Episode 43: This Week in Breastfeeding - Mar 5, 2021

Welcome back to another episode of Breastfeeding Talk: Milk, Motherhood, Mindset. I’m your host, Jacqueline Kincer. And this is another installment of This Week in Breastfeeding. Today is Friday, March 5, 2021. And I’m excited to bring a lot of cool information to you that has come up over this past week. In fact, one that’s making a huge amount of headlines. And I might as well just start there is that there is a preprint which is a study that has been released that has not yet been peer-reviewed. So meaning it has not been published in a journal it has not been certified by peer review. So you know, you want to keep that in mind when you’re determining levels of evidence and things like that. But I’m glad that it’s getting as much attention as it is because there’s really no surprise about the results in this and we’ll see what happens once it goes through the peer review process. But it’s called SARS cov.

Two antibodies detected in human breast milk post vaccination. The authors on this are Dr. Jill K. Baird, Dr. A PhD, Sean M. Jensen, Walter J. urba. Bernard, a fox and Jason are bared. So I will say there’s definitely some limitations to this, because I think they only have six women in the study. So yes, six lactating women who received two doses of SARS cov, two vaccine. And they observe significantly elevated levels of SARS cov. Do so, SARS cov to specific IgG and IGA antibodies, and breast milk beginning at day seven after the initial vaccine dose. And it was actually an IgG dominant response. So they found that very interesting, because normally, we would expect an IGA dominant response in breast milk of previously infected or exposed women. But since this is post vaccine, they’re supposing here that because the vaccine is ingested, injected intramuscularly, that there’s more of an IgG dominant antibody response. Whereas IGA would be more prominent if you had, you know, an infection occurring in the mucosa. So that’s very interesting.

You know, either way, there are some benefits to getting the vaccine while you’re breastfeeding, and it’s offering antibody protection to your infant. And what’s really important here to keep in mind that they didn’t include in any of their discussion here, though, but breastfed babies, all babies really, but their guts, their gut lining is open for about the first six months of life. And it is open because breast milk is a living tissue full of antibodies, full of stem cells, you know, all sorts of immune benefits and obviously wonderful nutrition on top of that. And that means that those those things go into your infants guts, and then they are able to go into the bloodstream into the body to offer that protection to your infant.

So breastfeeding, especially exclusive breastfeeding in the first six months of life is massively important for the immunity of your infant. And this is just another study showing that. So again, the sample size is small. One interesting thing that I thought they found that was very, you know, similar to what we saw in the trials with vaccine participants with mRNA vaccines was that the antibody levels initially, sort of, you know, spiked at day seven post vaccine, and that’s consistent between Maderna and Pfizer bio and tech vaccines, and then the levels of IgG. And IGA actually decreased prior to the administration of the second vaccine dose, and then it sharply increased after the booster. And what I like about this study is that they did they took samples of the breast milk, you know, pre vaccination, and they showed that there were, you know, really non existent levels of antibodies to SARS, cov to pre vaccination, and then they took samples at one day, four day, seven days, 11 days and 14 days post vaccine first vaccine dose when they fall that same schedule, post Second vaccine dose or the date the dose of the booster.

So showing that, really the booster is needed to provide a higher level of antibody response, and that what we’re seeing, actually in people who’ve been vaccinated translates directly to what we’re seeing in the breast milk samples that they analyzed. Some limitations of the study, again, are the small sample size. The other limitation there would also be that they didn’t measure the babies. So I would love to see a study where, you know, obviously, one with a bigger sample size, and also one where we look at the infants who are breastfed, I would like to see it to be one of infants that are exclusively breastfed, maybe you can even do compares exclusive breastfed infants to, you know, partial breastfed partial formula fed something like that. You know, that would be interesting, as well, as you know, obviously, infants who have receiving no breast milk, we would not expect them to have any sort of Spike protein antibodies, that would be impossible.

But I would love to see that. So you know, not Pooh poohing the study at all, I think it’s great. I’ll be interested to see what happens once it’s out of preprint status, but it’s available full text online, I’ll definitely link that up in the show notes. For those of you who are interested, it’s a real short read, it’s eight pages, they’re happy to look through the methods and things like that. So very, very good news, honestly, because I know there’s been some concerns about, you know, these mRNA vaccines now, Johnson and Johnson has received EUA here in the United States, less is known about that, because, you know, it’s a vector vaccine, it’s a different type of vaccines, not mRNA. So, you know, different mechanism there. So we don’t have as much information on that. But that being said, I know, this has been stated numerous times, by all sorts of medical authorities, though, that the mRNA itself is going to be very, very unlikely to ever make its way over to the breast tissue, let alone into the breast milk, even if by some weird off chance it did, it would be ingested by the baby and destroyed in their gut. It does, it’s, it’s their stomach acid would break it down very easily.

So, you know, that’s, you know, and obviously, even if they did adjust, it’d be, you know, very, very small sort of dose or whatever. But keep in mind that these are injected vaccines, not oral vaccines, they’re not meant to work through the oral cavity. So just something to keep in mind that, you know, we’re getting some more evidence here that vaccinating lactating individuals is very safe when it comes to these mRNA vaccines. And also, it’s doing a good job of providing immunity to the infants. So I think that’s just really cool. So I love science. I think that’s super cool. Now, I wanted to go over to this article, this is from the British Medical Journal. And I didn’t pay to access the full text. So full disclosure on that, but it’s an article here called postpartum thyroiditis. You know, this is one of the one of the biggest issues I actually see when I’m working with clients to be honest with you. Sometimes it’s known that they have thyroiditis other times, it’s not known and it’s gone undetected. And they make some really good points here. And again, I didn’t access the full text, but from the beginning sort of narrative that they share in this, I do have a couple of things there that I don’t agree with them on this, and I’ll share that with you here just in a moment.

But basically, what they what they stayed is, you know, just a bullet point, sort of beginning what you need to know. And it says that simple symptoms of hyperthyroidism, or hypothyroidism can be overlooked as quote unquote normal in the postpartum period, resulting in delayed diagnosis and treatment of postpartum thyroiditis. Yes, absolutely true. I see this all the time. In fact, it’s a huge struggle for any of my clients to get proper lab work done by their endocrinologist or their OB or their primary care physician. Often the orders, you know, they don’t do a full thyroid panel, which I feel like should be done. This article says that all we need to check is TSH. I don’t agree with that. TSH is levels are going to pick up you know, a more severe problem, but we’re not going to know exactly how to treat thyroid problem less, we’re looking at other other things on that thyroid panel. And too often, it’s just done far too late in the game. You know, if you’re not doing your postpartum follow up till six weeks, you know, the first two weeks post birth are the most critical times for establishment of your milk production.

So if you’re going to wait until you’re six weeks postpartum to get tested, we’ve lost that window and the chances of you recovering your milk supply or coming up with a full milk supply if a thyroid issue is the cause of low supply are pretty low. And that’s just poor treatment. So their next bullet point is what I disagree with Testing of thyroid stimulating hormone levels recommended during six to 12 weeks postpartum among high risk populations, and patients experiencing postpartum depression lactation difficulties or multiple symptoms of hyperthyroidism, or hypothyroidism, six to 12 weeks, it’s too late folks way too late. And also just from a postpartum depression perspective, that’s way too late. We should not be waiting two or three months to get people out of postpartum depression. Those are critical times for mothers to bond with their babies and to start feeling and in gaining and earning their confidence in motherhood. They may be returning to work in that timeframe. So we’ve missed a critical window for them to enjoy their time off on their short maternity leave here in the US. I don’t agree that we should wait six to 12 weeks postpartum, I think it’s way too late. Now, I don’t know that testing two days post birth is worth it.

