How placenta ingestion lowers milk supply

Key Points

Milk production is dependent on uninterrupted breast development and hormonal environments through the pregnancy and lactation cycles
Some hormones in the placenta counteract the hormones needed for breastfeeding
Ingesting placenta after the birth interrupts the hormonal environment needed to make sufficient milk

Research done in 1918 and 1954 on placenta as a galactagogue is not considered valid by today’s scientific standards
Placenta capsule ingestion is considered a cause for low milk supply

The concern of risks to milk supply with placenta ingestion

The complex cycle of hormones necessary for breastfeeding is orchestrated by a woman’s natural body rhythms from puberty through the pregnancy and postpartum time. Altering these hormonal environments may have serious consequences on milk production. The new trend of postpartum women ingesting their placenta may have undesired effects. Never before in human history has it been a traditional practice for a mother to consume her placenta. An increasing number of lactation consultants are reporting mothers ingesting their placenta having a direct and significant decrease in milk supply. However, some women who consume their placenta have been found to have a normal milk supply. Accurate assessment of milk supply by closely evaluating infant weight gain is important to determine the effect of the placenta pills. Low milk supply leads to slow weight gain and potentially to stunted growth and development for the infant. Considering the risks to milk supply, mothers should be given all the information before they make this important decision as to whether or not to ingest their placenta. Older papers written in 1918 and 1954 on placenta ingestion purportedly used to increase milk supply are considered unscientific in their methods. The Academy of Breastfeeding Medicine published in 2018 a revised protocol on the use of galactogogues (substances that can increase milk supply) for mothers with low milk supply. This protocol advises to first assess for possible causes of low milk supply before using substances to increase supply. They list the factors to assess for that could have contributed to low milk supply, and among these it includes ingestion of placenta capsules.

When consuming the placenta, via placenta pills for example, women are reintroducing pregnancy hormones back into their body. Hormones present in the placenta, progesterone and estrogen specifically, are known inhibitors of prolactin and milk supply. This suppression has been known to happen during lactation when a breastfeeding mother takes hormonal birth control, or becomes pregnant again. Ingesting placenta during the postpartum period is experimenting on the lactation cycle, altering a natural hormonal environment by adding the hormones known to decrease milk production.

See the section on how placental hormones can affect milk supply.

How milk is made

In order to understand how eating your placenta could affect milk supply, it is important to know how milk is made

Breast Development in Pregnancy

“The hormones affecting lactation play different roles during pregnancy, birth and breastfeeding”
(Mohrbacher p 393)

Mammogenesis
Early Pregnancy
A pregnant woman has high blood levels of pregnancy hormones that stimulate the breast tissue to develop and prepare for milk production (Mohrbacher 2010). Starting at 3 – 4 weeks of pregnancy, a woman’s breasts undergo growth and differentiation. This causes ductal branching and lobular formation occurring from the action of a range of hormones including estrogen, progesterone, prolactin, growth hormone, epidermal growth factor, fibroblast growth factor, insulin-like growth factor, human placental lactogen, and parathyroid hormone related protein. The completion of this stage results in differentiation of mammary lobules and alveoli, or milk making cells, which will be needed for milk production (Hale and Hartman 2007).
Lactogenesis I
Mid-pregnancy
The growth of breast tissue and the beginning of colostrum production is called ‘secretory differentiation’ or ‘lactogenesis I,’ and it begins mid-way through the pregnancy and ends on around day 2 after the birth. This stage is involved in producing the colostrum, the “first milk,” in the alveoli cells and milk ducts (Mohrbacher 2010).

While progesterone is one of the active hormones in the development of the mammary gland during pregnancy, another action of progesterone is to inhibit significant milk production during pregnancy. While the breast begins producing colostrum in pregnancy, progesterone’s presence during pregnancy directly inhibits the onset of copious milk secretion (Walker 2017, Mohrbacher 2010, Hale and Hartman 2007, Riordan 2005).
Lactogenesis II
Birth to postpartum day 2-3
Image used with permission

The expulsion of the placenta at birth triggers the hormonal chain of events that transitions a woman from the pregnancy hormonal state to the breastfeeding hormonal state. This hormonal cycle is what causes milk production to rapidly increase, and is called Lactogenesis II.

Lactogenesis II is the initiation of copious milk secretion and is triggered by the delivery of the placenta at birth, and the resulting withdrawal of progesterone from circulation. “Since it is the delivery of the placenta that initiates the fall in progesterone, lactogenesis II is therefore delayed until progesterone clears from the circulation, some 30 – 40 hours postpartum.” (Hale and Hartman p 98)

“Studies have shown that lactogenesis II is delayed in women who have retained placental products after birth. The capacity of the remaining placental fragments to secrete progesterone prolongs the inhibition of milk secretion in these women” (Hale and Hartman p 91).
Lactogenesis III
End of first week until weaning
Lactogenesis III is also known as Galactopoiesis, or the maintenance stage of milk production.

