Transcript: January 2023 Breastfeeding Updates

Hello, hello, and welcome back to the Breastfeeding Talk podcast. I'm your host, Jacqueline Kincer. And today's episode is going to be a little bit like This Week In Breastfeeding episodes that I've done in the past. But kind of more like an update about just certain things that are going on in the world, kind of news items, if you will, and just trying to keep things up to date for you so that you have some great information. 

 

One of the things that I really wanted to share with you was about the Pump Act. If you have not heard about this, this is something that I'm a little overdue on speaking about. But the Pump Act is something that depending on the time of the recording, and when you listen to it, there may be some updates to this, but the US Senate passed a couple of of acts actually, that helps working moms who are pregnant or breastfeeding. 

 

So there's the Pregnant Workers Fairness Act, which is really not a cool acronym. And then the providing urgent maternal protections, which is the Pump Act for Nursing Mothers act. And so these were added to the 2023 spending bill. So they've had they passed the Senate, they're headed to the house for a vote. So by the time you listen to this, maybe that will have been voted on. But basically, the pomp Act requires organizations to provide time and space for breastfeeding parents, we already got some of those protections from the Affordable Care Act back in 2010. So that requires employers to provide reasonable time to express breast milk provide a place for pumping, that's not the bathroom, that's something private with a locking door shielded from view all of that. But there was not those were really protections for like hourly employees, where salaried employees really didn't have, you know, specific break times that were carved out in their day or, you know, it was it was something that, you know, their compensation wouldn't have been affected in any way. 

 

So the Pump Act is extending those rights to all employees, whether or not they're paid hourly or salaried. And that's for the first year of the baby's life. And so they're actually going to categorize, categorize, time spent to express breast milk should be considered hours worked if the employee is also working. So meaning like, if you're in your private office, and you're pumping, but you're also answering emails or on a meeting or whatever it is, then that is not, that's time that you have to be paid for. So that's not considered a pumping break. That's not time that your employer isn't paying you for if you are an hourly employee. So I think this is really, really great, it's nice to see that we're getting some federal protections for these things. So it's, you know, not an end all be all. 

 

But there is a stigma, still, that we found in surveys about moms who are pumping at work, who are breastfeeding moms that are at work, and you know, unfortunately, just you know, having to wash your pump parts in, you know, a public scene, such as shared kitchen, seeing bathrooms, something like that, needing kind of their own space, you know, lactation room or something, you know, these things are still not very well accepted. They're not well adopted. large employers generally do much better with this, but smaller ones don't quite do as well. So anyway, there's a long way to go with that. But we also have the Pregnant Workers Fairness Act, which requires employers to provide reasonable accommodations for any medical conditions that might come up as a result of pregnancy or childbirth. So this is really important to have this, that employers cannot deny employment opportunities to people based on these accommodations. 

 

So it also can have a provision in that act, where employers cannot tell you like HR cannot say to you that you have to take paid or unpaid paid leave, if there's no reasonable accommodation. So if you need to have a different seating arrangement, if you need to have more breaks, more bathroom breaks, especially right you need to be able to have access to a water bottle while you're working. All of these things like they're just basics and they need to be provided. You. So this bill has widespread support from both Republicans and Democrats. There are some people that aren't in favor of this, just kind of making a slippery slope argument, but it's really not building anything other than accommodations for pregnant people. So I'm excited for this one, this is long overdue. I know there are a lot of people that during their pregnancies have had to make the difficult choice whether or not to remain employed, because of various issues with getting accommodations or complications that they have had. 

 

And I think that that is really unfair, you know, if we're going to live in a society where it's essentially needed to have a two-income household, then it's really unfair to not provide these accommodations for both pregnant and postpartum workers that enable them to remain in the workforce, you really shouldn't have to choose between having a child and working, you should be able to do both, if that's something that you want to or need to do. So anyway, there's some great progress being made there. You know, state, stay tuned with the news on this. And you know, just because something gets signed, it doesn't mean that it goes into effect just yet. So pay attention to that, once these laws are passed, which I assume they will be. And once they're in effect, these are something that you're gonna want to make sure you bring to any employer. 

