Download PRESENTATION NAME

Complementary and Alternative
Therapies in Breastfeeding
Jill Mallory, MD, IBCLC
Wildwood Family Clinic
Madison, WI
Objectives
1. Define “complementary and
alternative/integrative” as a general
class of approaches
2. How might you create a healing
environment?
3. Describe two therapies that
involve touch and how they might be
used?
Objectives
4. What might acupuncture be
beneficial for?
5. When might you suggest
chiropractic manipulation?
6. List 2 benefits of craniosacral
therapy for the nursing dyad.
7. What is the purpose of
remedial co-bathing?
Objectives
8. Why is homeopathy considered
safe in breastfeeding dyads?
9. List two herbs you can use safely
in lactating mothers?
In 2001, the Institute of
Medicine wrote:
"The US health care system is in need of a
change. Health care today harms too
frequently and fails to deliver its potential
benefits routinely. As medical science and
technology have advanced at a rapid pace,
the health care delivery system has
floundered. Between the care we have
and the care we could have lies not just a
gap, but a wide chasm."
What is Integration?
• From the University of Arizona Program
in Integrative Medicine:
• Integrative Medicine is healing-oriented
medicine that takes account of the
whole person (body, mind, and spirit),
including all aspects of lifestyle.
• It emphasizes the therapeutic
relationship and makes use of all
appropriate therapies, both
conventional and alternative.
Why should IBCLC’s take
an Integrative Approach?
• Healthy mother & baby by
empowering the dyad
• Therapeutic relationship
• Prevention
• Avoiding unnecessary & costly
pharmaceuticals and medical
intervention
• Optimizing nutrition for both
Why should IBCLC’s take
an Integrative Approach?
IBLCE states IBCLC’s “have the duty
to provide competent services for
mothers and families by providing
evidence-based information
regarding complementary and
alternative therapies during lactation
and their impact on a mother’s milk
production and the effect on her
child" (IBLCE, 2008)
National Center for
Complementary and
Alternative Medicine
(NCCAM)
1. Biologically-based
2. Manipulative/body-based
3. Mind-body based
4. Whole medical systems
5. Energy-based
(Religious healing not included)
•
How Much Do We Know?
According to Clinical Evidence, Summer 2007:
(Summarizing study results from 1850+ treatments used in
Western medicine)
23%
Beneficial
Likely Beneficial
Tradeoff
Not Beneficial
Harmful
NOT YET TESTED
8%
13%
6%
4%
?
46%
The Sliding Scale of Evidence
?
Behavior:
The Most Important Predictor of Health
Schroeder, NEJM; 357(12),2007
Environment
• Oxytocin
• The hormone of love, safety and
relaxation
Environment
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Light
Color
Sound
Temperature
Smell
Privacy
Attitude of the practitioner
Home and Office
Hospital Rooms
• A new mother is interrupted an
average of 54 times in 12 hours of
hospital stay
• Half of her time alone with her
infant is in intervals of 9 minutes
or less
Morrison, Ludington-Hoe, & Anderson, 2006
Hospital Rooms
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Close the door
Dim the lights
Draw the curtains
Turn off the TV
Calm yourself first
Feng Shui
• The art of arranging and
decorating space
• Chinese astronomy
• 4000 BC
Breastfeeding
Teaching/Support
Environments
• 7 groups
• Which were successful and why?
"comfort, refreshments,
temperature, noise"
Vs.
