Obstetrics Book


Breast Feeding Problems for the Mother

Aka: Breast Feeding Problems for the Mother, Lactation Problems for the Mother
  1. See Also
    1. Infant Feeding
    2. Infant Nutritional Sources
    3. Infant Nutrition Components
    4. Breast Feeding
    5. Breast Feeding Technique
    6. Nipple Soreness in Lactation
    7. Lactation Vitamin Supplementation
    8. Medications in Lactation
    9. Lactation Problems for the Infant
    10. Lactation for Infant with Cleft Lip or Palate
    11. Lactation for the Premature Infant
    12. Lactation Resources
    13. Mastitis
  2. Approach: Nipple Conditions
    1. Inverted Nipples
      1. Identify problem well before delivery
      2. Recommend nipple shells to help evert nipples
    2. Sore Nipples
      1. See Nipple Soreness in Lactation
    3. Milk Blebs (milk-filled Blisters on nipple)
      1. Soak Breast in warm water for 5-10 minutes, then gently rub nipple with washcloth to unroof Blister
      2. Blister may be unroofed with sterile 18 gauge needle
  3. Approach: Breast Engorgement
    1. Hand expression, massage therapy or pumping enough to soften the Breast
    2. Mild heat softens areola
    3. Frozen cabbage leaves held inside bra
    4. Increase Lactation frequency
    5. Ibuprofen or Acetaminophen for pain
    6. Apply reverse pressure at nipple and areola
      1. Temporarily force interstitial fluid deeper into Breast and away from nipple
  4. Approach: Decreased Milk Production (or concerns for insufficient milk supply)
    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)
    5. Demonstrate adequate feeding (when perceived to be inadequate)
      1. See Effective Breast Feeding Signs
      2. May pump to measure milk output
      3. Weigh clothed infant before and after feeding
        1. One gram of weight gain is equivalent to 1 ml of milk intake
  5. Approach: Milk Duct Stasis or blocked milk ducts
    1. Ensure adequate rest and hydration
    2. Heat (applied for 20 min by warm compress)
    3. Vibration or massage to area
    4. Alternate feeding positions
    5. Frequent nursing and Breast Pumping
    6. Decrease constrictive clothing that may decrease drainage
    7. Employ gravity at feeding, by dangling Breast over the top of infant to feed
    8. Consider Ibuprofen 600 mg every 6 hours to reduce pain
    9. Lecithin (herbal supplement) 1200 mg three to four times daily may be considered
    10. Evaluate for milk blebs (milk filled Blisters on nipple)
    11. Confirm proper latch-on technique by infant
    12. Confirm proper Breast Pump flange
      1. Nipple centered in tunnel and a small amount of areola in tunnel
  6. 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
  7. Approach: Medications
    1. See Medications in Lactation
  8. Approach: Infections
    1. Most maternal infections do not require interruption of Breast Feeding
    2. Mastitis
      1. See Mastitis (includes Breast Abscess)
      2. Breast Feeding may be continued despite Mastitis (except in Breast Abscess)
    3. Breast Abscess
      1. Interrupt Breast Feeding for first 24 hours on antibiotics
      2. Resume Breast Feeding after first 24 hours of antibiotics
    4. Varicella Zoster
      1. Lactation is only contraindicated when zoster involves the Breast
    5. Infections for which Breast Feeding is contraindicated
      1. HIV Infection
      2. HTLV-1
      3. Ebola
      4. Marburg
      5. Lassa Fever
      6. Smallpox
      7. African Trypanosomiasis
      8. Rabies
      9. Brucellosis
    6. Airborne infections in which direct Breast Feeding is contraindicated, but Breast Pumping and feeding may continue
      1. Varicella Virus
      2. Tuberculosis
    7. References
      1. Sakas and Welsh (2022) Crit Dec Emerg Med 36(3): 9
  9. Approach: Work-Related Lactation problems
    1. Educate regarding various Breast Pumps and devices
    2. Support and encourage using Breast Pump at work
  10. Approach: Vasospasm (Raynauds phenomenon of nipple)
    1. Decrease nipple cold exposure and warm nipple as needed
    2. Reduce nipple Trauma
    3. Avoid Vasoconstrictors (e.g. Caffeine)
    4. Consider Nifedipine 30 mg daily for 2 weeks (safe in Lactation)
  11. References
    1. (2016) Presc Lett 23(12): 71
    2. Westerfield (2018) Am Fam Physician 98(6): 368-73 [PubMed]

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