Lactation Failure: Causes and Management

Introduction:

Breastfeeding is a beautiful phase in the journey of motherhood, where women produce breast milk to feed the baby. The production and supply of breast milk depend on various factors and may show reduced supply in some women due to a wide range of reasons. The situation is a big challenge but can be managed with a professional approach and can ensure a regular milk supply to the newborn.

What Is Lactation?

Lactation refers to the biological process involving the production and release of milk from the mammary glands located in the breast. Begins during pregnancy when hormonal changes signal the mammary gland to produce milk and to prepare for childbirth. Lactation is a physiological process that is under neuroendocrine control. The milk produced or breast milk is the primary source of nutrition for the newborn. The act of directly nourishing the baby from the breast is referred to as breastfeeding or nursing.. And once the body stops producing milk, lactation ends.

Breast milk provides the ideal nutrition for the newborn, with proteins, vitamins, and fat that are more easily digested than formula milk. Breast milk also contains antibodies that help newborns to fight against diseases. Proper breastfeeding also reduces the risk for various diseases of newborns, like allergies, ear infections, respiratory illness, diarrhea, diabetes, and obesity.

What Is the Pathophysiology of Lactation?

The process of developing the ability to secrete milk is called lactogenesis. It has two stages secretary initiation and secretary activation.

• Secretary Initiation: The initial stage that occurs during the second half of pregnancy. The higher level of progesterone supplied by the placenta further inhibits differentiation. By week 16 of pregnancy, a small amount of milk will be secreted, and women can reduce colostrum by late pregnancy.

• Secretary Activation: The second stage proceeds with milk production following childbirth. As the placenta is removed, there is a rapid decrease in progesterone and elevated levels of hormones like prolactin, cortisol, and insulin, which help in the further production of milk.

Late milk production is seen in women with retained placental fragments, stressful vaginal delivery, and women with diabetes.

What Is Lactation Failure?

Lactational failure is the failure to produce enough breast milk by the mother to meet the baby's nutritional requirements. Breastfeeding failure can be temporary or long-term. Oxytocin is a hormone that has an important role in the production of milk. The oxytocin reflex is positively affected by the mother's feelings and sensations about the baby touching, smelling, and seeing the baby or even hearing the baby cry. In a mother who is emotionally disturbed or experiencing pain, the oxytocin reflex fails to work, leading to reduced breast milk production.

What Are the Causes of Lactation Failure?

Causes Related to Mother:

Psychological and Social:

• Insufficient milk.

• Unsuitable milk.

• Refusal by the baby.

• Disease of the mother.

• Maternal employment.

• Sick newborn.

• Dislike breastfeeding.

• Fixed schedule feeding.

• Previous unsuccessful breastfeeding experience.

• Lack of confidence.

• Stress.

• Religious customs.

Biological:

• Inverted nipple.

• Sore and cracked nipple.

• Mastitis and abscess

• Breast surgery.

• Abnormal breast.

• Engorged breast

• Retained placenta.

• Endocrinopathies (thyroid ovarian or pituitary dysfunction).

• Chronic maternal illness.

• Complications of pregnancy interfering with breastfeeding.

• Psychiatric disorder.

Breastfeeding Related:

• Delayed start of breastfeeding.

• Fixed schedule feeding.

• In frequent feeding.

• Short feeds.

• Poor attachment.

• Other fluids or food.

• Bottle or pacifier.

Drugs Causing Suppression of Lactation:

• Calcitonin - Calcitonin should be avoided in nursing mothers as it reduces the serum prolactin level.

• Diuretics - Diuretics during breastfeeding can decrease the milk supply.

• Dopamine Receptor Agonist - This drug is contraindicated during pregnancy and breastfeeding because it inhibits the activation.

• Ergotamine - Ergotamine and ergotamine derivatives have antiprolactin action, resulting in decreased milk production.

• Contraceptives - Control pills with hide houses of estrogen decrease the milk supply.

• Pyridoxine - Pyridoxin is considered as an anti-lactating agent coaching suppression of milk supply in the initial weeks.