"cold and uncomfortable"
Hoddinott, Britten, Pill 2010
The Power of Touch
Mother the Mother
Research done in South Africa
showed that women who were
talked to, smiled at, and stroked
themselves were more likely to talk
to, smile at, and stroke their
newborns
Sosa, Kennell, Klaus, Robertson, & Urrutia 1980
The Birth Environment
The Role of Birth
• CDC
• The Maternity Practices in Infant
Nutrition and Care
• "A substantial proportion of
facilities used maternity practices
that are not evidence-based and
are known to interfere with
breastfeeding"
Increase in Interventions
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57% oxytocin
94% continuous EFM
57% delivered on back
83% IV fluids
76% epidural or spinal anesthesia
>1/5 are induced → prematurity
C-section rate > 30%
Sakala & Corry, 2008
C-section
• Lower prolactin and oxytocin levels
on day 2 postpartum
• Delay in onset of lactogenesis II
Nissen et al., 1996
Evans et al., 2003
Birth Trauma
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Torticollis
Mandibular asymmetry
Muscular spams
Spinal malalignment
TMJ dysfunction
Cranial trauma
Emotional trauma
Separation
• 7/34 babies suck correctly if taken
away from their mothers for 20
min
• 24/38 had correct sucking if left
skin-to-skin
Righard & Alade 1990
• Mother-infant contact and
rooming-in increase breastfeeding
Kennell & Klaus 1998
Goal: Mother-Friendly
Childbirth and BabyFriendly Hospitals
The Power of Touch
The Power of Touch
Touch Therapies
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Skin-to-skin
Remedial co-bathing
Massage
Acupuncture
Chiropractic
Osteopathy
Craniosacral therapy
Skin-to-Skin
Skin-to-Skin
“As the most ancient and largest sense
organ of the body, the skin enables the
organism to learn about its
environment. It is the medium by
which the external world is
perceived. ”
(Montague, 1986)
Benefits of Skin-to-Skin
• Improved attachment behaviors
for both mom and baby for 2 years
• Improved survival for preemies
• Reduced illness and infection
• Better breastfeeding success
• Reduces crying
• Improves cardio-respiratory
stability
• Warms baby
The Breast Crawl
All mammals when placed skin-toskin can crawl to the breast and selfattach
Breastfeeding Success
• Research of over
21,000 infants in 18
different hospitals
shows:
The more time baby
spends skin-to-skin with
mom after birth, the
longer mom will
breastfeed that baby
(Bramson et al, 2010)
The First Step
You can start nearly all lactation
sessions with mother and babies in
skin-to-skin contact.
Massage
Massage at Birth
• The infant crawl and maternal
bleeding
• Infant massage of the breast
increases oxytocin levels
(Matthieson et al. 2001)
Infant Massage
• For preemies:
– Lower rates of sepsis
– Higher BMD
– Better bonding with parents
– Increases weight gain and
– Earlier discharge
(Field et al. 1986)
What Does Massage Do?
• Stimulates the vagus nerve
• Increases gastric motility
• Increases insulin and insulin-like
GF-1 levels
• Decreases cortisol
• Reduces metabolic demand
through reduced crying
Kirchner et al 2000, Field et al 2008, Lahat et al 2007
Infant Massage
• Better early weight gain in term
babies for the first 4 months
(Serrano et al., 2010)
• Improved attachment (Lee, 2006)
Maternal Massage
• Lowers stress hormones and blood
pressure for mothers too
Signs of Disruption in MaternalInfant Communication
• Mother shopping with screaming
infant in stroller
• Ignoring feeding cues
• Regarding every vocalization as
“fussiness ”
• Forcibly holding a pacifier in a
screaming infant’s mouth
• Looking at the clock to regulate
feeds
Mother-Infant Massage
• Healing a culture of crying and
delayed response
• Healing interactions that have
been negatively influenced by
books, expert opinions, family
members and the clock
• Healing the disconnect caused by
hospital practices
Breast Massage
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Increasing supply
Increasing fat content
Increasing pumping productivity
Increasing infant weight gain
Reduced engorgement
Reverse-pressure softening
Breast Massage
• Cultural tradition
– Oketani massage - Japan
– Russian mammology
– Gua-Sha - China
• DiSandro massage for recurrent
mastitis
– Bag of marbles technique
• Relief for plugged ducts
• Lymphatic drainage
Massage Resources
• www.lovingtouch.com
• www.infantmassageusa.org
• www.iaim.ws
Acupuncture
Acupuncture
• Over 5000 years old
• Fine needles placed
along meridians
• Part of TCM
• PET scan research
• Anesthesia
• Acupressure
Acupuncture
• NIH endorses for
– Labor pains
– Fertility
– Hyperemesis gravidarium
• Used for 1000’s of years for low
milk supply in China
– Research is limited
Acupuncture
• 1 small study showed improved
infant weight gain (Li, 2003)
• Another small study showed
increase in milk supply (Clavey,
1996)
• Some studies have shown increase
in prolactin and oxytocin
Acupuncture
• Sweedish study showed reduced
breast tension, redness and pain in
patients with mastitis
– (Kvist et al., 2007)
• Cochrane review showed
improvement in engorgement
– (Mangesi et al., 2011)
• Anecdotes abound
Acupunture
