Breastfeeding/lactation

• Lactation describes the secretion of milk from the mammary glands, and nursing describes the process of providing breast milk to the young. This process occurs in all female mammals, and in humans it is commonly referred to as breastfeeding. In humans and most species, milk comes out of the mother's nipples.
• Babies have a sucking reflex that enables them to suck and swallow milk. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. Some of the nutrients in breast milk, such as protein and vitamins, help protect an infant against some common childhood illnesses and infections, such as diarrhea, middle ear infections, and certain lung infections. Research indicates that women who breastfeed may have lower rates of certain breast and ovarian cancers.
• Colostrum is the first mild produced by the mother during the initial days after giving birth. Colostrum is low in fat and high in carbohydrates, protein, and antibodies to help develop and support the baby's immune system.
• Breastfed infants and infants who are fed breast milk have fewer deaths during the first year and experience fewer illnesses than babies fed formulas.
• Research also suggests that breast milk contains important fatty acids (building blocks of cells) that help an infant's brain develop. Two specific fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (AA), are components of the brain and are important for developing cognitive skills. Many types of infant formulas available in the United States are fortified with DHA and AA.
• While there are conflicting studies about the relative value of artificial feeding, including infant formula, it is acknowledged to be inferior to breastfeeding for both full-term and premature infants. In many countries, artificial feeding is commonly associated with illness and death in infants.
• National governments and international organizations, including the World Health Organization (WHO) and the American Academy of Pediatrics (AAP), promote breastfeeding as the best method of feeding infants in their first years of life and beyond. Although breastfeeding is widely regarded as superior to artificial feeding, authorities also encourage the development of safe and improved artificial feeding methods.
• Not all the properties of breast milk are understood, but its nutrient content has been well studied. The nutrients in breast milk come from the mother's blood and body. Some studies estimate that in women who exclusively breastfeed, 400-600 extra calories a day are used to produce milk. The water, fat, and nutrient content in breast milk may vary depending on several factors, including the manner in which the baby nurses, the mother's food consumption, and the environment.
• Certain medications may pass through the breast milk to the infant when women who are breastfeeding are taking the drugs. Because of the infant's small size and the difference in metabolism between infants and adults, occasionally this transfer of medication can be harmful to the infant. The majority of drugs that are given to breastfeeding women do not cause problems in infants. Questions regarding which drugs are safe to take when breastfeeding should be directed toward a healthcare provider.

• While breastfeeding difficulties are not uncommon, putting the baby to the breast as soon as possible after birth helps to avoid many problems. Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained nurses and hospital staff, and lactation consultants. Some factors that may interfere with successful breastfeeding include: formula feeding; artificial nipples or dummies (pacifiers); thrush (yeast infection in the baby's mouth); distractions or interruptions during feeds; long separations from the mother; rapid breathing (tachypnea) such as transient tachypnea of the newborn, surfactant deficiency, respiratory distress syndrome, or other infant medical conditions; swallowing difficulties such as with prematurity and coordination of sucking, swallowing and breathing, or gastro-intestinal tract abnormalities like tracheo-oesophageal fistula; pain resulting from surgical procedures like circumcision, blood tests, or vaccinations; difficulties latching onto the breast; poor sucking reflex; poor stamina; hypoplastic breasts/insufficient glandular tissue; cleft palate; ankyloglossia (tongue tie); hypoglycemia or hyperglycemia; hypotonia or "low-tone" infant disorder; hyperlactation syndrome (too much breast milk production); and overactive let-down.
• Premature babies can have difficulties coordinating their sucking reflex with breathing. They may also tire during feeding. Premature infants unable to take enough calories by mouth may need enteral or g-tube feeding (inserting a feeding tube into the stomach to provide enough breast milk or a substitute). This is often done together with prolonged skin-to-skin contact with the mother (called Kangaroo care), which makes later breastfeeding easier.
• Breast pain:
  Pain often interferes with successful breastfeeding. Breast pain is the second most common cause for the abandonment of exclusive breastfeeding after perceived low milk supply.
• Engorgement: Engorgement
  is the sense of breast fullness experienced by most women within 36 hours of delivery. Normally, this is a painless sensation of "heaviness." Breastfeeding on demand is the primary way of preventing painful engorgement.
• When the breast overfills with milk, it becomes painful. Engorgement comes from not getting enough milk from the breast. It happens about three to seven days after delivery and occurs more often in first-time mothers. The increased blood supply, the accumulated milk, and the swelling all contribute to the painful engorgement. Engorgement may affect the areola, the periphery of the breast, or the entire breast and may interfere with breastfeeding both from the pain and also from the distortion of the normal shape of the areola/nipple. This makes it harder for the baby to latch on properly for feeding. Latching may occur over only part of the areola. This can irritate the nipple more and may lead to ineffective drainage of breast milk and more pain. Engorgement may begin as a result of several factors such as nipple pain, improper feeding technique, infrequent feeding, or infant-mother separation.
• To prevent or treat engorgement, remove the milk from the breast by breastfeeding, expressing, or pumping. Gentle massage can help start the milk flow and reduce the pressure. The reduced pressure softens the areola, perhaps even allowing the infant to feed. Warm water or warm compresses and expressing some milk before feeding can also help make breastfeeding more effective. After breastfeeding, mothers can apply cold compresses to further reduce swelling and pain. One published study suggested the use of "chilled cabbage leaves" applied to the breasts. Attempts to reproduce this technique met with mixed results.Non-steroidal anti-inflammatory drugs, such as ibuprofen (Motrin®, Advil®) or acetaminophen (Tylenol®), may help relieve the pain. Check with a healthcare professional before using any non-prescription medication or dietary supplement while breastfeeding.
• Nipple pain:
  Sore nipples are probably the most common complaint after the birth. They are generally reported by the second day after delivery but improve within five days. Pain beyond the first week, severe pain, cracking, fissures, or localized swelling is not normal. The mother should see a doctor for further evaluation. Sore nipples, a common cause of pain, often come from the baby not latching on properly. Factors include too much pressure on the nipple when not enough of the areola is latched onto and an improper release of suction at the end of the feeding. Improper use of breast pumps or topical remedies can also contribute. Nipple pain can also be a sign of infection.
• Candidiasis:
  Symptoms of candidiasis, or yeast infection, of the breast include pain, itching, burning and redness, or a shiny or white patchy appearance. The baby could have a white tongue that does not wipe clean. Candidiasis is common and may be associated with infant thrush. Both mother and baby must be treated to get rid of this infection; first-line therapies include nystatin, ketaconacole, or miconazole applied to the nipple and given by mouth to the baby. Strict cleaning of clothing and breast pumps is also required to eradicate the infection.
• Milk stasis:
  Milk stasis is when a milk duct is blocked and cannot drain properly. This may affect only a part of the breast and is not associated with any infection. It can be treated by varying the baby's feeding position and applying heat before feeding. If it happens more than once, further evaluation is needed. Mothers are also encouraged to let their babies completely empty one breast before switching to the other. This helps prevent milk stasis.
• Mastitis: Mastitis is inflammation of the breast. It causes local pain, redness, swelling, and fever. Later stages of mastitis cause symptoms of systemic infection such as fever and nausea. Mastitis generally occurs two to three weeks after delivery but can happen at any time. It typically results from milk stasis with primary or secondary local, later systemic infection. Infectious organisms include Staphylococcus sp., Streptococcus sp., and E. coli. Prompt treatment can prevent complications, such as abscess formation. Mastitis that is caused by an infection is treated with antibiotics and self-care techniques, such as warm compresses and gentle massaging, to increase milk flow and reduce pain. Mothers with mastitis can safely continue breastfeeding because the infection cannot be passed through the breast milk. In fact, keeping the milk flowing in the infected breast helps get rid of the infection. If the nipples are too painful to continue breastfeeding, a breast pump may be used to empty the breast. However, some antibiotics may be harmful for nursing infants. Severe cases may require intravenous antibiotics. Patients should ask their doctors if they can continue breastfeeding while taking medications.

