About the Speaker

Solving breastfeeding mysteries has always been a passion for Lisa, who is known for her inquisitiveness and tenacity. Her specialization in milk production was born when, after a resurgence in scheduled feeding began to sabotage unwitting mother’s milk supplies, she discovered that there was no comprehensive, referenced source to explain milk production to parents. The process of researching and writing such a document laid the foundation upon which her later work was built. Lisa also personally experienced a mysterious loss of milk supply with her fourth child, the cause of which only became clear to her years later as her research into milk production issues deepened. As a result of her own experience, she has great empathy for her clients and a renewed desire to understand the mysterious and difficult. This led to her eventual master’s thesis on Polycystic Ovary Syndrome and its possible relationship to milk production problems, and other clinical situations have led to new areas of research. A born teacher, Lisa enjoys sharing what she has learned as much as the process itself. Her passion for her topics comes through clearly in her dynamic presentations, and she takes a personal interest in answering the needs and questions of any and all attendees. It is her desire that attendees not only go home with “what to do’s,” but more importantly, have a deeper understanding of the topics so that they can think through the unique situations that they face and develop better strategies targeted to the problems.

Official Bio for Brochure

Lisa Marasco has been working with breastfeeding mothers for over 30 years and has been Internationally Board Certified since 1993. She holds a Master’s degree in Human Development with specialization in Lactation Consulting and was designated a Fellow of ILCA in 2009. Lisa is co-author of The Breastfeeding Mother’s Guide to Making More Milk, a contributing author to the Core Curriculum for Lactation Consultants, and a new Cochrane Collaborative author. She is employed by WIC of Santa Barbara County while she continues to research, write and speak. In addition, Lisa is an Associate Area Professional Liaison for La Leche League of So. Calif/Nevada, and serves on the Breastfeeding Coalition of Santa Barbara County.

Bio for Introduction

Lisa Marasco has been working with breastfeeding mothers for 30 years .  Originally an accountant, Lisa fell in love with breastfeeding her own children and decided to change her career path, first by becoming a La Leche League Leader and then later pursuing a Master’s degree in Human Lactation with specialization in Lactation, becoming an IBCLC in 1993. Her thesis on Polycystic Ovary Syndrome and breastfeeding was the first to investigate infertility-related causes of insufficient milk production, and has since spawned new inquiries into other hormonal connections.  Driven by a passion to help her clients, Lisa has researched many challenging situations and  shared her discoveries in articles, conferences, online support groups,  and through co-authoring The Breastfeeding Mother’s Guide to Making More Milk as well as the Core Curriculum for Lactation Consultant Practice chapter on Insufficient Milk Production. In recognition of her contributions, Lisa was designated a Fellow of ILCA in 2009. She resides in Santa Maria, California and currently works as an IBCLC for the Santa Barbara County Public Health Department Nutrition Services/ WIC. Lisa and her husband Tom have 4 grown children and 6 grandchildren, all proudly breastfed.




Presentations

Breastfeeding on the Insulin Dysregulation Spectrum

Time-frame: 75-90
CERP: yes

Insulin is part of the Lactogenic Complex and Lactogenesis 2 cannot start without it. Until recently, however, we did not understand its role well. Emerging research is starting to shed light on specific roles for insulin in both pregnancy breast development as well as milk synthesis. Discover the how and why diabetes and insulin resistance can cause lactation problems, and what treatments may be helpful for affected mothers.

Deciphering the Lactation Curve: Lessons in Breastfeeding Physics from the Dairy Industry

Time-frame: 90
CERP: yes

The concept of a lactation curve is well known in the dairy industry, but not in the human lactation world.  When we look at milk production in the paradigm of this curve, we begin to understand the underlying drivers of milk production and why some women’s production seem more resilient than others. This talk explores the factors involved in the curve, the concept of persistency, and the importance of what happens in the beginning to long-term calibration.  Various curves will be shown and underlying causes discussed. The overall goal is to provide a new way of looking at milk production that will help us to understand our clinical situations better for the purpose of present and future strategizing.