 

And ideally, a good employer will start adopting these things before they're required to But oftentimes, the dates set for these things being adopted are later than we would like, or they're kind of, you know, grandfathered in, or sometimes, you know, employers are given a longer time or things happen once the Act is passed, where, you know, there's some amendments that are made or something like that. So just if it's important to you, if you are a working mom, I would encourage you to just, you know, keep your eye on these sorts of news items, because they'll apply to you for sure. Um, the other thing I wanted to talk about, is really just that there's been some articles that have come out sort of an expoze, if you will, from CBC. So that's Canadian news network. And it's about the drug Domperidone. And I shared this over on Instagram not too long ago, really in the stories, but I wanted to talk about it on the podcast. 

 

So if you're not familiar with Domperidone, it's also called Motilium, outside the US, and it's a medication that can be used for helping you increase your breast milk production. However, it's not the end all be all, it doesn't work for everybody. And there are absolutely some problems with it. And normally, the problems with it have to do with cardiac issues and Qt intervals, in terms of, you know, heart function. So that's something to keep in mind. And that's really why the FDA and the United States has not approved Domperidone for lactation. So it's very difficult to get in the United States. Most of the time, if a mom is taking it here, she's getting it from another country. Sometimes a physician can prescribe it in the US if they're willing to and you can get it filled at a compounding pharmacy. But it's off label, it's really not easy to get. And so unless you're in the another country, you probably aren't very familiar with Domperidone. And I don't necessarily think that you should be I've absolutely seen where the due diligence isn't done. 

 

So Domperidone is really something that would potentially increase prolactin levels. Prolactin, if you're not familiar, is a hormone that is manufactured by your pituitary gland. And it is really the main hormone that drives lactation that drives breast milk production. So sometimes one of the causes for low milk supply is having too low of a prolactin level. Now prolactin is one of those things that it's not just something that happens, you know, in a vacuum, it also is driven by how much breast stimulation and how much milk removal there is. So it you know, yes, it is produced. prolactin levels can rise once the placenta is burst and progesterone levels drop. So there is just an endocrine function that happens there. But there's also an autocrine function in terms of breast stimulation and milk removal. So I see a lot of times that moms are prescribed on Peridot but no one's ever done the lab work to check their prolactin levels and the way that prolactin is tested and how long after milk has been removed from the breast. And those labs are drawn the bloodwork has drawn depends on you know, kind of the result that you're expecting to see on the lab work. And so most providers really aren't well trained in looking at lactation hormones, unfortunately. And my thing is, I don't want to have somebody be prescribed medication without them needing that medication like yes, we can guess and test. But bloodwork is pretty simple to do. 

 

This is a really inexpensive test. It's usually covered by insurance in the United States. It's not always, I can't speak for other countries and in their health care systems, because I'm just not very familiar. But why not do a simple blood test before we throw a medication at someone that potentially has some side effects. Domperidone is actually also primarily used as a gastrointestinal medication. So it increases movements or contractions of the stomach in the bowels, it can also treat nausea or vomiting that might be caused by other medications. So that's really its primary purpose. The interesting thing about that is that oftentimes, you know, you have an increased appetite, when you're lactating, just by virtue of how many calories you burn to make that milk Domperidone can greatly increase your appetite and increase weight gain. So that's an unpleasant side effect for a lot of moms, especially after they've had a baby. And they're already carrying some extra weights. 

 

So I've seen that happen, you've usually you're going to the bathroom more often, because of those increased contractions, which for some of you might be a good thing for others of you, maybe not so much. So those were kind of the side effects that have been known for a very long time. In places like Canada and other countries, it's very common for providers to throw a Domperidone script at somebody, I am really, of the of the perspective that if you are prescribed a pharmaceutical for lactation, it should be taken for the least amount of time possible, it shouldn't be taken at the highest dose that you can take, it should be taken at the highest dose that's effective for you. Sometimes taking Domperidone at an effective dose for a short period of time, you can potentially wean off of it and maintain that level of milk production, it just depends. But I will say that Domperidone absolutely does not work for everybody, it really doesn't. And I find a lot of moms get their hopes up, they order the medication from overseas or what have you, you know, they go through great lengths to get it. And they find it didn't work, or it provided some sort of initial benefit, and then none or you know, a minimal benefit. And unfortunately, their side effects. But I want to bring your attention to something that was covered in this article that is really important for you to know is that there are reports of a lot of women experiencing some very concerning psychiatric thoughts and behaviors when they quit Dom theradome. Like kind of alluded to this already. 

