Lactation and Breastfeeding - Problems Faced and Therapies to Enhance

Introduction

Breastfeeding is always the gold standard criteria for infant feeding. The advent of new commercial artificial milk formulas as nutritional substitutes for infants gained momentum during the 20th century. In recent years, breastfed milk is reemerging as the ideal and essential source for infant nutrition, and more women are now choosing to breastfeed their babies. Even, adoptive parents prefer breastfeeding through induced lactation. However, there exists a wide gap between community knowledge of breastfeeding and the actual scientific approach. This article explores various therapies that are in day-to-day clinical use to ensure adequate lactation and improve breastfeeding.

What Are the Benefits of Breastfeeding?

Breastfeeding is beneficial for both the baby and the mother. Breast milk supplies the baby with essential nutrition and greatly helps in the growth and development of the baby. Breastfeeding also protects the baby and the mother from various illnesses and disorders. Some of the benefits of breastfeeding are as follows -

• Breast milk is considered the best and complete source of nutrition for newborns and infants.

• The supply and the composition of the mother’s milk vary to meet the growing needs of the baby as development progresses.

• Breastfeeding provides antibodies from the mother which protects the babies from various illnesses during the initial stages since their immune system is immature.

• The presence of the mother’s antibodies in the baby also helps in developing a strong immune system in the baby.

• Babies who have been breastfed are at a lower risk of developing certain disorders such as asthma, type 1 diabetes, sudden infant death syndrome (SIDS), and obesity.

• The development of ear infections is less likely in breastfed babies and their natural microbial flora of the gut is well established. So, they do not develop gut infections.

• Antibodies from the mother are transferred to the baby through breastfeeding.

• These shared antibodies help the baby to develop its own immune system and also ensure protection from illnesses till the maturation of the baby’s immune system.

• Mothers could immediately breastfeed their babies without any delay. Whereas, feeding formula foods requires time for preparing the bottles.

• Breastfeeding is also a convenient way for feeding babies without disrupting their normal routine during traveling.

• Breastfeeding favors the mother’s health by reducing the risk of developing breast or ovarian cancers, high blood pressure, and type 2 diabetes.

What Is Meant by Healthy Lactation?

Lactation refers to the process of making and secreting milk from the mammary glands that are present within the breasts. It usually occurs in all female mammals after giving birth to the young ones. Active lactation is initiated from the first suckling of the baby till the weaning period. Healthy lactation refers to a sufficient supply of milk to meet the growing demands of the baby without affecting maternal well-being. Some of the factors contributing to healthy lactation are as follows -

• The Suckling Reflex - Is initiated by the newborn. The lips and cheeks of the baby form a seal with the nipple and surrounding areola of the mother’s underlying breast tissue creating a proper latch-on for suckling. This initiates active production and secretion of milk.

• Lactating Hormones - Prolactin and oxytocin are the major lactating hormones that regulate the formation and production of mother’s milk.

• Feeding Frequency - The supply of milk from the mother depends on the baby’s demand and removal of formed milk. Feeding frequently according to the hunger cues of the baby ensures a good supply of milk.

What Are the Problems Faced during Breastfeeding?

Insufficient milk production or incomplete removal of formed milk are the reasons frequently associated with starting nutritional supplementation and premature cessation of breastfeeding. Many women eventually express their concern over the inability to produce the required quantity of milk. In reality, this is not true. Lack of scientific knowledge about the mechanics of breastfeeding and poor evaluation of lactating outputs are reasons for unsuccessful breastfeeding. Some of the problems faced during lactation and breastfeeding are -

• Incorrect breastfeeding techniques where proper seal between baby’s mouth and mother’s nipple is not established.

• Early discharge (within 24 hours) of the mother and the newborn before the establishment of proper lactation followed by the hasty follow-up (within two to three days).

• Engorgement of the breasts due to blockage in milk ducts.

• Sore or cracked nipple due to dryness, mechanical trauma, or infection.

• Mastitis is the development of infection in engorged breasts.

• Presence of abscess or lesions.

• Yeast infections of the breast.

• Premature or preterm infants.

• Poor suckling of the baby due to the presence of oral abnormality.

• Infants having neurological issues.

What Are the Therapies Followed to Improve Lactation and Breastfeeding?

Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination of breastfeeding. Several therapies are developed to enhance proper lactation and encourage breastfeeding in mothers. Some of the clinically practiced methods are as follows -

Oral Galactagogues

These are substances that stimulate the production of milk. They are of two types namely pharmacological and non‐pharmacological (natural) therapeutic agents. Oral galactagogues are effective in induced lactation.

Pharmacological Therapies

• Oral galactagogues are enhancers of milk production and facilitate lactation.

• Metoclopramide is a potent stimulator that causes prolactin release and is used in the treatment of lactation insufficiency.

• An initial oral dosage of 10 mg three to four times daily increases milk production. Its use is limited to 10 to 14 days followed by gradual tapering to avoid side effects.

• Domperidone, sulpiride, and thyrotropin‐releasing hormones are some of the galactagogues used to increase milk volume.

• However, the use of these drugs is not approved by the FDA because of their side effects. They are prescribed as off-label drugs.

Non‐Pharmacological Agents

• These include herbal galactagogues that are frequently influenced by familiarities or local cultures and customs.

• Fennel seeds, fenugreek, banana flower, ginger, moringa, palm dates, and certain natural mixtures are some of the commonly used herbal galactagogues.

• Fenugreek is a herb (used in Indian cooking) and is a well-tolerated galactagogue used by most women. It is taken in the form of herbal tea (two to three cups per day) or as capsules (2 capsules of 500 mg three times daily). Milk production evidently increases within 48 to 72 hours.

• Herbal remedies where fennel seeds are brewed as tea are also preferred.

Physical Therapies in Lactation

Physical therapies are considered safe and effective to promote lactation, especially in conditions such as breast or nipple pain, blocked or plugged ducts, engorgement, and mastitis. Some of the physical therapies to facilitate breastfeeding are as follows -

• Kinesiology Taping - is a physical procedure where an elastic cotton strip along with an acrylic adhesive isapplied over the breasts to improve milk outflow.

• Assisted lactation through kinesiology taping application is widely used in conditions such as breast engorgement during early postpartum stages. It is found to relieve pain in such conditions.

• Neural Mobilization - Neural mobilization also called neurodynamics is a technique that is based on a movement-based therapeutic intervention that aims at restoring milk homeostasis (regulated milk flow) through nerve stimulation.

• Therapeutic Ultrasound - It is widely used in blocked ducts where sound waves are used to penetrate deeply into the mammary glands and warm up the blocked milk ducts to ease the milk flow and relieve the discomforts in lactating mothers.

• Standard Care - This includes manual pumping, device-assisted lactation, cold compress, gentle massage of the breasts, ibuprofen for relieving pain, and shoulder girdle and breathing exercises to facilitate breastfeeding.

Kangaroo Mothering

• Kangaroo mother care establishes skin-to-skin contact between mother and child, and it is especially followed in the nursing of preterm or premature newborns.

• It is safe and effective for low birth weight babies and favors only exclusive breastfeeding.

Relaxation Therapies

• Proper milk ejection is disrupted in increased psychological distress which commonly occurs during the postpartum phase.

• Through relaxation therapies and proper lactation counseling milk ejection is considerably improved during breastfeeding.

Conclusion

Growing awareness about lactation and the importance of breastfeeding is encouraging more and more parents to breastfeed their babies. Newer scientific therapies and techniques are being developed to reduce the problems faced during breastfeeding. Proper consultation with the pediatrician and professional assistance from lactation counselors would enhance the efficacy of lactation and breastfeeding.