II. Approach: Inverted Nipples

  1. Identify problem well before delivery
  2. Recommend nipple shells to help evert nipples

III. Approach: Sore Nipples

IV. Approach: Breast engorgement

  1. Hand expression or pumping
  2. Mild heat softens areola
  3. Frozen cabbage leaves held inside bra
  4. Increase Lactation frequency
  5. Ibuprofen or Acetaminophen for pain

V. Approach: Decreased Milk Production

  1. Maximize maternal hydration and avoid Caffeine
  2. Maintain frequent nursing
  3. Avoid medications that interfere with milk production
    1. Oral Contraceptives
    2. Diphenhydramine
    3. Pseudoephedrine
  4. Avoid measures that are unproven
    1. Avoid supplements with unproven, but purported benefit (e.g. fenugreek, Brewer's Yeast)
    2. Avoid metoclopramide (unproven)

VI. Approach: Milk Duct Stasis

  1. Rest, heat, and massage
  2. Alternate feeding positions
  3. Frequent nursing

VII. Approach: Inhibited Milk let down

  1. Warm shower
  2. Privacy for Lactation
  3. Comfortable environment
    1. Private
    2. Soft music
    3. Low light intensity
  4. Local heat to Breast
  5. Relaxation Techniques

VIII. Approach: Medications

IX. Approach: Work-Related Lactation problems

  1. Educate regarding various Breast Pumps and devices
  2. Support and encourage using Breast Pump at work

X. References

  1. (2016) Presc Lett 23(12): 71

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