Malunggay: old food, new galactogogue?

Time-frame: 30-60
CERP: yes

Malunggay is an unfamiliar and exotic-sounding plant to westerners, but a well-known food in India, Asia and the Philippines that is often fed to new mothers to ensure a good milk supply. This talk will examine the use of malunggay as a galactogogue and available supportive research.

Counseling the High Need Mother

Time-frame: 75-90
CERP: yes

We all have those mothers who just seem to get the best of us, and we aren’t always sure why or what to do about it. This session discusses who the high need mother is, including situational issues and the impact of personality dysfunctions on the helping relationship. Appropriate boundary setting and proactive strategies are discussed to help cope more successfully with these challenges.

This session was originally co-developed in conjunction with my colleague Nancy Williams, IBCLC, MFT. It usually generates a lot of discussion in the audience; more time would allow for more discussion.

Is it her hormones? Hormonal Imbalances and Insufficient Milk Supply

Time-frame: 75-120
CERP: yes

When good management isn’t good enough to improve low milk supply, what else could it be? Hormones play important roles in lactation and when they aren’t working right, lactation may be affected. Conditions such as thyroid dysfunction, diabetes, prolactin problems and polycystic ovary syndrome affect lactation for some mothers. This session discusses how hormones work, what kinds of things can go wrong, identifying problems and developing treatment strategies.

The amount of foundational information before the specific conditions depends upon other sessions selected and time allotment.

Could it Be Baby? Infant contributions to Low Milk Supply

Time-frame: 60-75
CERP: yes

An overview of the role of the baby in calibrating milk production and infant conditions that can cause low milk supply in the mother. Case examples illustrate the subtle ways infant causes may present.

Pairs well with “Could it be Mother?”

Ethics of Complementary Therapies in the LC practice

Time-frame: 60-90
CERP: yes

Discusses ethical and legal ramifications of the use/recommendation of alternative therapies (especially herbs).

Herbal Galactogogues: An option for low milk supply

Time-frame: 75-120
CERP: yes

Herbal galactogogues are often looked upon suspiciously by those who are not familiar with them. But when a mother is already doing her best and prescription galactogogues don’t fit well into her picture, what else can be done? Mothers increasingly ask about herbs, but many LCs and health care providers have little knowledge and feel uncomfortable when asked to provide guidance. This session will familiarize the learner with important herb issues then examine individual profiles, research and clinical experience for some of the most popular reputed galactogogue herbs and products.

This session starts with an overview primer on herbs in general, reviews potential galactogogue mechanisms, and then examines specific herbs. The talk is customizable and designed to be audience driven after the overview so that we can focus on the herbs and products of greatest interest to the group. *Specific herb monographs *Combination products such as tinctures, capsules and teas *Optional: a brief on homeopathic galactogogues **Note: Ethics concerns are touched upon briefly. For a more in-depth discussion, pair this talk with the stand-alone Ethics session.

Lactogenic Foods for Milk Production

Time-frame: 60-75
CERP: yes

Historically, nutrition has always been a part of the health strategy of traditional cultures. New mothers especially have been offered special foods to ensure good milk production. Western society often views these practices as myths, but is that all they are? This session looks at the role of nutrition in milk production and existing research on certain foods as they relate to lactation.

Lesser-known and Novel ideas for increasing milk production

Time-frame: 60-90
CERP: yes

What else is out there when the tried and true remedies don’t seem to be enough? This session takes a broad and open look at alternative and complementary therapies (ie, acupuncture, foods). Some have been studied formally while others are based on clinical experience and anecdotal reports. Interesting ideas and outcomes are discussed. For the professional who hates to leave any stone unturned.

This session would benefit greatly from a generous allotted discussion time for participants to both discuss the merits of various ideas and also to share other ideas or insights.

