This week an opinion piece from an IBCLC in northern California has been going around the birth community. A number of my colleagues have asked my thoughts on this piece so I wanted to share what I think about this important question: Does placenta encapsulation LOWER milk supply?
My first reaction was "she does make a compelling argument", but it just doesn't jive at all with my experience of encapsulating over 700 placentas in 6.5 years.
My first reaction was "she does make a compelling argument", but it just doesn't jive at all with my experience of encapsulating over 700 placentas in 6.5 years.
In 2013 I co-presented a poster presentation at the annual PSI (Postpartum Support International) conference in Minneapolis on placenta encapsulation. I used data I had collected from 68 clients. Of those clients 63% reported an average milk supply, 29% reported an oversupply, 6% reported a low supply and 1% didn't breastfeed.
Just recently I shared new data from the last year or so. The numbers are quite close to my 2013 data. Of 49 moms who filled out my anonymous survey, 55% reported an average milk supply, 35% reported an oversupply and 8% reported low supply. So looking at both sets of data, 90% of moms who took my survey did not have low milk supply.
Now, it is possible that more clients who had a low supply didn't report it. But the survey is anonymous which I would hope would welcome everyone to share their experience because of course we really want to hear from all our clients whether they have a positive experience or not.
She is correct in saying that progesterone and estrogen can inhibit lactation. It is true that when the placenta is retained in the uterus, the body thinks it is still pregnant and may not switch into breastfeeding mode, and really boost the hormones needed for lactation. But as I've previously written, having a piece of placenta still inside the uterus is very different than taking a tiny dose of placenta a couple days after the placenta has left the body. If the average mom gets 150 capsules and takes 4 per day she is getting a dose of approximately 3% of the mass of her placenta and it is going through the digestive system which is different than a piece of placenta still being in the uterus.
When talking about research on encapsulation that came out in 2016, this IBCLC said "The authors of this study found that there are only estrogens and progesterone remaining in the pills and that these reach physiological effect thresholds." In fact, the researchers looked for 17 hormones in the capsules and found 16 present. They said that estrogen and progesterone were the only two that "could conceivably yield physiological effects". Not that they actually do reach physiological effect thresholds. That is not what the study was about. Here is the abstract for the study. My information about estrogen and progesterone being at higher levels than the other hormones comes from Rebecca Dekker's video on the new research regarding encapsulation which you can find by clicking here. Keep in mind this was a study of only 28 placentas so the sample size is low. It doesn't tell us for sure if there are enough hormones in placenta capsules to help balance hormones, as so many placenta professionals suspect is part of why moms report so many great benefits of encapsulation, or if it could, as this IBCLC suggests, impact milk supply in a negative way.
One reason I think placenta encapsulation seems to work so well is due to the fact that the placenta is an iron rich organ. Pregnant women tend to be more anemic, then lose blood after giving birth, further affecting their hemoglobin levels. Low hemoglobin can lead to fatigue, which new parents are already facing from a lack of sleep! Fatigue can be a risk factor for postpartum mood disorders. And when the body is busy trying to rebuild red blood cells, perhaps it can't make milk as effectively. Thus, by using a natural source of iron, perhaps improving a woman's iron stores quickly with placenta encapsulation is the cause of the increased energy, better mood, and better milk supply that so many mothers report.
This IBCLC talks about recent research that looked at this question. She said "Another recent study shows that there is no iron benefit to consuming placenta vs a placebo, which debunks one of the claimed benefits of consuming placenta that is promoted by encapsulators (Gryder et al., 2016)." She neglects to mention that the "placebo" in this study was beef. Or that this was a very small pilot study with only 23 participants. Interestingly, the study found that the placenta capsules DID have more iron in them than the beef "placebo" but for some reason it didn't have a larger impact on the woman's hemoglobin. You can read the abstract for this research here and Rebecca Dekker talks about it in her video that I linked to above.