 

But DOM paradigm is something that really like a lot of medications, but this one in particular, ideally, it's best to wean off of it very, very slowly, one so that you don't create some sort of big hormonal crash, which may be behind this, this reason why some women are experiencing these side effects and these effects, but to that you don't crash your milk production, right. So if you took it, you got benefit from it, right? You don't obviously want to just stop taking it overnight. So talk to your doctor about that if this is something that you've been prescribed, you know, nothing I'm saying here as medical advice is just sort of general knowledge about Domperidone. So this article highlights, you know, trigger warning, some severe psychiatric symptoms that people have experienced when weaning off of Dawn paradigm. They talk about very specific people sharing their stories of people just you know, having some odd symptoms, like bumping into things, but then also starting to have panic attacks, intrusive thoughts, self harm thoughts, suicide attempts, and really just feeling horribly depressed and a little bit crazy, often very, very anxious guilt, panic, all of these terrible feelings that have come on. And it's really things that they're seeing our withdrawal symptoms. 

 

So stopping this medication, even people who have really tried to wean off of it more slowly, have still experienced a lot of these things. And of course, this is very concerning, because one, postpartum is sometimes a crazy time for your mental health, right, you've got a lot of different things going on, you've got a lot of hormones at play. So on a biological level, there's a lot going on, but also obviously, just mentally, emotionally, sleep eating, all of these things can be disruptive, right? And you can have postpartum depression, postpartum anxiety, you can already have a baseline, you know, kind of something going on with perinatal mood disorder or something previously existing. But there were a lot of moms that they were talking to, I think it was nine in the article total that they were having panic attacks, insomnia, intrusive thoughts, they were so severe that they were unable to function normally in daily life, they couldn't care for their children. Some of these people had to stop working, they had to move in with family, one woman tried to take her own life, and they were completely unaware of these things that this could potentially happen. And so I'm sharing this information with you because whether or not this is something that's just highlighted in this article, or is more widespread, and we just don't really know about it or talk about it because truthfully, as lactation consultants, you know, absolutely we do weaning consults. Asians most of the time we're doing, you know, consultations for people who are looking to continue breastfeeding. Right. So they come up here and there. But generally speaking, whenever I've done a weaning consultation with someone, you know, they've had a very successful breastfeeding experience, or they've kind of given it their all and they've come to a certain point, but we're not helping them wean off of a medication, because that's not what we do. We can't prescribe medications, so we can't unprescribed them. 

 

But to just I would say, it's really uncommon when we're doing a weaning consult for someone to be on Domperidone at that time. So we as lactation consultants, have really not seen this, this would be something that's more happening with mental health professionals may be, you know, an obstetrician gynecologist, primary care provider, something of that nature, a midwife, something like that. So I think it's really unfortunate that there's not been really anything in the documentation on this medication about these potential effects, you know, don't know if this is really related to women who are postpartum or have been lactating? Or is this something that if someone's taking this drug for gastrointestinal purposes, are they experiencing this, when they wean off? Does this happen to men does happen to people that have not gone through, you know, childbirth, we really don't know, we don't have enough information. But I would say that this article highlighted some severe psychological effects that, you know, really are very concerning. And if you don't know about these things, it's very difficult for you to make an informed decision to go on a medication, and from what we're learning, and what I've known about the medication for years as a lactation consultant, you know, this is not something that your doctor is going to know unless they happen to see this news article. There isn't really anything that's, you know, totally out there and just released other than this article, and it getting some traction, thankfully, a lot of traction. 

