Many new mothers worry about their milk supply. For some, support from a breastfeeding counsellor or lactation consultant helps.

Others cannot make enough milk no matter how hard they try. These are women whose breasts are not physically capable of producing enough milk.

Our recently published research gives us clues about breast features that might make it difficult for some women to produce enough milk. Another of our studies shows the devastating consequences for women who dream of breastfeeding but find they cannot.

Some breasts just don’t develop

Unlike other organs, breasts are not fully developed at birth. There are key developmental stages as an embryo, then again during puberty and pregnancy.

At birth, the breast consists of a simple network of ducts. Usually during puberty, the glandular (milk-making) tissue part of the breast begins to develop and the ductal network expands. Then typically, further growth of the ductal network and glandular tissue during pregnancy prepares the breast for lactation.

But our online survey of women who report low milk supply gives us clues to anomalies in how some women’s breasts develop.

We’re not talking about women with small breasts, but women whose glandular tissue (shown in this diagram as “lobules”) is underdeveloped and have a condition called breast hypoplasia.

We don’t know how common this is. But it has been linked with lower rates of exclusive breastfeeding.

We also don’t know what causes it, with much of the research conducted in animals and not humans.

However, certain health conditions have been associated with it, including polycystic ovary syndrome and other endocrine (hormonal) conditions. A high body-mass index around the time of puberty may be another indicator.

Could I have breast hypoplasia?

Our survey and other research give clues about who may have breast hypoplasia.

But it’s important to note these characteristics are indicators and do not mean women exhibiting them will definitely be unable to exclusively breastfeed.

Indicators include:

• a wider than usual gap between the breasts
• tubular-shaped (rather than round) breasts
• asymmetric breasts (where the breasts are different sizes or shapes)
• lack of breast growth in pregnancy
• a delay in or absence of breast fullness in the days after giving birth

In our survey, 72% of women with low milk supply had breasts that did not change appearance during pregnancy, and about 70% reported at least one irregular-shaped breast.

The effects

Mothers with low milk supply – whether or not they have breast hyoplasia or some other condition that limits their ability to produce enough milk – report a range of emotions.

Research, including our own, shows this ranges from frustration, confusion and surprise to intense or profound feelings of failure, guilt, grief and despair.

Some mothers describe “breastfeeding grief” – a prolonged sense of loss or failure, due to being unable to connect with and nourish their baby through breastfeeding in the way they had hoped.

These feelings of failure, guilt, grief and despair can trigger symptoms of anxiety and depression for some women.

One woman told us:

[I became] so angry and upset with my body for not being able to produce enough milk.

Many women’s emotions intensified when they discovered that despite all their hard work, they were still unable to breastfeed their babies as planned. A few women described reaching their “breaking point”, and their experience felt “like death”, “the worst day of [my] life” or “hell”.

One participant told us:

I finally learned that ‘all women make enough milk’ was a lie. No amount of education or determination would make my breasts work. I felt deceived and let down by all my medical providers. How dare they have no answers for me when I desperately just wanted to feed my child naturally.

Others told us how they learned to accept their situation. Some women said they were relieved their infant was “finally satisfied” when they began supplementing with formula. One resolved to:

prioritise time with [my] baby over pumping for such little amounts.

Where to go for help

If you are struggling with low milk supply, it can help to see a lactation consultant for support and to determine the possible cause.

This will involve helping you try different strategies, such as optimising positioning and attachment during breastfeeding, or breastfeeding/expressing more frequently. You may need to consider taking a medication, such as domperidone, to see if your supply increases.

If these strategies do not help, there may be an underlying reason why you can’t make enough milk, such as insufficient glandular tissue (a confirmed inability to make a full supply due to breast hypoplasia).

Even if you have breast hypoplasia, you can still breastfeed by giving your baby extra milk (donor milk or formula) via a bottle or using a supplementer (which involves delivering milk at the breast via a tube linked to a bottle).

More resources

The following websites offer further information and support:

• Australian Breastfeeding Association
• Lactation Consultants of Australia and New Zealand
• Royal Women’s Hospital, Melbourne
• Supply Line Breastfeeders Support Group of Australia Facebook support group
• IGT And Low Milk Supply Support Group Facebook support group
• Breastfeeding Medicine Network Australia/New Zealand
• Supporting breastfeeding grief (a collection of resources).

Shannon Bennetts, a research fellow at La Trobe University, contributed to this article.

Renee Kam, PhD candidate and research officer, La Trobe University and Lisa Amir, Professor in Breastfeeding Research, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

From “breathwork recipes” to breathing techniques, many social media and health websites are recommending breathwork to reduce stress.

But breathwork is not new. Rather it is the latest in a long history of breathing techniques such as Pranayama from India and qigong from China. Such practices have been used for thousands of years to promote a healthy mind and body.

The benefits can be immediate and obvious. Try taking a deep breath in through your nose and exhaling slowly. Do you feel a little calmer?

So, what’s the difference between the breathing we do to keep us alive and breathwork?