From the delivery of the placenta, estrogen, progesterone and placental lactogen blood levels fall quickly and stay low during breastfeeding, while prolactin levels stay high due to its secretion from the pituitary gland. At this stage of lactation, the hormones important to milk production are prolactin, oxytocin, cortisol, thyroid-stimulating hormone, and insulin. (Walker 2017, Mohrbacher 2010, Hale and Hartman 2007, Riordan 2005).

After the hormonal chain of events of the first days after the birth, hormones have only a minor role in maintaining milk production. Lactogenesis III is under autocrine, rather than hormonal control, which means that effective milk removal is the primary method for influencing the rate of milk supply. At this stage in lactation, milk removal is what is meant to keep prolactin levels high and is the primary driver of milk production (Mohrbacher 2010).

The pituitary gland’s secretion of prolactin for ongoing maintenance of milk production depends on a positive feedback loop. The infant suckling at the breast, and the regular emptying of the breast, are essential to the promotion of prolactin secretion. Levels of prolactin in the blood are highest in early lactation and will decline as lactation progresses. There is evidence that the function of prolactin may change during the course of lactation (Hale and Hartman 2007).

Understanding lactation physiology is important to see how the body is meant to maintain milk supply. The author of the book, Breastfeeding and Human Lactation explains the importance of prolactin receptors in long term milk supply, stating “the controlling factor in breastmilk output is the number of prolactin receptors rather than the amount of prolactin in serum” (Riordan p 77). The early weeks after birth may be a critical period for activation of enough prolactin receptors in the breast for ample long-term milk production (Mohrbacher 2010).

Oxytocin is released by the posterior pituitary gland in response to the baby sucking at the breast. The oxytocin hormone is released in pulsatile waves, causing surges of high levels that act on the muscles fibers surrounding alveolar cells in the breast, causing them to contract and release the milk. This is known as the “milk ejection reflex” (Walker 2017).

Low Milk Supply Causes

If a woman is thought to have low milk supply, “the best gauge of adequate production is the baby’s weight gain and growth” (Mohrbacher p 401).

Low milk supply can occur following an initially normal milk supply that has been down regulated due to breastfeeding mismanagement and/or infant related conditions. If the breasts are not effectively and regularly drained, from either infrequent feedings and/ or ineffective feedings (due to infant related conditions such as tongue-tie, prematurity, etc.), milk supply can be low.

Low milk supply can also be due to maternal causes, such as from a mother’s underlying medical or surgical history, breast development or use of medications or substances during lactation. According to Morhbacher, a mother’s hormonal levels need to be in a normal range to produce enough milk. She states, “For adequate milk production, a mother’s hormones should be in balance, and her hormones and receptors should work well…Her body’s response to a hormone will be partly determined by how many receptors for this hormone she has and how many are activated” (Mohrbacher p 392).

Placenta capsule ingestion is a potential cause of low milk supply

The Academy of Breastfeeding Medicine (ABM) is an organization that develops clinical protocols with the goal of helping health care professionals manage common medical problems that impact breastfeeding success. According to the Academy of Breastfeeding Medicine (ABM) updated Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018, “It is always important to ensure that low weight gain is due to insufficient calories from low milk supply and not other infant causes” (ABM Protocol #9 2018).

Below is an excerpt from the ABM Protocol #9, 2018, that lists practice recommendations to evaluate causes of low milk supply. Note that placenta capsule ingestion is included as one of the possible causes of low milk supply (bold added):

“1. Evaluate the mother for medical causes of low milk supply: pregnancy, medications, primary mammary glandular insufficiency, breast surgery, polycystic ovarian syndrome, hypothyroidism, retained placenta, ingestion of placenta capsules, theca lutein cyst, loss of prolactin secretion following postpartum hemorrhage, heavy smoking or alcohol use, or other pertinent conditions. Treat the condition as indicated if treatment is available. For many of these women, a galactogogue should not be recommended or prescribed.”

See the section on Hormones to see how placenta pills can affect the lactation hormones

The concern of use of contraceptives containing estrogen and progesterone with breastfeeding

The Academy of Breastfeeding Medicine’s ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015, advises using caution when choosing hormonal contraception methods that could lower milk supply, such as estrogens and progestins. This protocol explains that the studies involving various hormonal contraceptives and their effect on milk supply are not conclusive, and often have poor study design in evaluating breastfeeding: “A Cochrane review indicated that evidence from randomized controlled trials on the effect of hormonal contraceptives during lactation is limited and of poor quality: ‘‘The evidence is inadequate to make evidence-based recommendations regarding hormonal contraceptive use for lactating women.’’ Until better evidence exists, it is prudent to advise women that hormonal contraceptive methods may decrease milk supply especially in the early postpartum period. Hormonal methods should be discouraged in some circumstances” (ABM 2015). The ABM protocol concludes, “For the individual breastfeeding family, this lack of sufficient data regarding the impact of hormonal contraception may have significant negative consequences” (ABM 2015).

