LOW MILK PRODUCTION BY RITA RAHAYU OMAR LACTATION COUNSELOR Momslittleones.com

LOW MILK PRODUCTION OBJECTIVES At the conclusion of this session, participants will be able to:1. Identify variation in patterns of growth in breastfeeding babies. 2.

Distinguish low milk production from lack of confidence.

3.

Help a mother to increase milk production and confidence

4.

Help a mother to relactate

1. PATTERN OF GROWTH IN BREASTFEEDING BABY 

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Most babies will start gaining weight very soon if there are exclusively breastfed immediately after birth Babies lose 10% of its birth weight – 3-4 weeks Weight increase by 2 to 3 week with frequent breast feeding Weight gain 18 – 30 gm/day for first 6 month Usually babies double their birth weight by 5- 6 month and triple it by 1 year.

SIGN THAT A NEWBORN IS RECEIVING SUFFICIENT BREASTMILK 

Baby is breastfed at least 8 times in 24 hours

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During a feed, his sucking rhythm will slow down as milk is released, and swallowing or gulping may be heard

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He is alert and has good muscle tone and healthy skin

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He is contented between feeds (though well – fed may be fussy for other reason, leading mothers to believe they don’t have enough milk)

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Wet diapers six times or more in 24 hours

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3 – 8 bowel movements in 24 hours

As babies grow older, stooling may be less frequent 

Consistent weight gain – 18 – 30 gm/day

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Mother’s breast may feel full before a breastfeed and softer afterward, though not all women experience a dramatic change

SIGN THAT A BABY IS NOT GAINING WEIGHT ADEQUATELY 

Weight gain less than 18 gm/day

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Has not recovered his birth weight by 3 weeks

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Growth line is not rising appropriately on the growth curve

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He sleeps for long periods of time Lethargic and has a weak of high pitched cry

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Urine output may be low – concentrated urine

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Urine output alone is not reliable measure of weight gain.

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Has very low stools, or non at all

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He may stay at the breast constantly

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He may have a worried look on his face with hanging folds of skin on his body

2.IS IT LOW MILK PRODUCTION OR LACK OF CONFIDENCE? If a baby does not gain weight fast enoughMother may believe that she does not have Enough milk. This can be avoided if breastfeeding begins well and if the mother is encourage to follow her baby’s cues for feeding. The health worker can help mother to decide if They actually have low milk supply, identify cause and make the changes necessary to increase milk supply.

THE PRINCIPLE CAUSES OF LOW MILK PRODUCTION      

Other food or drink are being given to the baby. Nipple confusion due to the bottle feeding pacifier or dummy. Breastfeeding: not frequent enough. Night breastfeeds were stopped too early. (prolactin response are higher at night) Breastfeeding: not long enough Baby not latched on correctly.

PRINCIPLE CAUSE OF LOW MILK TRANSFER 

The baby is not attach at the breast for effective sucking.

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Breastfeed are short and hurried.

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The baby is being removed from the breast to soon and not receiving hind milk.

THE MOTHER MAY BE:

Embarrassed or unsure of her ability to breastfeed her baby.

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Using nipple shield to breastfeed.

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No moral support from family and friend.

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Sleep far from her baby.

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Taking medication especially contraceptives.

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Fatigued or ill

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Thyroid disease (rare)

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Extremely low food or fluid intake (rare except in food crisis)

THE BABY MAY BE :   

Sleepy Difficulty attaching and sucking Very ill baby Medical condition : - metabolic disorder - Congenital heart disease - Respiratory infection - Urinary infection - Hypothyroidism

3. HOW TO INCREASE MILK PRODUCTION ADVISE TO MOTHER  Feed the baby regularly.  Proper attachment and positioning.  Offer both breast a feed.  Feed frequently and longer day/night  Stop all feeding bottles and dummies  Weigh the baby. Once it improves, reduce supplements slowly.

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Increase her own food and fluid intake. Rest and relax – help milk flow. Offer breast for comfort if her baby is fussy. Use local galactogogues . Express breast milk between breastfeeds Express on one side and feed baby on the other Give EBM to her baby with cup or supplementer.

4. HELPING A MOTHER TO RELACTATE DEFINITION: Re-establishing adequate milk production in a mother who has a greatly reduced milk production or has stopped breastfeeding. If a mother has stopped producing breastmilk and wishes to breastfeed again, the health worker can help her to relactate. Relactation will help a mother who has been breastfeeding and needs to increase her milk production.

It is also recommended as part of pediatric care for sick babies whose mothers are not lactating. Admit all sick child to the hospital with Their mothers.

CONDITION THAT WILL HELP A MOTHER TO RELACTATE 

She is motivated and persistent

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She receives support and encouragement from her health team and family.

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The baby is put to breast frequently for sucking

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She express milk between breastfeed.

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Reduced supplementation slowly as her milk production increases.

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The baby is fed only at the breast, with breastfeeding supplementer

INDUCED LACTATION Induced lactation is the process by which a nonpuerperal woman is stimulated to lactate,in other words, breastfeeding without Pregnancy. Relactation is the process by which a woman who has given birth but did not initially breastfeed is stimulated to lactate

FACTORS WHICH EFFECT THE SUCCESS OF INDUCED AND RELACTATION Strong desire by the mother or foster mother  Stimulation of the nipples  Promotion of induced and relactation part of health care  Support system to build and maintain the woman’s confidence 

FACTORS RELATED TO THE INFANT The main requirement for induced lactation is that the infant should suckle. This is affected by: - the infant’s willingness to suckle - The infant age - The infant’s breastfeeding gap - the infant’s feeding experience during the gap - Infant-related reasons for interrupting breastfeeding

OTHER FACTORS OF PTENTIAL BUT UNKNOWN SIGNIFICANT INCLUDE: -

Gestational age (for low birth weight babies

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Intake of complementary food (for older infant)

FACTORS RELATED TO THE MOTHER OR FOSTER MOTHER The most importance are: - the woman’s motivation - Her lactation gap - The condition of her breasts - Her ability to interact responsively with her child - Support from her family, community and health workers

COMPOSITION OF MILK IN RELACTATION AND INDUCED LACTATION No significant differences have been identified between breastmilk produced during relactation or induced lactation -

Mother did not produce colostrum

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The milk is similar in it’s protein, alphalactalbumin, and IgA content to transitional and mature milk.