Megan Keuler, MD, MPH, is a family medicine physician, International Board Certified Lactation Consultant (IBCLC) and perinatal mental health certified (PMH-C) physician with the University of Minnesota Physicians (M Physicians) Mill City Clinic.
Dr. Keuler talks about her expertise in lactation and perinatal care, common challenges her patients may experience with breastfeeding and lactation, and how she supports new and expecting families at the Mill City Clinic.
What inspired you to become an International Board Certified Lactation Consultant (IBCLC) and get certified in perinatal mental health (PMH-C)?
Dr. Keuler: My first child was born in December 2020, and we struggled to establish a breastfeeding relationship. I realized how few supports there can be in the medical system for people who are struggling with breastfeeding and also how little I knew as a physician about helping people who want to breastfeed do it successfully. It spurred me to get more education around breastfeeding medicine and started me on the path toward becoming an IBCLC.
Adding on the perinatal mental health certification bolstered my ability to support families in the early postpartum period. Postpartum success relies on adequate mental health support and family medicine is also a logical site for breastfeeding medicine care. Where your OB is more focused on the parent and your pediatrician is more focused on the baby, family medicine is trained to do both. My training has set me up to care for the whole family in that breastfeeding relationship, not just mom or baby.
What kinds of prenatal counseling related to breastfeeding and lactation do you offer to expecting families at the Mill City Clinic?
Dr. Keuler: I offer a prenatal planning visit for parents and families in the mid to late third trimester, usually around 34 to 36 weeks. This tends to be the sweet spot where we have enough time to plan, but it’s not too early to where you forget it all.
I do an individualized visit with each person. We get together to review your background and how the pregnancy has gone so far. We talk about goals and come up with a plan for what feeding should look like for mom and baby during those first one to three days. Everyone walks out with an individualized plan to set themselves up for the best success. Then, we work to set up follow-up appointments for after the baby’s here to see how that plan is going. What is going well and what isn't.
How do you support new parents with establishing early breastfeeding care?
Dr. Keuler: It's individualized. There are great lactation consultants, postpartum nurses and other people that do early hands-on care, in those first few days. I usually see people in that three to seven day post-discharge range. When you don't have someone bringing you food in the hospital anymore. You don't have someone you can grab and ask, does this latch look okay? Is this enough milk? Is this poop okay?
That's where my role steps in to say, okay, how did things go for those first critical few days? How can we set you up for success in getting your milk supply to come in? To get your milk output to increase? To make breastfeeding more comfortable for you? Or to manage any complications that come up? My role is trying to ease that transition from the hospital to home, establishing that breastfeeding relationship and setting them up for success in the best way possible.
Some of the common challenges Dr. Keuler helps families navigate include:
- Latch difficulties, including concerns for painful latch and ineffective milk transfer for baby
- Low milk supply and putting together a supplementation plan. Do you need to supplement? How much do you need to supplement? How do we taper that?
- Nipple blebs, mastitis, or other conditions at the breast
- Hyperlactation, when people make too much milk, and figuring out how to downregulate that supply
- Pumping and plans for returning to work. How much milk do you need in the freezer? How can I set you up for pumping success when you return to work?
- Problems or difficulties with weaning
- Inducing lactation for non-gestational parents
What advice would you give to new parents that might be feeling overwhelmed or experiencing challenges with breastfeeding or lactation?
Dr. Keuler: Breastfeeding is not as innate and natural for most people as we like to pretend that it is. There is often practical support needed to make a successful relationship between the parent and the baby. Always reach out for support. Not just medical support, but reaching out to your community as well.
At the prenatal planning visit, one of the things I ask parents about is what their postpartum plan looks like. Who will be available to help you and how practically will they be able to help you? Can they walk the dog for you? Are there house chores that you want them to do? Some of those simple decisions feel overwhelming when you're trying to juggle 500 things at once, sleep deprived and hormonal all at the same time. Have very practical and tangible ways your support network can help so that you can focus on what's important, which is resting, recovering your body, bonding with your baby and feeding your baby.
How do you support parental mental health as a part of postpartum care?
Dr. Keuler: Normalizing it, specifically with intrusive thoughts. The thought that like, oh my gosh, I'm gonna drop the baby. What happens if I fall down the stairs with the baby in my arms? These things seem entirely irrational, but they're very common experiences in the postpartum period. It’s important to have that open dialogue and talk about what is normal versus what is more concerning. While those intrusive thoughts may be very normal, postpartum depression and postpartum anxiety are very prevalent and should be treated for the health of the parent and baby.
The benefit of family medicine doing this is that we see you frequently. We see the baby every one to three months in the first six months of life. That’s the perfect opportunity to be checking in on the mental health of the parents as well. Your sleep is disrupted. Your whole life has changed in so many ways. It's understanding that this can be a time of worsening mood and mental health for parents. Let's get you on my calendar. Let's talk about this in more detail and support you.
Dr. Keuler sees patients to help with these needs–and more–at the M Physicians Mill City Clinic. Call the clinic at 612-338-1383 to schedule an appointment.