 

But we don't know what whether you'll or not, you'll experience these symptoms in advance. We don't know how intense they'll be we so you know, it's really unknown. But it's something to be aware of that if you're thinking about going on Domperidone, or maybe you're currently taking it, this is something that you want to think about this article is linked up in the show notes for you. So this is something that I would encourage you to talk to your provider about. And just, you know, look up the reasons why the FDA has not approved this drug in the United States. I think those are important things to know, too. Because again, there's other side effects. Besides, you know, severe psychological symptoms, there are some of these case studies that have been published in the Journal of breastfeeding medicine. But beyond that, we just don't really have a lot of research about this. So I'm sharing this information with you to just put this out there, create awareness around it, I'm not saying Domperidone is good or bad. You know, as with most medications, there are risks, there are benefits. So knowing all of those things is really, really important, because then you get to make the decision that's best for you. Right? So if you're well supported, if you already have psychological support in place, then maybe this is something that would be okay for you. But again, I would also just really encourage your provider to be educated on whether or not Domperidone would be helpful to you, if it's something that they're thinking about prescribing for you or something they're suggesting, like, is there enough benefit here? You know, will you get the therapeutic benefit that you're hoping for or that your provider is hoping for, you know, ask good questions, because it's just concerning. You know, the other thing that I'll say is there's another medication out there, really kind of the only other one for lactation and that's called Reglan. And if there's anything that's prescribed for lactation in the US, it's Reglan, not very commonly, I find it's pretty rare. But Reglan already has a blackbox warning on it for these same side effects essentially. So, there have been suicidal thoughts, suicide attempts, severe psychiatric psychological side effects from taking Reglan. So not even weaning off of it, but actually taking it. So I generally counsel any patients that we have, who are considering this or their their provider is considering prescribing this drug hate, you really need to make sure that you're making the people that you live with aware of these things, so that they can, you know, keep an eye on your behalf. You need to make sure that if these things are happening, you talk to your doctor right away, because again, it's very concerning. 

 

So there must be some, you know, mechanism of action here that is potentially causing these symptoms to happen. And with Reglan, you know, usually it's a short course, it's not something you stay on the duration of lactation. But I've seen with Domperidone that people take it a lot longer. Oftentimes they stay on it the entire duration of lactation. So these things are just something to keep in mind. Unfortunately, we don't have really good or I would even say safe pharmaceutical options for helping with lactation. There's just not enough research in these areas. It's so frustrating. It's frustrating for us as lactation consultants, it's even more frustrating for all of the moms out there who would love an excellent solution. And honestly, I feel like it's something that drug companies should really get behind because there are a lot of women out there that really want to breast feed, they will pretty much do anything a lot of the time. I mean, you know, if you're one of those, you've spent money on cheese and expensive pumps, and lactation cookies, and lactation consultants and maybe supplements like, it all adds up, right? It's a lot, there was perhaps a medication that could help you that, you know, didn't have those kinds of concerning dangerous side effects. Gosh, you know, that would be a really great option for a lot of people. I will say the reasons for low milk supply are not just simply, you know, a low level of prolactin, right, there's many other reasons. And so thinking that, you know, a drug is going to be the miracle cure for you, you know, may not be the case, right? There's, there's different reasons why it happens. 

 

But that's where medical decision making comes in. So anyway, I just wanted to share this information with you something to think about, if you have a friend who's taking this, you know, make them aware, just send them the article, you know, if you have a doctor that's thinking of prescribing you, or has prescribed you these medications, you know, bring this article to them, you know, print it out, bring it with you share it with them have a discussion, because the last thing that we would want is for somebody to come into this, you know, really, I think the point of the new story is that, you know, these moms came into this having no idea that this was a possibility. And all of a sudden thinking that, you know, they're going crazy. And essentially, that's what was happening, right, they really didn't know, obviously put two and two together at some point. But you know, completely unforeseen and, you know, obviously this could have all been avoided, I will say that there is no time ever that I would ever replace, you know, the importance of providing breast milk to your child above the importance of you being mentally and emotionally safe. I really wouldn't. 