The body’s introduction of naturally occurring pregnancy hormones from a new growing placenta has been shown to have a negative impact on a breastfeeding mother’s milk supply. The diminishment of milk supply of a breastfeeding mother when she becomes pregnant again has been widely observed and reported anecdotally. When looking at this from a physiological standpoint, a new pregnancy grows a new placenta and with this comes circulating hormones of pregnancy, including high levels of estrogen and progesterone. The literature review published in 2017, Breastfeeding During Pregnancy: A Systematic Review shows evidence of this phenomenon in the research studies. This review looked at a the scientific evidence from the literature that pertained to breastfeeding during pregnancy. They found 19 studies examining the effect of a new pregnancy on the breastfeeding mother’s milk supply and composition.

This systematic review reported, “The studies suggest that pregnancy causes changes in both the amount and the composition of breastmilk…it is agreed that more than 66% of mothers experience a drop in milk production during pregnancy, and that mature milk turns into colostrum by late pregnancy” (López-Fernández et al. 2017). Included was a study that found that 18% of women lost their milk supply completely during pregnancy.

In the study, Mammary Gland Function During Gradual Weaning and Early Gestation in Women, researchers examined and compared markers of milk composition in a group of women weaning and another group of women in early pregnancy to see if there were any differences. They concluded, “The results indicate a progressive loss of secretory activity by the mammary gland during weaning and early gestation. During weaning this loss appears to be directly related to the decrease in the infant’s suckling frequency, whereas during early gestation there would appear to be an inhibition of milk secretion which over-rides the positive stimulus provided by the infant’s suckling” (Prosser et al. 1984). This gives further evidence into the action of the presence of circulating pregnancy hormones on lowering of milk supply.

Research often cited to support placenta ingestion is not scientifically valid

Proponents of placenta ingestion often cite two previously published studies published on placenta use as a galactagogue in humans. One was done in 1918 by Hammett and the other in 1954 by Soykova-Pachnerova and colleagues.

Numerous recent literature reviews have determined that these two studies had major design flaws including limited information provided, failure to blind researchers as to whether participants received placenta or placebo, no or poor control measures, a vague set of inclusion criteria and subjective or no specific standardized measures given for interpreting the results. Therefore, they do not provide accurate conclusions that contribute to our understanding of the effects of placentophagy on lactation (Cole 2014, Coyle et al. 2015, Farr et al. 2017, Hayes 2016).

In addition, a paper published in 1917 by Hammett and McNeill stated that in their review of the literature, there were three previous studies of placenta ingestion that failed to show an increase in milk supply and two studies (Mackenzie in 1911 and Gaines in 1915) that concluded it reduced milk supply.

Regardless of the results reported from these early papers, their conclusions should not be considered as having a valid scientific basis according to current research standards.

References

Academy of Breastfeeding Medicine Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018.

Academy of Breastfeeding Medicine Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015.

Cole, M. (2014). Placenta Medicine as a Galactogogue: Tradition or Trend? Clinical Lactation 5:116‐122.

Coyle, C., Hulse K., Wisner, K., Driscoll K., Clark, C (2015). Placentophagy: Therapeutic Miracle or Myth? Arch Womens Ment Health.18(5): 673–68

Farr A, Chervenak FA, McCullough LB, Baergen RN, Grünebaum A. (2017). Human Placentophagy: a Review. American Journal of Obstetrics and Gynecology. 218:401.

Gaines, W. L., Am J. Physiol., 1915, xxxviii, 285.

Hale, T., Hartman, P. (2007). Textbook of Human Lactation. (1st edition). Amarillo, TX:Hale.

Hammett FS, McNeile LG. (1917). The Effect of the Ingestion of Desiccated Placenta on the Variations in the Composition of Human Milk During the First Eleven Days After Parturition. J Biol Chem, 30:145-53.

Hammett, F. S. (1918). The Effect of the Maternal Ingestion of Desiccated Placenta Upon the Rate of Growth of the Breast-fed Infant. Journal of Biological Chemistry, 36, 569–573.

Hayes, E. H. (2016). Consumption of the Placenta in the Postpartum Period. JOGNN, 45, 78–89.

López-Fernández G., Barrios M., Goberna-Tricas, J., Gómez-Benito, J. (2017). Breastfeeding During Pregnancy: A Systematic Review. Women and Birth 30; e292–e300

Mackenzie, K., Quart. J. Exp. Physiology., 1911, iv, 305.

Mohrbacher, N. (2010). Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Hale Publishing.

Prosser CG, Saint L, Hartmann PE. Aust J Exp Biol Med Sci. (1984). Mammary Gland Function During Gradual Weaning and Early Gestation in Women. Apr;62 (Pt 2):215-28.

Riordan, J.(2005). Breastfeeding and Human Lactation. (3rd edition) Sudbury,MA:Jones and Bartlett Publishers.

Soykova-Pachnerova, E., Brutar, V., Golova, B., & Zvolska, E. (1954). Placenta as a Lactagogon. Gynaecologia, 138(6), 617–627.

Walker, M. (2017). Breastfeeding Management for the Clinician: Using the Evidence (4th edition) Sudbury, MA: Jones and Bartlett.

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