The Making of a Milk Factory

Time-frame: 60-90
CERP: yes

Lactation is the end-product of a long process that involves laying a foundation and then building upon that foundation during each pregnancy. This process can be affected by hormonal, environmental, and pregnancy factors. By the end of this session, participants will be able to identify some of these risk factors for milk supply problems and have a better understanding of what to expect and how to help the mother in her situation.

This session provides lays a foundation for understanding the implications of various conditions. . The Life Cycle of the Breast Hormones and Receptors Environmental Contaminant Issues Role of the Placenta Alternate titles: The Making of a Milk Factory An Inside Look at the Milk Factory A Milk Factory is Only As Good as its Foundation

Thyroid dysfunction: how the “other” master gland can affect lactation

Time-frame: 60-90
CERP: yes

The connection between the thyroid gland and milk production has not been well understood. New animal research is providing insights into the possible effects of thyroid dysfunction. This research will be discussed in context with current knowledge and case studies, along with possible treatment strategies.

This is the most detailed version of this topic. When a more comprehensive lactation failure talk is selected, this topic is covered more briefly.

PCOS Update: What we’ve learned

Time-frame: 75-90
CERP: yes

PCOS is frequently characterized by hyperandrogenism. Over the past few years, research has begun to focus on androgen imbalances and their impact from fetal development through the life cycle. These studies, together with accumulating clinical experience, are shedding light on what may be inhibiting milk production for a subset of PCOS mother. This session looks at the the role of androgens in the breast and lactation with an eye to specific treatment strategies.

PCOS in specific is discussed, but the application can extend to androgen conditions beyond PCOS.

Recognizing When Things are Heading South: Investigating for Low Milk Production

Time-frame: 75-120
CERP: yes

When low milk production concerns present, where do you start? Is it real or perceived? Delayed, secondary or primary? Which came first, the chicken or the egg? This session walks through the assessment process to determine what the cause of a low milk supply might be.

The amount of detail depends upon the allotted time. It is not intended to discuss conditions in-depth, but rather to help the attendee through the differential diagnosis process in order to develop a treatment strategy. Pregnancy issues Environmental issues Postpartum issues/delayed lactation Maternal self-sabotage/management Maternal physical Maternal hormonal Infant contribution

Talking to Mothers About Alternative Therapies: Learning Real Practices of Mothers

Time-frame: 60-90
CERP: yes

Evidence-based strategies are the first line of defense for assisting mothers with breastfeeding problems. When the rubber meets the road, though, clinicians and mothers often employ alternative strategies that may or may not be supported by research. These choices are driven by a number of factors, including responsiveness of the specific problem to standard recommendations, the clinical experience/judgment of the consultant, cultural preferences, or maternal choice. The role of the LC is determine the problem(s) and assist the mother in developing a care plan that most closely fits her needs. This talk explores why alternative therapies may be an option, interviewing the mother, prioritizing options, how to conduct a discussion of options, and developing a referral/resource base.

Mothers Speak Out: Top Five Traits of a Great LC

Time-frame: 70-120
CERP: yes

What makes for a great LC? Find out what real mothers had to say about what was most important and impressive to them! Great insights for improving effectiveness and clinical outcomes.

Galactogogue Case Studies

Time-frame: 70-120
CERP: yes

Case studies of real women- their clinical picture, LC thoughts, maternal choices, and outcomes.

Hormones of Lactation: Too Much, Too Little?

Time-frame: 70-120
CERP: yes

We all understand that there are hormones important to lactation, but when it comes to understanding the clinical picture of a breastfeeding problem, we usually hit a wall. This talk takes a closer look at prolactin, oxytocin, thyroid, androgen and insulin hormones and their relative impact on reproduction and lactation from the perspective of “too much” and “too little,” ending with a discussion on the when, how, and what’s of hormone testing.

Getting a Better Grip on Prolactin

Time-frame: 70-120
CERP: yes

Prolactin is considered to be a key hormone for lactation, yet our knoweldge has been surprisingly sparse. It is necessary for pubertal and pregnancy mammary development as well as milk synthesis. While prolactin level does not correlate directly to milk production, lactation fails without it. This talk will take a closer look at current research and what we do and do not yet understand about prolactin. We will then examine specific cases and discuss the process of elimination, as well as possible strategies for affected mothers.