 

There is no medication, you know, that is worth that, right. So I'm not saying don't ever take these medications, but what I am saying is that, you know, they come with concerns, and maybe there's a predisposition for you there that you would have a greater concern for something. But the last thing that we want is for people to be, you know, even just suffering mentally. But oftentimes, these things are actually, you know, creating physical symptoms and manifestations as well. And that's very, very scary. So you probably don't want to go to the hose lengths to provide breast milk. There are some moms who are really, really invested in it, and seemingly will do anything. So I would just say, you know, word of caution there, make sure that you really know what you're getting yourself into, that you have fully formed consent around anything that you do or take, because it's really important. And I felt like this information was important enough to really kind of spend the majority of this podcast episode on it, because I would just hate to see this happen to somebody else. So if you do find that you take a medication, this is true for any medication, by the way, it just you you have some unexpected or unintended side effects. Something is problematic about that medication that is not already known. If you're in the US, you can actually report that to the FDA, right? Oftentimes, the manufacturer of the medication, whether, you know, every generic also has a manufacturer or brand, right, you can report that to them as well. So I would encourage you to report those things. Because the more that you do that the more attention that it gets. And ultimately, that's how news articles and awareness like this come out. 

 

And hopefully, this will spur some more studies, they will look into this, they will discover, you know, potential mechanism of action, maybe something like this will actually generate more research or innovation into pharmaceuticals for assisting with things, you know, regarding lactation and breastfeeding, that would be great. So I'm glad this information has come out, I'm glad that I have the opportunity to share it with you. And I would just say that, you know, really looking at the facts, not just looking at one side of the of the story. You know, there are many people that have had great success with Domperidone. But sounds like there are also many people who have not, and knowing those things before you get yourself into something that you know may be difficult to reverse or change is really, really important for you to make a solid decision. So that's what I have to say about those topics. I also have just seen, you know, random things kind of online floating around about some celebrity that, you know, feels the need to share something that really impacted them with breastfeeding. And they, you know, kind of make these blanket, you know, warnings or advisories to their followers, I would really encourage you to not follow that kind of advice. 

 

And I would really encourage you to stop following influencers for healthcare related advice in general. We've seen this as healthcare providers that there's a very ill effect, especially during the pandemic where people are getting their information from these online sources that are just not reputable. They're not to be trusted, and it's quite sad because it can sound very believable. It can sound like someone has the right experience to guide you in something but not necessarily, and one of the status things that I've seen is literally a colleague of mine, Dr. Dave soukous. He was on an earlier podcast episode about food allergies, and intolerances in breastfed babies, and breastfeeding moms, he posted, gosh, I It's been several weeks now about social media for medical professionals. And he really just expressed some feelings of exhaustion and frustration. And he wanted to post online just, you know, in his free time, which he does not have a lot of out of the goodness of his heart, some really solid information about allergies. And he's been doing that, but he is just feeling really defeated about misinformation, that social media algorithms are promoting promoting influencers, or people that are peddling, you know, emotional anecdotes, or sometimes pseudoscience. And these things sort of go viral, right? They become more legitimate when somebody has more followers. And he was just kind of talking about how science is often very boring. And people want easy answers, and they want quick fixes. And you know, people are buying into these fees promise people are buying into these false promises. 

 

And I can absolutely see his point. I would say that I agree that there is a frustration, absolutely. On our part, right. That's why we have the podcast and also Instagram. But it's very, very often with with clients with patients that we're hearing these things inside the nurture collective members share things and say, Well, I heard you know, XY and Z is something you should avoid or, or that this is, you know, something that's helpful. And it's like, well, no, it's not, we have to come back to the science to some degree. I think anecdotes are powerful. And they are to be believed. But we also have to come at that with, you know, proper medical, like training and knowledge of all the available science out there in order to discern, you know, is that just some, you know, correlative behavior or outcome that has nothing to do with the intervention that's being described? Or is there may be some real, like, health, medical validity to that there's a balance and all of this, but we can't just, we can't just believe things from an emotional perspective, right? 