Because there’s such a shift in hormones that we would absolutely expect. Maybe one to two weeks, I really don’t know, I’d like to see more information and research on that and what the optimal timing is to do a postpartum thyroid check. I don’t necessarily know that we should necessarily look at only high risk populations. I think, really any postpartum woman these days, I could consider high risk for thyroid issue, not just because of, you know, hormones and things like that, but stress, the birth experiences that a lot of women are having, especially amidst a pandemic. There’s so many reasons why we should be checking this on way more people. So, you know, they actually get this example here that contradicts their own recommendation. This is how it starts out. It says, a 27 year old woman with type one diabetes presents at four months postpartum, after the uncomplicated pregnancy and delivery of her second child complaining of hair loss, anxiety, irritability, and insomnia. She recalls that following her first pregnancy, she had a gradual onset of fatigue, weakness, sleep disruption, low milk supply, and a halt and weight loss at approximately three weeks postpartum. So just to interject here, she noticed the symptoms that three weeks postpartum with her first child, but they’re recommending we don’t even check until six to 12 weeks postpartum.

Now, she’s never been checked for thyroid issues, she has a second baby and she’s experiencing the same or more issues. This is unfortunate, this is really a lack of care. So then they go on to say after a few months trial of antidepressants was ineffective. And you know, that to me just are man that makes me a little angry just because there are some real side effects to antidepressants. And we should not just be willy nilly dismissing women’s, you know, physiological complaints as some sort of mental health issue.

That’s medical gaslighting, and I think it’s just super sad. So they go on to say a thyroid stimulating hormone level was drawn and found to be elevated, her symptoms improved after initiation of levothyroxine replacement. For this presentation, she is again prescribed antidepressants for postpartum depression. But after these are ineffective, ineffective TSH level is drawn and found to be low or feeling hyperthyroidism. So mean, we’ve got to do better as a medical community. I like that they’re bringing attention to this, I like that they actually recognize that thyroid issues cause lactation difficulties. So at least there’s more of an awareness of this, I’d love to dive in more to the full text. If anyone has access to that. I’d love for you to send that to me, but I’ll link this up in the show notes. But basically, you know, if you’re noticing some symptoms, please don’t wait six weeks to talk to your provider about anything that you feel like is off. You know, unfortunately, dysfunction has been normalized, especially for women.

This is true, whether or not you’re dealing with motherhood or parenthood on any level. You know, it’s it starts with menstrual cramps and getting dismissed and being thrown on birth control, rather than looking at what’s really going on. So I would love for the medical community to recognize that this is an issue and that it needs to be treated much sooner than six to 12 weeks, a mother who’s experiencing severe depression and all of these other symptoms, if the issue is not truly just isolated depression on its own, but there’s something physiological going on as the basis why are we making her wait, why are we prolonging her suffering? This is not just impacting her, it’s impacting her entire family.

So you know, I just really a message to you providers out there, if you are listening to this, please, please, please be following up with your patients much sooner than that six weeks postpartum. I really wouldn’t wait any longer than two weeks. If it was up to me. Just seeing this population and seeing how much they struggle and lack support during this timeframe, especially with a pandemic and just medical care in person being so much more limited. I just breaks my heart. So anyway, enough about that topic. Um, you know, this is an article that I saw come out of Australia actually It was a ABC, Australia. And the headline here is midwifery researchers find teenage obese and smoking mothers are less likely to breastfeed. Yes, that’s, that’s actually very, very true. And so they go on to talk about kind of some personal experiences here that, you know, this, that, especially young mothers are feeling like, it’s it’s pushed on them to breastfeed, and they’re not really, you know, they don’t have a lot of education.

In fact, one is quoted here saying it really didn’t have anything to do with midwives, doctors or lactation consultants. It was just because I was a bit more experienced in what I was doing with a baby. This is just an interesting, interesting quote. Because, you know, teen mothers have a lot going against them, unfortunately. And, you know, I think that, from what I’ve heard, just, you know, with colleagues and whatnot, that it’s sort of expected that teen mothers aren’t going to breastfeed, so therefore, they’re not offered the same level of education and support in the hospital setting, or prenatally, which is really, really unfortunate. So there’s vulnerable populations out there, we’ve got to be, you know, doing a better job of recognizing those populations screening for them.

And, you know, breastfeeding is something that often gets missed. Right. So this is an interesting quote here, it said, there isn’t an area of medicine, which covers breastfeeding, despite it being a key thing, which happens in a woman’s body. Yes, that is true, we have ibclcs, but we don’t have, we don’t have a physician level breastfeeding expert. So you know, we have a, we have a podiatrist, there’s doctors for feet, but we don’t have breastfeeding doctors, you know, that’s always kind of blown my mind. So, you know, doctors can actually, you know, absolutely take it upon themselves to study more, but it’s not an official specialty. So, you know, I think that’s, that’s just a huge issue there. And I liked that they brought attention to that. So that’s really awesome.

