ALL OF IT IS MEANT TO HELP. But when it comes to even the seemingly-simplest of nursing issues, how can moms possibly sort this all out? Sometimes they'll get lucky and go with advice that happens to be sound, and all is smoothly resolved. But sometimes, not.

Let me see if I can illustrate this with an example. In my Advanced Case Studies class a few terms ago, one of our texts was the excellent book "Case Studies in Breastfeeding: Problem-Solving Skills and Strategies" by Karin Cadwell and Cynthia Turner-Maffei. In it was an table that sums the social media support dilemma up perfectly.

As part of learning the Eight-Level Lactation Consulting Process, a chart was laid out with six different dyads, labeled A through F. Eight columns listed the various steps: 1) History, 2) Assessment, 3) Symptoms, 4) Problem Formulation, and so on.  The interesting part: Column three was identical in every case. "Mother describes hard breast with shiny skin; breast larger than normal and warm to the touch; breast pain."

Every single mother presented with the exact same symptoms. And EVERY SINGLE ONE OF THEM had a totally different underlying cause, with a different strategy devised to address their issue.

But in (totally well-intended!) online situations, many sympathetic moms will read the presenting symptom and only know their own individual, unique experience of that symptom. That experience might be relevant to the mother at hand - and it also very well might not. And sometimes moms simply want to share their own stories in return, which is also a very valid need - but conflating that with offering advice is treading into very tricky territory. This was an insight shared with me by Jennifer Tow, and I think about it frequently when following such conversations. It can be so hard for both storyteller and advice-seeker to know whether the shared story has any practical relevance to the situation at hand.

Case in point: Fenugreek might very well have helped your supply, but it is absolutely not appropriate for every woman, nor is it a panacea for supply issues in general, which can range from simply turning around some poor management in the early postpartum period to very complex physiological conditions.

Lactation pros are sometimes present on such threads - and it is worthwhile to note that they are often the ones offering the LEAST advice of all. This may be partly for financial reasons, partly for liability concerns, but primarily because they know full well just how individual each case really is. Without a maternal health history, information about the birth itself, a feeding assessment, an oral evaluation, and any number of other relevant pieces, the full situation is incomplete - and that's not even getting into the options for how to actually address the issue (once it is actually identified) with a comprehensive care plan. The variables are endless and the details always, always matter.

I think lactation professionals have been reluctant to bring this matter up because seriously, the good intentions of everyone ARE so deeply felt and appreciated, and who wants to be the Scoldsy McBuzzkill who rains on the peer support parade? Honestly, where would we even BE without peer support? The progress we as a society have made in reclaiming breastfeeding has everything to do with it, and we owe an immense debt of gratitude to the founders of La Leche League, the most famous breastfeeding peer support group of all time. LLL began as peer support, continues as such, and is AWESOME for it . . . but there's a fourth L in that organization that makes all the difference in the world. Every meeting is facilitated by a Leader. Some meetings need more active guidance, in others the mothers need very little input, but that guidance is there for a reason.

For the most part, I write this post not because I have solutions to propose, and certainly not because I think lactation consultants should be the only persons allowed to speak about breastfeeding (because how paternalistic would that be?), but because I want to open this up for discussion. Let's talk about this. IBCLCs, moms, other perinatal professionals, breastfeeding peer counselors. I truly believe that unless the formula companies have become so devious that they're willing to plant undercover undermining minions on message boards ( . . . actually, let's not rule that out altogether), every mother posting in groups and boards is doing so mainly because they genuinely want to help. This is not an easy topic to discuss, but I think it's time.

How can we best help each other to help each other?

Thursday, February 7, 2013

First Blood, Then Milk

A reading from this week's Breastfeeding Politics & Policy class stopped me in my tracks, for obvious reasons.
"I think she looks like you," [the lactation consultant] says with a wink.

"I'm adopted," I say blankly. It's a telling response. I'm so accustomed to discounting the physical resemblance people claim they see between me and my own mother that I forget Faith and I are related. Even though I have the episiotomy stitches to prove it. Which, right now, are hurting me a lot.

Lisa studies me for a while.

"So am I," she replies slowly. Then she shows me a picture of her own (breastfed) daughter, now eight years old. Bright eyes, mile-wide grin, she looks like a miniature version of her mother.

And that's when I know it is no accident that Lisa has devoted her career to helping mothers forge abiding, biological bonds with their babies. Nor is it any accident that I desire this relationship so deeply. Your body out of mine. From my body into yours. First blood, then milk. These are the living threads that weave mother and child together. As much as I love my adoptive mom, this bond is a connection we never had. And as for the unknown woman who gave birth to me, we were lost to each other before I was even as old as Faith is now. And for about the twelfth time today, I begin to cry.

Another rumination of mine on adoption: