Last week I saw a woman who was having difficulty with nursing. She was 2 1/2 weeks postpartum. She brought her beautiful daughter with her which was such a treat! Then her husband took the baby so we could have some good time to look at what was going on.
After a good birth a bit after term, her baby had difficulty latching on. The days of effort left the mom’s nipples feeling very raw and painful. It’s much easier on the nipples when a baby really latches on. But, she also felt that her baby was frustrated because the milk supply was not robust. Since the birth she had not felt any sensation of fullness in the breast nor any sense of let-down. She began to supplement with formula some to make sure her daughter was getting enough and also pumped to keep what milk she had available for the baby. She was worried that her daughter would get so used to the ease of the bottle that she might not want to nurse any more at all.
Why was there not enough milk? It’s normal for the postpartum woman’s breasts to be engorged with milk and for the let-down to allow milk to flow freely for the baby.
In working with postpartum women, I take seriously the words of my teacher, Dr. Qiu Xiao-Mei, who was a Chinese medical gynecologist and obstetrician.
In view of the fact that a special characteristic of a post partum woman is physical exhaustion combined with excess stasis, our predecessors had three examinations for the diagnosis and treatment of post partum women: The first is to examine whether or not the lower abdomen is painful or not. This will tell you if there remains any lochia. The second is to see if the bowels are open or blocked. This will tell you whether the fluid is abundant or lacking. Finally, examine the breast milk to determine if it is flowing well and if the woman has a desire for food and drink. This will show you the strength or weakness of the Stomach Qi. In order to carry out a synthesized analysis, this information is combined and compared with the partuant woman’s body type, pulse, tongue and other symptoms. Only in this way is one able to carry out the correct differential diagnosis and treatment for postpartum diseases.
These words are not passed on flippantly. I think this case shows the importance of following these instructions:
The first is to examine whether or not the lower abdomen is painful or not. This will tell you if there remains any lochia.
Palpating my patient’s belly, I could tell that her uterine area was still painful. This should not be the case 2 1/2 weeks after a vaginal birth. I asked about her lochia and it had not stopped yet. Moreover, the blood was sometimes dark and contained clots. What does this tell me? It tells me there is some leftover stasis in her womb. What does this have to do with breast milk? Everything! When there is leftover stasis in the womb, it causes continuous, albeit scanty, bleeding. This is because the micro-clots block the capillary blood vessels in the womb so that they break open and then blood flows out. When there is bleeding below, the body uses its fluids to keep replacing the lost blood. This is fluid that would otherwise be milk. It’s important to see the stomach and spleen of the middle Jiao as a place that transform food and fluids and then either sends milk up to be milk or down to be blood. So, in this case, the fact that the lochia had not cleared, was a clear causative factor in the scanty breast milk.
The second is to see if the bowels are open or blocked. This will tell you whether the fluid is abundant or lacking.
When I asked about her bowels, she told me that they were fine. But then she added, “well, as long as I take the stool softener.” Oh! She told me that she was taking a vitamin that contained iron which made her constipated and she needed the stool softener to keep things moving. To me, this is constipation. Constipation can come from or lead to drying of fluids. Again, it is the fluids of the digestive system that go to produce the milk. If these are dried, then milk will be scanty. This was a second factor in her scanty lactation.
Finally, examine the breast milk to determine if it is flowing well and if the woman has a desire for food and drink. This will show you the strength or weakness of the Stomach Qi.
I asked about her appetite and she said it was okay but not great. We want the postpartum woman to eat and drink well but a good appetite shows us that her body is ready to metabolize what she is eating into good stuff. This was a third factor in her insufficient lactation, though for me not a major one because her appetite was only slightly low.
A final factor may have been that she took antihistamines at times throughout the pregnancy to treat migraines. This could have also contributed to drying of fluids.
My treatment strategy was to first clear the lochia so as to stop the leakage of blood. For this I gave her 6 days worth of Sheng Hua Tang, Generate and Transform Decoction in a bulk form. ( Click here for a previous blog post that goes into great detail about the use of this formula.) Secondly, I recommended she stop the vitamin supplement as constipation is much worse for your blood than iron is good for it! I asked her to stop the stool softener when she felt she could. Finally I recommended she make and consume a soup made from pig’s trotters. ( Click here for a previous blog post that goes into great detail about the use of this soup.)
I heard from her a few days later that her milk was increasing and that nursing was getting easier and more satisfying for both mom and babe.
Afterword: There are many formulas for increasing lactation. However, none of them would have been appropriate in this case. I thought this was a great case for illustrating how important it is to dig deep into the causes of the manifesting problem whether it be pain, lyme disease, or insufficient lactation. It’s easy to throw formulas at diseases but one will never be very successful that way. It’s important to read the wise words of our forbearers and to understand physiology very deeply so that we can understand what is really going on and apply the accurate remedy.