Breathwork is about control

Breathwork is not the same as other mindfulness practices. While the latter focus on observing the breath, breathwork is about controlling inhalation and exhalation.

Normally, breathing happens automatically via messages from the brain, outside our conscious control. But we can control our breath, by directing the movement of our diaphragm and mouth.

The diaphragm is a large muscle that separates our thoracic (chest) and abdominal (belly) cavities. When the diaphragm contracts, it expands the thoracic cavity and pulls air into the lungs.

Controlling how deep, how often, how fast and through what (nose or mouth) we inhale is the crux of breathwork, from fire breathing to the humming bee breath.

Breathwork can calm or excite

Even small bits of breathwork can have physical and mental health benefits and complete the stress cycle to avoid burnout.

Calming breathwork includes diaphragmatic (belly) breathing, slow breathing, pausing between breaths, and specifically slowing down the exhale.

In diaphragmatic breathing, you consciously contract your diaphragm down into your abdomen to inhale. This pushes your belly outwards and makes your breathing deeper and slower.

You can also slow the breath by doing:

• box breathing (count to four for each of four steps: breathe in, hold, breathe out, hold), or
• coherent breathing (controlled slow breathing of five or six breaths per minute), or
• alternate nostril breathing (close the left nostril and breathe in slowly through the right nostril, then close the right nostril and breathe out slowly through the left nostril, then repeat the opposite way).

You can slow down the exhalation specifically by counting, humming or pursing your lips as you breathe out.

In contrast to these calming breathing practices, energising fast-paced breathwork increases arousal. For example, fire breathing (breathe in and out quickly, but not deeply, through your nose in a consistent rhythm) and Lion’s breath (breathe out through your mouth, stick your tongue out and make a strong “haa” sound).

What is happening in the body?

Deep and slow breathing, especially with a long exhale, is the best way to stimulate the vagus nerves. The vagus nerves pass through the diaphragm and are the main nerves of the parasympathetic nervous system.

Simulating the vagus nerves calms our sympathetic nervous system (fight or flight) stress response. This improves mood, lowers the stress hormone cortisol and helps to regulate emotions and responses. It also promotes more coordinated brain activity, improves immune function and reduces inflammation.

Taking deep, diaphragmatic breaths also has physical benefits. This improves blood flow, lung function and exercise performance, increases oxygen in the body, and strengthens the diaphragm.

Slow breathing reduces heart rate and blood pressure and increases heart rate variability (normal variation in time between heart beats). These are linked to better heart health.

Taking shallow, quick, rhythmic breaths in and out through your nose stimulates the sympathetic nervous system. Short-term, controlled activation of the stress response is healthy and develops resilience to stress.

Breathing in through the nose

We are designed to inhale through our nose, not our mouth. Inside our nose are lots of blood vessels, mucous glands and tiny hairs called cilia. These warm and humidify the air we breathe and filter out germs and toxins.

We want the air that reaches our airways and lungs to be clean and moist. Cold and dry air is irritating to our nose and throat, and we don’t want germs to get into the body.

Nasal breathing increases parasympathetic activity and releases nitric oxide, which improves airway dilation and lowers blood pressure.

Consistently breathing through our mouth is not healthy. It can lead to pollutants and infections reaching the lungs, snoring, sleep apnoea, and dental issues including cavities and jaw joint problems.

A free workout

Slow breathing – even short sessions at home – can reduce stress, anxiety and depression in the general population and among those with clinical depression or anxiety. Research on breathwork in helping post-traumatic stress disorder (PTSD) is also promising.

Diaphragmatic breathing to improve lung function and strengthen the diaphragm can improve breathing and exercise intolerance in chronic heart failure, chronic obstructive pulmonary disease and asthma. It can also improve exercise performance and reduce oxidative stress (an imbalance of more free radicals and/or less antioxidants, which can damage cells) after exercise.

A mind-body connection you can access any time

If you feel stressed or anxious, you might subconsciously take shallow, quick breaths, but this can make you feel more anxious. Deep diaphragmatic breaths through your nose and focusing on strong exhalations can help break this cycle and bring calm and mental clarity.

Just a few minutes a day of breathwork can improve your physical and mental health and wellbeing. Daily deep breathing exercises in the workplace reduce blood pressure and stress, which is important since burnout rates are high.

Bottom line: any conscious control of your breath throughout the day is positive.

So, next time you are waiting in a line, at traffic lights or for the kettle to boil, take a moment to focus on your breath. Breathe deeply into your belly through your nose, exhale slowly, and enjoy the benefits.

Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong and Judy Pickard, Senior Lecturer, Clinical Psychology, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Julia J Rucklidge, University of Canterbury; Elena Moltchanova, University of Canterbury; Roger Mulder, University of Otago, and Siobhan A Campbell, University of Canterbury

Antenatal depression affects 15% to 21% of pregnant women worldwide. It can influence birth outcomes and children’s development, as well as increase the risk of post-natal depression.