She also suggests that consuming placenta could increase the risk of blood clots or stroke because of estrogen. The Academy of Breastfeeding Medicine protocol she references is about birth control options while breastfeeding. It specifically talks about various birth control methods including contraceptive pills, patches and vaginal rings and how the use of these hormonal birth control methods can impact milk supply and how they are linked to a higher risk of blood clots or stroke in the early weeks postpartum. It is a stretch to compare hormonal birth control methods that use high levels of hormones to prevent pregnancy to the small amount of hormones found in placenta capsules. Hopefully someone above my pay grade can figure out the level of estrogen in placenta compared to these hormonal birth control methods to determine if this is a real risk moms need to consider.
Lastly she mentioned the CDC "notes from the field" from one case study about a mom in Oregon whose baby got sick twice from Group B Strep (GBS). I've already written about this here but there are three main points to consider:
1) The CDC acknowledged they couldn't rule out other causes of this baby's GBS infection and re-infection
2) It is believed that the encapsulator was not following proper protocol because the usual preparation provides enough heat for a long enough time to kill bacteria including GBS and
3) That mother should have never been taking her capsules in the first place since her baby had an active infection.
As a birth professional who provides lactation support and education myself, I feel for any mom who suffers from low milk supply. We know that the causes of low milk supply are vast including but not limited to supplementing, pacifiers, scheduled feedings, sleepy babies (may be linked to medications used during birth), anatomical problems with the baby (tongue/lip tie, palate issues, etc.), health issues for the mother (PCOS, thyroid imbalance, anemia), retained placenta, previous breast surgery, medications mom is taking, and hypoplasia, also called insufficient glandular tissue. It is sometimes very difficult to tease out why a mom is struggling. If a mom is struggling and wants to stop her capsules to see if that helps I 100% support that choice.
Placenta capsules aren't "magic". But something about them does help moms, often in dramatic ways. I have never and will never tell a mom all they need to do is consume their placenta and they will not have a postpartum mood disorder or will for sure make enough milk. For sure the ABSOLUTE BEST thing new parents can do to have enough milk is stay in bed nursing that baby as much as possible for the first two weeks. We know that breastfeeding is a demand and supply system. Too often moms are pressured to get right back to normal life after having a baby. So often moms are told to "get their baby on a schedule" and that their baby "can't possible be hungry again" an hour after the last feeding even though we know breast milk digests quickly because it is so perfectly designed for baby's digestive system. Check out the book Breastfeeding Made Simple by Nancy Mohrbacher and Kathleen Kendall-Tackett to learn just how your milk supply is established in those early weeks and what you can do to ensure the best supply possible for you and your baby.
Just recently I shared new data from the last year or so. The numbers are quite close to my 2013 data. Of 49 moms who filled out my anonymous survey, 55% reported an average milk supply, 35% reported an oversupply and 8% reported low supply. So looking at both sets of data, 90% of moms who took my survey did not have low milk supply.
Now, it is possible that more clients who had a low supply didn't report it. But the survey is anonymous which I would hope would welcome everyone to share their experience because of course we really want to hear from all our clients whether they have a positive experience or not.
She is correct in saying that progesterone and estrogen can inhibit lactation. It is true that when the placenta is retained in the uterus, the body thinks it is still pregnant and may not switch into breastfeeding mode, and really boost the hormones needed for lactation. But as I've previously written, having a piece of placenta still inside the uterus is very different than taking a tiny dose of placenta a couple days after the placenta has left the body. If the average mom gets 150 capsules and takes 4 per day she is getting a dose of approximately 3% of the mass of her placenta and it is going through the digestive system which is different than a piece of placenta still being in the uterus.
When talking about research on encapsulation that came out in 2016, this IBCLC said "The authors of this study found that there are only estrogens and progesterone remaining in the pills and that these reach physiological effect thresholds." In fact, the researchers looked for 17 hormones in the capsules and found 16 present. They said that estrogen and progesterone were the only two that "could conceivably yield physiological effects". Not that they actually do reach physiological effect thresholds. That is not what the study was about. Here is the abstract for the study. My information about estrogen and progesterone being at higher levels than the other hormones comes from Rebecca Dekker's video on the new research regarding encapsulation which you can find by clicking here. Keep in mind this was a study of only 28 placentas so the sample size is low. It doesn't tell us for sure if there are enough hormones in placenta capsules to help balance hormones, as so many placenta professionals suspect is part of why moms report so many great benefits of encapsulation, or if it could, as this IBCLC suggests, impact milk supply in a negative way.
