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.
Lisa Marasco has been working with breastfeeding mothers for 35 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 Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, a contributing author to the Core Curriculum for Interdisciplinary Lactation Care, and a new Cochrane Collaborative author. She is recently retired from WIC of Santa Barbara County but continues to research, write and speak. In addition, Lisa is affiliated with La Leche League of So. Calif/Nevada, and serves on the Breastfeeding Coalition of Santa Barbara County.
Lisa Marasco has been working with breastfeeding mothers for 35 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 and hormonal-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 Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production as well as the Low Milk Production and Infant Weight chapter in the Core Curriculum for Interdisciplinary Lactation Care. Her most recent projects included a seminal article on Unsolved Mysteries of the Human Mammary Gland and a Cochrane Review of oral galactogogues. In recognition of her contributions, Lisa was designated a Fellow of ILCA in 2009, and in 2018 received the USLCA Award of Excellence for her research work. After 17 years of service, Lisa recently retired from her “day job” as an IBCLC for Santa Barbara County Public Health Department Nutrition Services/ WIC but she continues to research, write and speak. Lisa and her husband, Tom, reside in Santa Maria, California; they have 4 grown children and 7 grandchildren, all proudly breastfed.
Milk removal drives milk production and feeds the baby. The ability to remove milk from the breast depends strongly on the milk ejection or letdown reflex. While normally robust, a number of factors can influence it, some more obvious than others. When milk flow suddenly becomes an issue, the rush is on to determine why and what to do about it. This session will take a deeper look at how this reflex works, factors that can affect it positively or negatively, and potential strategies to help.
PCOS is the leading cause of infertility in women and involves multiple possible hormonal imbalances. What has been learned about its impact on breastfeeding? We will take a look at the emerging evidence for insulin resistance, along with how the frequent co-morbidities of obesity, hyperandrogenism, and thyroid dysfunction can interrelate and also contribute to lactation problems. The next step explores potential strategies/treatments that are based on underlying etiologies. Note: this overlaps with other hormone talks.
Based on Lisa’s seminal article on the topic, this presentation explores what we do and do not yet know on topics that impact lactation clinicians, including the “true” rate of insufficient milk, FIL, infertility, the milk ejection reflex, hypoplasia, hypertension, nutrition, maternal age, serotonin, and more. Current challenges in obtaining the research we all want will also be discussed with an eye to how we can help. “Unsolved Mysteries” is a relational presentation that engages the audience by allowing them to choose the topics for discussion; attendees are guaranteed to walk away with new insights/information.
When the topic of galactogogues comes up, a commonly heard refrain is “there is no evidence that galactogogues work…” But that’s not true! The results of a Cochrane review that cast a world-wide net will be presented, along with insights about historical differences in the goals of studies and other interesting facts gleaned during the review process regarding. By the end of the session, the participant will be able to list four components of a model study (a better “mousetrap”), as well as 10 galactogogues that have been studied, and discuss the strength of the evidence.
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 insulin resistance, type 2 and gestational diabetes can cause lactation problems, and what strategies may be helpful for affected parents.
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 seems 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.
We all have those clients who just seem to get the best of us, and we aren’t always sure why or what to do about it. This session explores who those people are, including situational issues (including Covid-19) and the impact of personality disorders on the helping relationship. Appropriate boundary setting and proactive strategies are discussed to help the learner 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.
When good management isn’t enough to improve low milk supply, what else could it be? Hormones govern lactation and when they aren’t functioning properly, breastfeeding may be negatively affected. This talk starts with a brief discussion on how hormones work, then highlights hormonal conditions that can alter the course of lactation, including thyroid dysfunction, prolactin problems, insulin resistance, obesity, and PCOS. The goal is to coach serious lactation professionals in how to take problem-solving to the next level. By the end of the session, participants should have a broader awareness of how hormones work, what kinds of things can go wrong, what types of clues to look for, and strategies to assist and advocate for struggling parents.
The amount of foundational information before the specific conditions depends upon other sessions selected as well as time allotment for this talk. Note that this is a “Reader’s Digest” condensed version of the more detailed stand-alone hormone talks. Topics can be adjusted if an overlapping hormone talk is also selected. Alternate titles: Breastfeeding Support for Parents with Hormone-based Disorders; Hormone Testing When Nothing Else Makes Sense
“What can I say?” When it comes to complementary and alternative therapies, many lactation consultants are unsure of how to conduct this conversation with a client. We will take a look at our professional guidelines, the question of evidence, and handling real-life dilemmas that come up. This is an E-CERP talk.
Herbal galactogogues- substances that boost milk production– are often looked upon suspiciously by those who are not familiar with them. But when a client is already doing her best and prescription galactogogues don’t fit well into the picture, what else can be done? Parents 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.
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.
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.
Lactation is the end-product of a long process that involves laying a foundation and then building upon that foundation during each pregnancy. The process can be affected by hormonal, environmental, and pregnancy factors. This talk lays a foundation for understanding the implications of various conditions. 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. Note to conference organizers: this talk overlaps with the Hypoplasia talk.
The connection between the thyroid gland and milk production has not been well-recognized or appreciated . The good news is that new animal research is providing us insights into the possible effects of thyroid dysfunction. This talk takes a detailed look at hypothyroidism, hyperthyroidism, postpartum thyroiditis and thyroid cancer and the unique challenges each present for lactation, and then discusses treatment strategies and interfacing with the health care team. Note: This is the most detailed version of this topic.
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, including infant contributions such as tongue-tie.
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.
Prolactin is considered a key hormone for lactation, yet our knowledge has been surprisingly sparse. It’s necessary for pubertal and pregnancy mammary development as well as milk synthesis. While prolactin levels don’t 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, especially in the face of undetermined milk supply problems. We will then examine specific cases and discuss the process of elimination, as well as possible strategies for affected clients.
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.
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. Note to conference team: this talk has overlap with the Milk Factory
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.
Chapter 22, Low Milk Production and Infant Weight, co-authored with Kay Hoover and Kelli Fornow
Overview of issues that affect mothers but have not been researched sufficiently.
Second Edition! Updated with newly expanded Milk Supply Equation, pregnancy/birth issues, lactogenic foods, complementary therapies, Lactation Curve, and more.