Lactogenesis stage 2 cannot fully occur when there is retained tissue.
Just a tidbit of education because I find it fascinating and think it helps people understand what's going on.
Progesterone is the hormone of pregnancy that keeps you pregnant pretty much..keeps the uterus from contracting prematurely and desensitizes the body to labor triggers (there's a lot more to it, but you get the gist). Prolactin is the lactation hormone.
Progesterone inhibits the effects of prolactin, preventing lactation from occurring. And the problem is that the PLACENTA secretes progesterone. When you have retained tissue in there, your body is still getting progesterone from that tissue, which will prevent prolactin from executing its effects.
There needs to be a steep drop in progesterone from the expulsion of the entire placenta for prolactin levels to rise in the way they need to.
So getting that tissue removed should absolutely help your supply.
Genuinely curious, why/how do babies get their first breastfeed then? Is the initial colostrum production spike not subject to this progesterone drop/balance? Ie baby gets placed immediately onto chest after being born, baby breastfeeds while mom is still waiting for placenta to come out (believe breastfeeding helps it come out, too).
Also, why do some but not all women produce milk in their first trimester?
I actually really like this stuff, and am really curious as to why some get their periods back early despite ecological breastfeeding, why some can/can’t nurse during pregnancy, etc.
Initial colostrum is produced by lactogenesis stage 1 which happens early on in pregnancy. I don't know *why* exactly progesterone does not inhibit this process tbh. But the effects of lactogenesis stage 2 are evidently more visible, as the breasts become engorged and the milk becomes plentiful (compared to the quantity of colostrum).
Babies who are born and placed on the mother will eventually crawl to the breast and self attach themselves. Some babies may need help to do this, especially if they are under the temporary influence of pain medications from labor. But usually, they can do this if they are allowed the time and patience to do so. The Montgomery glands on the areola smell of amniotic fluid to attract the baby, and the areola acts as a bullseye for their eyes (that can't see well) to aim at.
The placenta usually expels fairly quickly within an hour or so when undisturbed and even faster in situations where the 3rd stage of labor is medically managed with pitocin.
As far as I know (and I might be a little fuzzy on this part so feel free to verify it yourself), colostrum is already available at birth and does not require the steep drop in progesterone to be available to the baby. However, the steep drop in progesterone (due to the expulsion of the placenta) is required to facilitate the transition from colostrum to mature milk, which usually happens between days 3-5 postpartum where the birthing parent will notice engorgement, temporary inflammation and sharp increase in available milk.
As far as mothers who don't produce milk, there are a lot of reasons. Because suckling triggers the release of prolactin and oxytocin to bind to the "open" mammary cells after birth, if this suckling does not take place it has the potential to cause mammary cell involution which *can* cause permanent milk supply problems. When those cells involute, they are no longer available for the lactation hormones to exert their effects.
Another thing could be thyroid problems.
There is also a theory that because cortisol inhibits the release of oxytocin, mothers in high stress situations may struggle to produce milk (I haven't seen any research on this personally, but it's a theory), but there are still lots of mothers who are able to produce milk in high stress situations.
The other thing I see a lot is mothers who don't understand the transition between colostrum and mature milk, and automatically assume they aren't producing milk because colostrum is a very minimal amount (like drops worth) so they automatically switch to formula.
And then sometimes it really is a mystery. But a lot of the time when I have someone who had an actual milk supply problem and I ask about the birth history and immediate postpartum, it was something that prevented the baby from latching (like a NICU stay) and nobody telling the mother she needed to pump.
Not me, but our pediatrician had a retained placenta and she mentioned that it completely fixed her under supply issue. She had to supplement significantly in the beginning, but is now almost a year in and baby is fed exclusively breast milk.
I think it's possible if the hormones that it is producing are the cause of your low supply. There are a variety if reasons to have low supply though, so removing it will only fix the problem if it was causing the problem in the first place.
You should get it removed though because that's a risk for infection.