What About Next Time? Planning for the Next Baby

Time-frame: 70-120
CERP: yes

When a mother has struggled with chronic low milk production, sooner or later she begins to wonder about the next baby. Will this happen to me again? Is there anything I can do to increase my chance of more success the next time around? Should I even try breastfeeding again? Research suggests that mothers often do better with subsequent babies, but not all mothers wish to wait passively on the roll of the dice. For those who desire to be proactive, there often are concrete clues that can help paint a prognosis and lend guidance to future plans. This session will look at various scenarios of low milk supply and analyze potential variables that might be influenced in the future. Specific cases with varying outcomes will be presented, along with discussion on counseling challenges and helping mothers find emotional balance in the process.

Hypoplastic Breast Syndrome: The hot new diagnosis?

Time-frame: 70-120
CERP: yes

Baby is here, but where’s the milk? One of the hottest breastfeeding problem topics among mothers on the internet is insufficient glandular tissue, and many are making this self-diagnosis in the absence of other explanations. LCs want to assure mothers that this is a rare phenomenon, but wonder what is going on when women have “questionable” breasts and poor milk output. This session takes a closer look at normal and abnormal breast development in the context of fetal, pubertal and pregnancy stages of development to better understand what may be going on. Discussion includes the relative merits and drawbacks of popular treatment approaches.

Hormone Testing When Nothing Else Makes Sense

Time-frame: 70-120
CERP: yes

What do you do when you’ve explored the possibilities for a mother’s low milk supply and yet cannot give her an answer? Some problems are hormonal in nature and defy traditional management solutions. There are many conditions that can impact lactation. This talk is divided into three parts: how hormones work, hormonal conditions that can affect lactation, and how to go about assessment, testing and dealing with the results. The goal is to coach serious lactation professionals in how to take problem-solving to the next level. By the end of the sessions, participants should have a broader awareness of various problems that can affect lactation and what types of clues to look for, as well as their advocacy role for the mother.

Why Can’t That Baby Latch? How Tongue and Lip Mobility Restriction Can Affect Breastfeeding

Time-frame: 60-90
CERP: yes

Successful lactation depends in part on a baby’s ability to latch and draw milk from the breast in an effective and efficient manner. When baby isn’t able to do his job, everyone suffers. Tongue and lip mobility restriction can both overtly and subtly impact baby’s suck, yet this problem is rarely picked up by most health care providers. Anterior tongue-tie is easiest to identify, but restrictions involving the posterior tongue or the lip can be equally devastating and yet are almost unknown. This talks covers the role of the tongue and lips in sucking and red flags for tongue mobility restriction. Each variation of problem is illustrated by multiple photos and video clips, and optional cases describe presentation, treatment and outcome.

Could it Be Baby? Infant contributions to Low Milk Supply

Time-frame: 60-75
CERP: yes

An overview of the role of the baby in calibrating milk production and infant conditions that can cause low milk supply in the mother. Case examples illustrate the subtle ways infant causes may present.

Is it her hormones? Hormonal Imbalances and Insufficient Milk Supply

Time-frame: 70-120
CERP: no

When good management isn’t good enough to improve low milk supply, what else could it be? Hormones play important roles in lactation and when they aren’t working right, lactation may be affected. Conditions such as thyroid dysfunction, diabetes, prolactin problems and polycystic ovary syndrome affect lactation for some mothers. This session discusses how hormones work, what kinds of things can go wrong, identifying problems and developing treatment strategies

Lisa Marasco


Country: USA
Email: LisaIBCLC@Marasco.us
Site: http://lowmilksupply.org
Download CV

Publications

Core Curriculum for Lactation Consultant Practice Third Edition

Chapter 42 Insufficient Milk Supply co-authored with Kay Hoover