You know, I don’t I’m gonna keep this actually probably pretty, pretty short and sweet. This episode today, but this one came up in another article, and then I saw it again, pop up on my news here. And the headline is Facebook breastfeeding group allows, quote, unquote, creepy men to pay to secretly look at photos. If you’ve not heard about this scandal, I encourage you to pay close attention to this, especially if you’re breastfeeding mom, I have always discouraged people from going to free Facebook groups for breastfeeding support. The reason is, is because if you’re having breastfeeding problems that you cannot self resolve, chances are, you probably need to be working with a lactation consultant. And so when you go on a Facebook group, and you read posts of other people’s situations that are not your own, and probably don’t have the same root cause as your own, and you try to apply that advice, advice, it ends up not working, and then you’ve wasted more time, and you become less confident with breastfeeding. And ultimately, it tends not to lead to breastfeeding success.

Now, I know there were probably people that have hopped into groups and gotten some good tips. And it’s got them through or at least they they really enjoyed the encouragement of the fellow members. And I would say, the real role of these groups should be encouragement and support of you in your journey of breastfeeding. But it shouldn’t be tactically trying to address breastfeeding problems. The other issue I’ve always had with these groups is lack of privacy. Very often mothers are posting photos of them pumping breastfeeding injuries to their breast, what have you photos of their baby’s diaper patches, I mean, you name it, you’d be surprised if you’re not in these groups. And that’s really one inappropriate and two, you’re asking for medical advice. So anybody that’s running a group like that, and giving advice is is doing something that they shouldn’t be doing. So that’s super problematic. But the other problematic factor here is that there was a group of 22,500 members were the administrator got found out that they were accepting quote, unquote, good money from men in Facebook message to another Moderator.

So the moderator was getting some odd messages from men and reached out to the administrator and said, Hi, I just wanted to reach out and let you know, there are some men and fake accounts in here. I got some disturbing messages from one and wanting to let you know, the administrator wrote back and said, Yes, thanks for letting me know. Don’t worry about those profiles. Then the moderator responded, but that’s pretty creepy, though. No. Then the administrator said listen, those profiles pay good money to be in the group. I would appreciate if you stepped back. I will be removing your mob status not sorry it didn’t work out. I assumed Just a typo. And she meant now. So yeah, there were, you know, unfortunately, women there who were thinking that they’re there to get some breastfeeding support, and what have you and men are messaging women asking to buy their breast milk, they are downloading these photos and doing what God knows what with them, and just sending some very creepy messages.

And so the group is apparently now shut down. But it’s very disturbing and the fact that the moderator was accepting money in exchange for this. So sometimes when you get what you pay for, and when you don’t pay for something, unfortunately, you can find yourself in some troubling situations like this. So anyway, just sharing that to send a word of caution to you all on that front, because, you know, there is a an online sort of support education platform that I’ve been working on for a long time that I’m putting together. And one of the things that I’m going to make sure that is not allowed in that sort of forum, that community is posting of photos. And that’s for your protection, really, it’s not because I don’t want to help you. But you know, when I exchanged photos with my patients and clients, we do it through, you know, a HIPAA secure app and things of that nature.

Because, again, I value your privacy, I want to make sure that there’s nothing odd going on there and all of that. So just be careful. You know, that’s, that’s all I would say, use your best judgment. But you know, just definitely need to do more to protect yourself online these days, unfortunately. So, um, yeah, just sharing that with you. I know that’s kind of a weird sort of topic, but I think it’s an important one to discuss. So that pretty much wraps it up for this episode. I wanted to keep it short and sweet, really just sharing some important things health-wise here, about COVID vaccines for breastfeeding postpartum thyroid issues, and then online safety and free support groups. So I hope that’s been really helpful to you. And if you enjoy the episode, you know, definitely make sure to share it with anyone you think it’s relevant to. And I will talk to you on the next show.