• Licensure varies from state-tostate
• Some insurances do cover
• Resources
– http://nccam.nih.gov/health/acupuncture/
– http://www.acupuncturewisconsin.org/
Chiropractic
Chiropractic
• Founded by Dr. David Palmer in
1895
• Defined by the American Chiropractic
Association: “a healthcare profession
that focuses on disorders of the
musculoskeletal and nervous systems,
primarily the spine, and seeks to restore
the healthy relationship between the
body’s structure and function
Chiropractic
• Adjustment
– Restore joint mobility and alignment
by application of controlled force
Chiropractic
• A Doctor of Chiropractic
– 4 year post-baccalaureate degree
– Pass a state licensing exam
• 6 main different styles:
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Network Chiropractic
Network Spinal Analysis
Mixer
• Palmer/Straight
Reform
• Applied Kinesiology
• Objective Straight
Chiropractic vs. Osteopathy
• Osteopath (DO) attends a 4 year
medical school similar to MD’s
• Also learn manipulation
• Most do not use this in practice
History of Mistrust
• Law suits
• AMA
Chiropractic
• Birth injury
– Stiff neck
– Tilted jaw
– Torticollis
Chiropractic
• Indications for baby
– Poor latch
– Clamping down on mother’s nipple
– Poor milk transfer
– Can nurse only in one position
– Poorly coordinated suck-swallowbreathe
– Very fussy and difficult to settle
– Vacuum extraction (Le Leche League)
Chiropractic
• Indications for mother
– Neck pain
– Back pain
– Low milk supply
Chiropractic
• Little published evidence
• Case series of 114 babies with
sucking difficulties
– 78% showed improvement with 4 tx
and were able to exclusively
breastfeed
– Miller et al., 2009
Chiropractic
• Colic or abdominal distress
– Can lead to premature weaning
– One study of 100 infants showed
benefit with chiropractic
• Olafsdottir, 2001
A Word About Applied
Kinesiology
• Mixed study results
• Anecdotes abound
Craniosacral Therapy
Craniosacral
• Dr. John Upledger, an
osteopath
• Gentle, non-invasive,
hands-on technique
• Evaluation of the
membranes and CSF
• OT’s, PT’s, IBCLC’s
Craniosacral
• Indications for baby
– Torticollis
– Colic and irritability
– Infant feeding or sucking difficulties
– Restriction in movement
– Irregular head shape/asymmetries
– Tongue mobility issues
– Traumatic delivery, cesarean section,
forceps or vacuum
Craniosacral
• Indications for baby
– Post frenotomy
• Indications for mothers
– Pain
– Anxiety
– Frustration
– Pelvic tension
– Birth trauma
Craniosacral
• Evidence is lacking
• 1999 meta-analysis of 33
studies found mixed
results (Green et al.)
• Studies were small and of
poor quality
• Difficult to blind or sham
• Considered safe
Craniosacral Tips
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Consider costs
Usually 3-4 session
Response arises over time
Expect to see changes in postural
states
• Suck changes may not come till
after the second visit
• www.upledger.com
Remedial Co-Bathing
Remedial Co-Bathing
• No research
• All theory
• Presented by Australian midwife
Heather Harris at ILCA 1994
• Combines skin-to-skin time with
warm water tub immersion
Remedial Co-bathing
• Calm relaxing time for mother and
baby together
• Chance to re-do their initial
meeting
• Dyad may or may not feed during
the bath
• Present it as something new and
fun to do with baby
Remedial Co-Bathing
• When to consider it
– Breastfeeding rehabilitation
– Mom wants to breastfeed, but can’t
– Mom is not happy and not having
fun with her baby
– Offset the pressure of a rigorous
lactation regimen
– Mother is otherwise
resistent to skin-to-skin
Remedial Co-Bathing Tips
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Low light
Privacy
Warmth (98-102F)
Cup to drizzle water
Cool wet washcloth
Drink for mother
Baby on torso
Have help nearby
Homeopathy
Homeopathy
• Over 200 years old
• Founded by Samuel Hahnemann in
Germany in 1790
• Theory: ultra low-doses of a
substance stimulate the body’s
immune system to react to the
disease or condition
Homeopathy
• “Like cures like”
• For example, ipecac in
pharmaceutical doses causes
nausea and vomiting
• Ipecaucanha can relieve nausea
and vomiting
• Constitutional vs. acute
Homeopathy
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Plant, mineral, animal, food
Alcohol/water for 1 month
Serial dilutions and successions
6X potency = diluted 610 times
The more dilutions, the stronger
the remedy
• No pharmacologic activity
Homeopathy
• Sometimes blended with lactose
or sucrose
• Melted under the tongue
• Dissolved in water or human milk
• Cheap
• Easy to find
• No adverse effects
Homeopathy
• Research is little and mixed
• Meta-analysis found homeopathy
effective in treatment of
– Diarrhea
– Hay fever
– Flu
– Pain
– URI
(Mathie, 2003)
Homeopathy
• No research in lactation
• Common uses
– Phytolacca 30 C for early mastitis or
plugged ducts
– Conium for breast pain
– Chamomilla for teething
– Byronia for engorgement
– Pulsatilla for oversupply
Herbs
Herbs
Keep a list of herbs to avoid
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(T. LowDog)
Aloe vera latex (not juice) (Aloe spp.)