C

Unclear or conflicting scientific evidence

• Asparagus
  : Asparagus (Asparagus officinalis) may help promote the secretion of milk in women. There is currently not enough scientific evidence to recommend asparagus during pregnancy and breastfeeding. Additional study is needed to better understand the potential galactagogue (breast milk stimulant) properties of asparagus.
• Avoid if allergic or hypersensitive to asparagus or other members of the Liliaceae family. Use cautiously with edema (accumulation of fluid) caused by impaired kidney or heart function. Studies testing the safety of asparagus for pregnant or breastfeeding mothers are currently lacking in the available literature.
• Coleus
  : Coleus has been used as a breast milk stimulant for hundreds of years, however, this traditional use has not been well documented and scientific evidence is limited. Additional study is needed to make a conclusion.
• Avoid if allergic to Coleus forskohlii and related species. Use cautiously with diabetes, thyroid disorders, heart disease, asthma, low blood pressure, or if at risk of developing low blood pressure. Use cautiously with a history of bleeding, homeostatic disorders, or drug-related homeostatic problems. Use cautiously if taking asthma medications (e.g. bronchodilators), anticoagulants, anti-thrombotic agents, or anti-platelet medications. Do not use two weeks before and immediately after surgical or dental procedures that have bleeding risks. Avoid if pregnant or breastfeeding.
• Fenugreek
  : Fenugreek has been used in Indian and Chinese medicine to help with labor and digestion. Traditionally in India, fenugreek has been used to increase milk flow. Additional study is needed to better understand the use of fenugreek as a galactagogue (breast milk stimulant).
• Avoid if allergic to fenugreek or chickpeas. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with asthma, diabetes, or with a history of ulcers or stroke. Avoid if pregnant. Children should not take doses larger than those commonly found in foods.
• Jasmine
  : In the Ayurvedic tradition, jasmine has been used for lactation suppression. Preliminary clinical study found that application of jasmine flowers to the breast significantly decreased prolactin levels, breast engorgement, and milk production. More higher-quality studies are needed in this area.
• Use cautiously during pregnancy. Use cautiously in patients allergic to jasmine, jasmine oil, or other fragrances. Use cautiously during lactation. Avoid oral consumption of essential oils, including jasmine essential oil, as they are extremely potent and can be poisonous.
• Vitamin B6
  : The body needs vitamin B6, or pyridoxine, to make the neurotransmitters serotonin and norepinephrine, as well as myelin. Studies evaluating pyridoxine for lactation suppression have yielded mixed results. Well-designed clinical trials are needed before a firm conclusion can be drawn.
• Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when used orally in doses not exceeding the recommended dietary allowance (RDA).