Current treatments like therapy can be inaccessible and antidepressants can carry risks for developing infants.

Over the past two decades, research has highlighted that poor nutrition is a contributing risk factor to mental health challenges. Most pregnant women in New Zealand aren’t adhering to nutritional guidelines, according to a longitudinal study. Only 3% met the recommendations for all food groups.

Another cohort study carried out in Brazil shows that ultra-processed foods (UPF) accounted for at least 30% of daily dietary energy during pregnancy, displacing healthier options.

UPFs are chemically manufactured and contain additives to improve shelf life, as well as added sugar and salt. Importantly, they are low in essential micronutrients (vitamins and minerals).

The consumption of these foods is concerning because a nutrient-poor diet during pregnancy has been linked to poorer mental health outcomes in children. This includes depression, anxiety, hyperactivity, and inattention.

Increasing nutrients in maternal diets and reducing consumption of UPFs could improve the mental health of the mother and the next generation. Good nutrition can have lifelong benefits for the offspring.

However, there are multiple factors that mean diet change alone may not in itself be sufficient to address mental health challenges. Supplementing with additional nutrients may also be important to address nutritional needs during pregnancy.

Micronutrients as treatment for depression

Our earlier research suggests micronutrient supplements for depression have benefits outside pregnancy.

But until now there have been no published randomised controlled trials specifically designed to assess the efficacy and safety of broad-spectrum micronutrients on antenatal depression and overall functioning.

The NUTRIMUM trial, which ran between 2017 and 2022, recruited 88 women in their second trimester of pregnancy who reported moderate depressive symptoms. They were randomly allocated to receive either 12 capsules (four pills, three times a day) of a broad-spectrum micronutrient supplement or an active placebo containing iodine and riboflavin for a 12-week period.

Micronutrient doses were generally between the recommended dietary allowance and the tolerable upper level.

Based on clinician ratings, micronutrients significantly improved overall psychological functioning compared to the placebo. The findings took into account all noted changes based on self-assessment and clinician observations. This includes sleep, mood regulation, coping, anxiety and side effects.

Both groups reported similar reductions in symptoms of depression. More than three quarters of participants were in remission at the end of the trial. But 69% of participants in the micronutrient group rated themselves as “much” or “very much” improved, compared to 39% in the placebo group.

Participants taking the micronutrients also experienced significantly greater improvements in sleep and overall day-to-day functioning, compared to participants taking the placebo. There were no group differences on measures of stress, anxiety and quality of life.

Importantly, there were no group differences in reported side effects, and reports of suicidal thoughts dropped over the course of the study for both groups. Blood tests confirmed increased vitamin levels (vitamin C, D, B12) and fewer deficiencies in the micronutrient group.

Micronutrients were particularly helpful for women with chronic mental health challenges and those who had taken psychiatric medications in the past. Those with milder symptoms improved with or without the micronutrients, suggesting general care and monitoring might suffice for some women.

The benefits of micronutrients were comparable to psychotherapy but with less contact. There are no randomised controlled trials of antidepressant medication to compare these results.

Retention in the study was good (81%) and compliance excellent (90%).

Beyond maternal mental health

We followed the infants of mothers enrolled in the NUTRIMUM trial (who were therefore exposed to micronutrients during pregnancy) for 12 months, alongside infants from the general population of Aotearoa New Zealand.

This second group of infants from the general population contained a smaller sub-group who were exposed to antidepressant medication for the treatment of antenatal depression.

We assessed the neuro-behavioural development of each infant within the first four weeks of life, and temperament up to one year after birth.

These observational follow-ups showed positive effects of micronutrients on the infants’ ability to regulate their behaviour. These results were on par with or better than typical pregnancies, and better than treatments with antidepressants.

Infants exposed to micronutrients during pregnancy were significantly better at attending to external stimuli. They were also better able to block out external stimuli during sleep. They showed fewer signs of stress and had better muscle tone compared to infants not exposed to micronutrients.

They also displayed greater ability to interact with their environment. They were better at regulating their emotional state and had fewer abnormal muscle reflexes than infants exposed to antidepressant medication in pregnancy.

Reassuringly, micronutrients had no negative impact on infant temperament.

These findings highlight the potential of micronutrients as a safe and effective alternative to traditional medication treatments for antenatal depression.

The prenatal environment sets the foundation for a child’s future. Further investigation into the benefits of micronutrient supplementation would gives us more confidence in their use for other perinatal (from the start of pregnancy to a year after birth) mental health issues. This could provide future generations with a better start to life.

We would like to acknowledge the contribution of Dr Hayley Bradley to this research project.

Julia J Rucklidge, Professor of Psychology, University of Canterbury; Elena Moltchanova, Professor of Statistics, University of Canterbury; Roger Mulder, Professor of Psychiatry, University of Otago, and Siobhan A Campbell, Intern Psychologist, Researcher – Te Puna Toiora (Mental Health and Nutrition Research Lab), University of Canterbury

This article is republished from The Conversation under a Creative Commons license. Read the original article.