PCOS and Breastfeeding

Recently Deseree, a third time mom with a history of PCOS, asked a question about how to avoid a milk supply problem when her next baby is born.    To summarize, she has attempted breastfeeding twice, both times her breastfeeding started out well with initial physiologic engorgement, her milk “came in” and the babies were eating well.  At two weeks old however her babies were not gaining weight.  She is now 37 weeks pregnant and wants to know what she can do to prevent a third disappointing breastfeeding experience.

First it is important to say that what Deseree needs most is a supportive and knowledgeable lactation consultant who can complete a full history and breast exam to rule out the most common problems.  Since the problem happened for both of her children I will assume that the issue is maternal and not a newborn issue, but that is just an assumption.  Deseree, it is important that you first look for the low hanging fruit; are you eating a balanced diet (Vegans, women with absorption issues, gastric bypass patients all are more likely to have an infant with slow weight gain).  Next I would like to do a complete physical exam to rule out breast issues, hypoplastic breasts or those with inadequate glandular tissue would also raise a red flag.  Finally, I think it is important to ensure that breastfeeding begins on a positive note with as few barriers and booby traps as possible.  I always recommend prolonged, uninterrupted skin to skin contact until breastfeeding is well established.  Assuming that all of the easy fixes have been addressed, I think the most likely source of your trouble is polycystic ovary syndrome (PCOS). 

Polycystic Ovarian Syndrome is an endocrine disorder that affects up to 15% of women, it is marked by irregular menses, infertility, recurrent pregnancy loss, facial hair, acne, and a host of other interesting symptoms brought on primarily by excessive androgen production and insulin resistance.    Of course anything powerful enough to cause all of those hormonal disturbances in a non-pregnant woman can certainly wreck havoc on a breastfeeding mother.  There is good evidence that PCOS can lead to breastfeeding problems, particularly problems with inadequate milk supply.  The best source of information I have on this problem is Diana West and Lisa Marasco’s excellent book “The breastfeeding mother’s guide to Making More Milk” (McGraw-Hill, 2009).  This source has a comprehensive section on PCOS and how to help improve breastfeeding success.  There is a medicine that your doctor can prescribe called Metformin.  This drug helps the body process insulin which will, in turn improve milk supply.  I recommend starting it as soon as possible and begin pumping at 38 weeks to stimulate breast growth. 

If your doctor is unwilling to prescribe metformin, or if you want to try a “double whammy” you can also take a couple of herbal supplements.  Goat’s Rue (actually contains a precursor to Metformin called Guanidine) has been shown to increase milk production in dairy animals by 35-40% and stimulate breast growth.  Goat’s Rue can be taken as a tea (1 tsp of leaves steeped in one cup of water for 10-15 minutes 2-5 times a day), a tincture (there are several available doses, you will need to get with an herbalist to find the best dose and brand available but they range from 1-4 ml up to 4 times per day), or as a capsule from Motherlove taken four times a day).    Another herbal supplement to use in conjunction with Goat’s Rue is Marshmallow Root.  Marshmallow root is believed to enhance the effectiveness of Goat’s Rue and may enhance the richness of your milk.  It can also be taken in a tea (1 tbsp in 5-8 ounces of cold water allowed to stand for 30 minutes), a tincture (1-4 ml three times a day), or a capsule 2-4 capsules three times a day).    Consult an herbalist for the best product available to you. 

Finally, if it comes to having to supplement your baby it is vital to remember that breastfeeding does not have to be ALL OR NOTHING.  You may find that your baby needs a little more than you have to offer, but if that becomes necessary I recommend using a supplemental nursing system (SNS) which will allow your baby to continue to breastfeeding (thereby stimulating milk removal, breast growth & development, and increasing milk supply) while also encouraging your infant to achieve robust growth.  I often use the analogy of walking when I talk about breastfeeding difficulty.  No parent would ever accept that their baby just didn’t or couldn’t walk.  Rather, a five year old who is struggling with walking is offered physical therapy, braces, assistive devices, walkers, crutches, and every manner of surgery and medical treatments.  Some children actually need help with walking and they get it.  No mother would simply say “My baby didn’t want to walk, so I bought her a wheelchair.  What’s the benefit to walking anyway?”  But replace “walk” and “Wheelchair” with “Breastfeed” and “Formula Feeding” and you a lactation consultant hears that almost every day.  No, it doesn’t have to be ALL OR NOTHING, if it isn’t perfect, it is still breastfeeding. 

I’m sorry that it took me this long to reply, if you have any other questions or concerns, please don’t hesitate to ask.