One reason I think placenta encapsulation seems to work so well is due to the fact that the placenta is an iron rich organ. Pregnant women tend to be more anemic, then lose blood after giving birth, further affecting their hemoglobin levels. Low hemoglobin can lead to fatigue, which new parents are already facing from a lack of sleep! Fatigue can be a risk factor for postpartum mood disorders. And when the body is busy trying to rebuild red blood cells, perhaps it can't make milk as effectively. Thus, by using a natural source of iron, perhaps improving a woman's iron stores quickly with placenta encapsulation is the cause of the increased energy, better mood, and better milk supply that so many mothers report.
This IBCLC talks about recent research that looked at this question. She said "Another recent study shows that there is no iron benefit to consuming placenta vs a placebo, which debunks one of the claimed benefits of consuming placenta that is promoted by encapsulators (Gryder et al., 2016)." She neglects to mention that the "placebo" in this study was beef. Or that this was a very small pilot study with only 23 participants. Interestingly, the study found that the placenta capsules DID have more iron in them than the beef "placebo" but for some reason it didn't have a larger impact on the woman's hemoglobin. You can read the abstract for this research here and Rebecca Dekker talks about it in her video that I linked to above.
She also suggests that consuming placenta could increase the risk of blood clots or stroke because of estrogen. The Academy of Breastfeeding Medicine protocol she references is about birth control options while breastfeeding. It specifically talks about various birth control methods including contraceptive pills, patches and vaginal rings and how the use of these hormonal birth control methods can impact milk supply and how they are linked to a higher risk of blood clots or stroke in the early weeks postpartum. It is a stretch to compare hormonal birth control methods that use high levels of hormones to prevent pregnancy to the small amount of hormones found in placenta capsules. Hopefully someone above my pay grade can figure out the level of estrogen in placenta compared to these hormonal birth control methods to determine if this is a real risk moms need to consider.
Lastly she mentioned the CDC "notes from the field" from one case study about a mom in Oregon whose baby got sick twice from Group B Strep (GBS). I've already written about this here but there are three main points to consider:
1) The CDC acknowledged they couldn't rule out other causes of this baby's GBS infection and re-infection
2) It is believed that the encapsulator was not following proper protocol because the usual preparation provides enough heat for a long enough time to kill bacteria including GBS and
3) That mother should have never been taking her capsules in the first place since her baby had an active infection.
As a birth professional who provides lactation support and education myself, I feel for any mom who suffers from low milk supply. We know that the causes of low milk supply are vast including but not limited to supplementing, pacifiers, scheduled feedings, sleepy babies (may be linked to medications used during birth), anatomical problems with the baby (tongue/lip tie, palate issues, etc.), health issues for the mother (PCOS, thyroid imbalance, anemia), retained placenta, previous breast surgery, medications mom is taking, and hypoplasia, also called insufficient glandular tissue. It is sometimes very difficult to tease out why a mom is struggling. If a mom is struggling and wants to stop her capsules to see if that helps I 100% support that choice.
Placenta capsules aren't "magic". But something about them does help moms, often in dramatic ways. I have never and will never tell a mom all they need to do is consume their placenta and they will not have a postpartum mood disorder or will for sure make enough milk. For sure the ABSOLUTE BEST thing new parents can do to have enough milk is stay in bed nursing that baby as much as possible for the first two weeks. We know that breastfeeding is a demand and supply system. Too often moms are pressured to get right back to normal life after having a baby. So often moms are told to "get their baby on a schedule" and that their baby "can't possible be hungry again" an hour after the last feeding even though we know breast milk digests quickly because it is so perfectly designed for baby's digestive system. Check out the book Breastfeeding Made Simple by Nancy Mohrbacher and Kathleen Kendall-Tackett to learn just how your milk supply is established in those early weeks and what you can do to ensure the best supply possible for you and your baby.