• Tamoxifen - Tamoxifen and its metabolites are detected in milk, and accumulated over time causing suppression of lactation.

Neonatal Causes:

1. Neonatal Illness:

• Early separation of mother and infant interferes with the initiation of lactation.

• Preterm birth.

• Neonatal asphyxia (difficulty initiating breathing after birth).

• Choanal atresia (narrowing the blockage of a nasal pathway causes difficulty in breathing).

2. Disorders with Poor Suck:

• Cleft lip.

• Cleft palate.

• A short frenulum, or tongue tie, occurs when the thin band of tissue beneath the tongue attaches the tip of the tongue to the floor of the mouth, leading to difficulties in proper sucking during feeding.

• Micrognathia (a condition where the lower jaw is of smaller size).

Maternal or Infant Medication:

• Drugs transfer to the breast milk and reaches the baby, which may cause risk to the breastfed baby.

Breast Rejection:

• Breast rejection occurs when the Infant refuses breastfeeding due to difficulty to latch on the breast properly, are the use of a traditional bottle or pacifier.

What Are the Signs of Lactation Failure Shown by a Newborn?

• The child is not satisfied after feeding.

• Frequent crying.

• Long feeds.

• Improper weight gain.

• Less wet diapers.

• Infrequent bowel movements.

During the 1st week of childbirth, the symptoms shown by a newborn include:

• Weight loss exceeding 10% of the birth weight.

• Not gaining weight in the initial weeks of life.

• Absence of urinary output for 24 hours.

• Absence of yellow stools in the initial weeks.

• Showing clinical signs of dehydration.

How to Approach a Mother With Lactation Failure?

• Complete history and clinical examination of the mother to find any systemic illness.

• Assessment to find out whether it is a true lactational failure or not.

• If not, the new mother needs counseling.

• Check for the position of the baby's attachment and suckling while breastfeeding.

• They ask for the number of fields and frequency.

• Steps should be initiated for relaxation.

How to Manage Lactation Failure?

Lactation failure can be managed by a multi-factored approach, which addresses all possible causes.

1. Professional Help:

Consultation with a gynecologist or a lactation consultant will help to find out the factors that prevent lactation and provide expert guidance and support. They provide personalized advice to evaluate the breastfeeding situation or any other issues faced by the new mother.

2. Proper Latch and Positioning:

For successful breastfeeding, ensure to latch the baby correctly onto the breast. Proper latching stimulates milk production and transfer to the baby. If not aware of proper positioning and latching, speak with help from a lactation consultant, who teach proper techniques.

3. Frequent Feeding:

The production of breast milk can be increased and maintained by frequent nursing. Ensure to breastfeed the baby frequently and when the baby shows signs of hunger. Strict feeding and Scheduled feeding should be avoided.

4. Breast Compression:

Practicing breast compression while nursing helps to increase the milk supply and helps to ensure that the baby receives enough milk.

5. Nutrition:

Proper diet and nutrition are important for the lactating mother for good milk production. Staying hydrated is also important.

6. Breastfeeding Aids:

Breastfeeding aids like nipple shields or breast pumps can be used under the guidance of a lactation consultant. These aids help in increasing the milk supply and breastfeeding.

7. Reduce Stress:

Following childbirth, a woman may face postpartum depression, stress, and anxiety. These can lead to alterations in the hormonal level and affects the production of milk and breastfeeding. Engaging in stress management techniques such as deep breathing, meditation, yoga, and counseling helps to minimize stress. This can lead to the mother's well-being and directly results in proper breast milk production.

8. Galactagogues:

Galactagogues are substances that support milk production. Food rich in galactagogues, like fenugreek, fennel, and blessed thistle, helps in milk production. Always seek advice from healthcare professionals before incorporating them into the diet.

Conclusion:

Lactation failure is the reduced milk supply from Mother due to various causes. This can be a very challenging and stressful experience for the new mother, and they need proper support and care to manage the milk supply. Consultation with a lactation specialist will help to find out the cause and support which steps to increase milk production. Also, it helps to know about the right method for breastfeeding, which can help manage the situation.