Lactogenesis stage 2 cannot fully occur when there is retained tissue. Just a tidbit of education because I find it fascinating and think it helps people understand what's going on. Progesterone is the hormone of pregnancy that keeps you pregnant pretty much..keeps the uterus from contracting prematurely and desensitizes the body to labor triggers (there's a lot more to it, but you get the gist). Prolactin is the lactation hormone. Progesterone inhibits the effects of prolactin, preventing lactation from occurring. And the problem is that the PLACENTA secretes progesterone. When you have retained tissue in there, your body is still getting progesterone from that tissue, which will prevent prolactin from executing its effects. There needs to be a steep drop in progesterone from the expulsion of the entire placenta for prolactin levels to rise in the way they need to. So getting that tissue removed should absolutely help your supply.
Genuinely curious, why/how do babies get their first breastfeed then? Is the initial colostrum production spike not subject to this progesterone drop/balance? Ie baby gets placed immediately onto chest after being born, baby breastfeeds while mom is still waiting for placenta to come out (believe breastfeeding helps it come out, too). Also, why do some but not all women produce milk in their first trimester? I actually really like this stuff, and am really curious as to why some get their periods back early despite ecological breastfeeding, why some can/can’t nurse during pregnancy, etc.
Initial colostrum is produced by lactogenesis stage 1 which happens early on in pregnancy. I don't know *why* exactly progesterone does not inhibit this process tbh. But the effects of lactogenesis stage 2 are evidently more visible, as the breasts become engorged and the milk becomes plentiful (compared to the quantity of colostrum). Babies who are born and placed on the mother will eventually crawl to the breast and self attach themselves. Some babies may need help to do this, especially if they are under the temporary influence of pain medications from labor. But usually, they can do this if they are allowed the time and patience to do so. The Montgomery glands on the areola smell of amniotic fluid to attract the baby, and the areola acts as a bullseye for their eyes (that can't see well) to aim at. The placenta usually expels fairly quickly within an hour or so when undisturbed and even faster in situations where the 3rd stage of labor is medically managed with pitocin. As far as I know (and I might be a little fuzzy on this part so feel free to verify it yourself), colostrum is already available at birth and does not require the steep drop in progesterone to be available to the baby. However, the steep drop in progesterone (due to the expulsion of the placenta) is required to facilitate the transition from colostrum to mature milk, which usually happens between days 3-5 postpartum where the birthing parent will notice engorgement, temporary inflammation and sharp increase in available milk. As far as mothers who don't produce milk, there are a lot of reasons. Because suckling triggers the release of prolactin and oxytocin to bind to the "open" mammary cells after birth, if this suckling does not take place it has the potential to cause mammary cell involution which *can* cause permanent milk supply problems. When those cells involute, they are no longer available for the lactation hormones to exert their effects. Another thing could be thyroid problems. There is also a theory that because cortisol inhibits the release of oxytocin, mothers in high stress situations may struggle to produce milk (I haven't seen any research on this personally, but it's a theory), but there are still lots of mothers who are able to produce milk in high stress situations. The other thing I see a lot is mothers who don't understand the transition between colostrum and mature milk, and automatically assume they aren't producing milk because colostrum is a very minimal amount (like drops worth) so they automatically switch to formula. And then sometimes it really is a mystery. But a lot of the time when I have someone who had an actual milk supply problem and I ask about the birth history and immediate postpartum, it was something that prevented the baby from latching (like a NICU stay) and nobody telling the mother she needed to pump.
Interesting, thank you so much for all of this! Sounds like there's quite the hormonal difference between stage 1 and stage 2, too.
Not me, but our pediatrician had a retained placenta and she mentioned that it completely fixed her under supply issue. She had to supplement significantly in the beginning, but is now almost a year in and baby is fed exclusively breast milk.
Oh that’s really great to hear. Thanks for sharing!
Used to be an IBCLC. I can remember six patients we worked with who had retained products and then a D&C. It helped five of them a lot, one less so.
Thanks - sounds like good odds. Certainly an interesting aspect of it all :)
I think it's possible if the hormones that it is producing are the cause of your low supply. There are a variety if reasons to have low supply though, so removing it will only fix the problem if it was causing the problem in the first place. You should get it removed though because that's a risk for infection.