 

We can't just believe things from, you know, this idea of, wouldn't that be nice if a batch of lactation cookies, you know, got me pumping? A full milk supply? Yeah, that would be great. Okay. Is it realistic? No, is it based on science? Not really know, you know, if lactation cookies do it for you, either you're not consuming enough calories, or enough carbohydrates, or, you know, just the right types of foods. It's not the sugar guarantee. That's not going to do it for you. Maybe it's the fiber, maybe it's it's the grains, maybe it's simply calories, right, whatever it is, you don't need a cookie to do that, though. There's other ways to get that kind of benefit. So I share that with you just to say that, should we believe people stories? Yes, absolutely. Especially when we get to a certain threshold of a number of people. And we can sort of, you know, narrow it down to it's not something else. It was absolutely that, you know, it's like people say, you know, I was blue Gatorade for years, and now it's body armor, and probably something else, you know, oh, these electrolyte drinks, you know, they they made me make more milk. Yeah, electrolytes are important for lactation, it does not need to be a specific color of Gatorade, it doesn't need to be a specific brand of a drink. In fact, I don't think that you need a specific brand of anything. I do think that yeah, in general, for us to be healthy, we need a certain amount of electrolytes. This has been known for a very long time in medicine, whether or not you're lactating. So yes, that's important. That comes from diet, it comes from hydration, it can come from, you know, supplements of some kind if you're generally very deficient. 

 

So that's important. But to say that moms who are struggling with milk supply just need to go and buy XYZ brand of a drink or this particular flavor or what have you. That's simply not true. And I think that does a big disservice to people. So just tempering that, right? We've got to temper expectations, we've got to kind of put a filter on things. I do think critical thinking skills are something that you know, really all of us are completely capable of, if you understand that social media is designed to keep you on it, right? It's kind of designed to be addictive, if you will, it's designed to influence you. It's, you know, just taking a moment to just pause and reflect like, Should you immediately share that piece of information? Should you dig deeper and see if you can confirm that elsewhere? Is it something you should immediately believe these are all good questions to ask? Which is why I said what I said about the whole Domperidone issue coming out, you know, is this something that I would expect to happen for every single person who takes it? No, definitely not. I really hadn't heard of this happening and neither had most of my colleagues until this article came out. 

 

But then seeing that there have been published case studies in a peer reviewed journal. Seeing that, you know, this is definitely something that's been happening with more people than we previously knew. It sort of reached a threshold to come out on a legitimate news outlet, again, seemed more of a piece of investigative reporting. So this is something that yeah, we want to keep this in mind. And we want to dig deeper, right? If you ever read a really, really good study, oftentimes at the end of that study, it will say, well, more research is needed to confirm or to look into why this is happening. There's usually a call at the end of that study, in the conclusion, or in the summary to say, more research is needed. And I would agree, I think we always could use more research. So anyway, I just wanted to share all of that with you, to give you some things to think about to keep you informed. And if you ever have any questions about something that maybe comes out in the news, or a little hack that you've seen floating around, you know, by all means, you know, go over to Instagram, follow us, at holistic lactation, send us a DM, ask us a question. Maybe it's something that, you know, we generate a post out of maybe it's big enough that we cover it in a podcast episode. But either way, when we get to hear those things about what you're experiencing, what we're being exposed to what you're seeing out there, the algorithm is going to treat you differently than it will us. So let us know if you have any questions about things like that. 

 

And we're always happy to give you the best possible answer that we can or share some great information or create sort of a correction of misinformation, if you will, that is shareable. That is well communicated, and creates a clear message so that you have a good understanding of what's really going on. So thank you for being a listener. I appreciate all of you who are also subscribed to the podcast. If you haven't had a chance, please, please, please head over to Apple podcasts. Leave us a review. Even if you've never done it before, it's really easy. You just pick however many stars, five is obviously the best and provide your feedback. Honest, feedback is great. We'd love to hear it. And if you appreciate the episodes in the show, share it with a friend who could use this information. Let your child's pediatrician know that this podcast has helped you. It's something they can easily for free pass on to their patients. So we appreciate you all out there who our listeners who enjoy the show and who share it with many. Thank you so much for your dedication and I hope to talk to you on the next episode