Black cohosh (Actaea racemosa)
Bladderwrack (Fucus vesiculosus)
Blue cohosh (Caulophyllum thalictroides)
Borage (Borago officinalis)
Buckthorn fruit (Rhamnus cathartica)
Bugleweed leaf (Lycopus spp)
Cinchona bark (Cinchona spp)
Cola seeds (Cola nitida)*
Coltsfoot leaf (Tussilago farfara)
Comfrey leaf/root (Symphytum officinale)
Ephedra (Ephedra spp.)
Guarana (Paullinia cupana)*
Jasmine flowers (Jasminum pubescens)
Kava (Piper methysticum)
Madder root (Rubia tinctorum)
Ma Huang (Ephedra sinica)
Pulsatilla (Anemone pulsatilla)
Queen of the Meadow root/herb (Eupatorium purpureum)
Senecio (Senecio aureus)
Wormwood herb (Artemesia absinthium)
Fenugreek (Trigonella
foenum-graecum)
• FDA lists it as GRAS (generally regarded
as safe).
• 1-4 capsules (580-610mg) 3-4 times
daily
• It can also be taken as a tea of ¼ tsp
seeds steeped in 8oz of water for 10
minutes, taken 3 times daily.
• Fiber -> GI upset
• Maple syrup smell
Fenugreek (Trigonella
foenum-graecum)
• Huggins reported the use of fenugreek in 1200
women who had increased milk supply within
24-72 hours.
• Swafford S, Berens P: Effect of fenugreek on
breastmilk volume. Abstract, 5th International
Meeting of the Academy of Breastfeeding
Medicine, September 11-13, 2000, Tucson, AZ.
• Co MM, Hernandez EA, Co BG: A comparative
study on the efficacy of the different
galactogogues among mothers with lactational
insufficiency. Abstract, AAP Section on
Breastfeeding, 2002 NCE, October 21, 2002.
Goat’s Rue
(Glaega officinalis)
• Widely used as a galactogogue in
Europe based on the observation that it
increased milk supply in cattle in the
early 1900’s.
• No human trials for effectiveness have
been done
• Rosti L, Nardini A, Bettinelli ME, Rosti D:
Toxic effects of an herbal tea mixture in
two newborns. Acta Pediatr 83:683,
1994.
Goat’s Rue
(Glaega officinalis)
• Usually used as a
tea. 1 tsp dried
leaves steeped in 8oz
of water for 10
minutes taken 2-3
times daily.
• Also available in
tincture form
Galactagogues
• Blessed Thistle leaves:
– Cnicus benedictus tincture, twenty drops 24 times daily
• Borage leaves: Do not use!
– Due to the presence of pyrrolizidine
alkaloids
– hepatotoxins,
which readily
pass into the
breastmilk
(Panter 1990).
Galactagogues
• Milk Thistle (Silybum marianum)
– Best known for its liver-protecting
effects, has been used for lactation
for centuries.
– There are no human studies
evaluating its purported effects on
lactation.
– No known safety concerns with the
seed.
Galactagogues
• Milk Thistle (Silybum marianum)
– The tea is prepared by simmering one
teaspoon crushed seeds in 8 oz of water for
10 minutes.
– The dose is 1-3 cups daily or 1-3 grams of
the ground seeds in capsule form.
– (Note that this is not the standardized
extract typically used for liver disorders.)
Galactagogues
• Fennel/Barley Water
• Steel cut oats
• Hops: Beer is a convienent source. Can
also use tea or infusion.
Wild Asparagus
(Asparagus racemosus)
• Roots, also known as shatavari
• Ayurvedic tradition to increase milk
production in lactating women.
• Shatavari Kalpa, a combination of wild
asparagus root and cardamom.
• Handful of animal and human studies
that support the lactogenic effect of
wild asparagus, given either alone or in
combination with other herbs (Goyal
2003)
Wild Asparagus
(Asparagus racemosus)
• RCT of A. racemosus in women with
insufficient milk supply failed to find
any effect on milk production or
prolactin levels (Sharma 1996).
• The dose is 1 gram powdered root per
day taken in milk or juice.
Thank You