Guest: Dr. Jean Rhodes - Nurse Practitioner and Director of MUSC Lactation Consultant Services.
Host: Dr. Linda Austin – Psychiatry
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. Today, I am interviewing Dr. Jean Rhodes, who is a Nurse Practitioner and she is the Director of the MUSC Children’s Hospital Nurse Lactation Services. She is the Director of the MUSC Lactation Consultant Services. Dr. Rhodes, lactation or breast feeding is certainly a practice that has gone, one might say, in and out of style over the centuries I am sure and even recent decades. What is the current thinking about the importance of breast feeding your baby?
Dr. Jean Rhodes: The current thinking is that lactation is extremely important to the health not only of the newborn infant and young child, but also to the mother and in the last 10 years, we have had an explosion of the research that tells us how beneficial breast feeding is. In other words, 15 years ago we used to say breast feeding was great for bonding with your baby and also for helping prevent ear infections and respiratory tract infections, and diarrhea in newborns. Now, we know that lactation and breast feeding benefits an infant in those regards, but also in terms of preventing things like childhood cancer, reducing the risk of that, reducing the risk of diabetes even as an adult, and reducing the risk of hypertension as an adult. There are many, many benefits that we had no idea about until more recently, and then we also know for the mothers that breast feeding helps reduce the risk of breast cancer and diabetes in women; the longer she breast feeds, the more her reduction is of the risk of diabetes as an adult and also ovarian cancer. So, there are significant health benefits both to babies and to mothers.
Dr. Linda Austin: Now, those benefits -- let’s talk about just the mother.
Dr. Jean Rhodes: Okay.
Dr. Linda Austin: From the mother’s side. Are those benefits all due to hormonal changes that accompany breast feeding?
Dr. Jean Rhodes: No, I don’t think so. Certainly, the reproductive benefits are in terms of the reduction of the risk of breast cancer and ovarian cancer because during lactation, especially during the months when a woman is exclusively breast feeding and not giving her infant other foods, the mother’s estrogen, which is one of her hormones, is reduced and that then helps reduce the risk overall of reproductive cancers like breast cancer and ovarian cancer. So, some of it is hormonal, but some of it I think is metabolic and as I mentioned a woman’s risk of type 2 diabetes goes down when she breast feeds. What we know, is it for every year a woman breast feeds, her risk is reduced by 15%. So, a woman who breast feeds several children over the course of several months to a year significantly reduces her risk of diabetes as an adult.
Dr. Linda Austin: This is may be a simple-minded question, but is that because the breast feeding allows her to regain a normal weight faster or might there even be more long-lasting affects than just getting your weight down?
Dr. Jean Rhodes: I think it has more to do with the metabolic changes in the mother’s body while she is breast feeding, the changes in terms of her own hormones that are required for lactation, not just the reproductive hormones, but also the thyroid hormones and the changes in her insulin. Breast milk has insulin in it from the mother’s body to the baby. There are so many components there that we are finding out about that I think overall what we are seeing is a reduction in the risk of certain types of diseased state.
Dr. Linda Austin: Now, how about the benefits to the baby, you mentioned decreased rates of childhood cancer, which cancers in particular?
Dr. Jean Rhodes: Particularly, leukemia and lymphoma.
Dr. Linda Austin: To what degree?
Dr. Jean Rhodes: I honestly don’t know. Those studies are usually population studies and the degree is based impart on the amount of breast milk an infant gets from its mother over the course of time, so you can imagine that there really aren’t randomized trials in which a mother was only allowed to breast feed for certain length of time and the baby got only a certain amount. Breast feeding tends to be very individual and many women will breast feed anywhere from a few weeks to several years. We know that the more a mother breast feeds, the longer an infant nurses, and the more milk a baby gets from the mother, the better the benefits. So, in terms of an absolute risk reduction, I can’t really answer.
Dr. Linda Austin: Now, every once in a while, there is woman who cannot?
Dr. Jean Rhodes: Right.
Dr. Linda Austin: breast feed -- for what reason?
Dr. Jean Rhodes: Well, there are a few reasons; women who are HIV positive and women who have HTLV-1 which is a virus. It’s very similar to HIV. Those women in developed countries like the United States are not encouraged to breast feed because there is a risk of passing that virus through the breast milk to the infant. There are other categories; mothers who have had breast cancer and are undergoing chemotherapy or radiation, women who have other types of cancers and are undergoing similar treatments are also usually discouraged from breast feeding; some of that depends on the agents that they are receiving. Some other cases would be women, who are abusing drugs. Drugs do pass through the breast milk to the infant and can harm or kill an infant. Women who are abusing substances are not encouraged to breast feed.
Dr. Linda Austin: As well as some medications.
Dr. Jean Rhodes: Some medications, and again the medications can be tricky because we don’t have a lot of information about the specific affects on lactation or on the infant through lactation and the newer drugs are particularly hard to get information on because usually those are case studies. Again, they don’t do randomized trials on mothers, who are breast feeding, who are taking certain medications and then look at the impact on their infant. It is just not ethical to do it that way, so usually what happens is case studies that grew over time, and some studies are also done just looking at studying the mother’s milk, examining it to see what levels of the drug are in the milk. We use several sources on a daily basis to investigate medications that mothers are taking to give us information about whether or not it’s safe for her to breast feed her baby, and that information in terms of research, case studies and milk studies, those are coming out daily. It’s just like with drugs that are being produced, they come out so rapidly that it’s hard to stay on the top.
Dr. Linda Austin: But this is clearly something a woman needs to talk with her OB/GYN about.
Dr. Jean Rhodes: Absolutely.
Dr. Linda Austin: When?
Dr. Jean Rhodes: During the time, she is pregnant.
Dr. Linda Austin: Are there any anatomical reasons why individual woman cannot breast feed? For example, I have heard woman with inverted nipples say that they have a hard time breast feeding?
Dr. Jean Rhodes: Well, certainly there can be challenges and inverted nipples or flat nipples can present a challenge to a woman, who is breast feeding. There are some women, because of their nipple anatomy like inverting nipples that honestly never are able to achieve a latch with the baby, but those woman many times would choose to pump their milk, they will express milk for their infant and give it to the baby by bottle. But I have also seen many women with inverted nipples, who were able to successfully breast feed. So, as a lactation consultant, I try to evaluate each mother’s situation and her baby as well and then work with her to achieve her goals and to bring in whatever tools we need breast pumps, nipple shields, or supplemental nursing systems whatever we need to do to help her meet her goal, but occasionally there will be times where we just cannot achieve a good latch with the baby.
Dr. Linda Austin: Thank you very much Dr. Rhodes.
Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.