User:Clayoquot/Low milk supply

Definition
Most mothers can produce enough milk to provide all the nutrition their baby needs for the first six months, as recommended by the World Health Organization.

Definition
Copious milk production usually begins 48 - 72 hours after delivery, and adjusts to match the demand of the baby, or multiple babies in the case of multiple births.

What is normal milk volume in mL/day?

First days are colostrum. Delayed onset of lactation:

Fatigue is a risk factor for low milk production.

Mothers who express breast milk, but do not directly nurse their baby, usually see milk supply decline after several weeks. Risk factors for delayed onset of lactation include Caesarean delivery.


 * Build supply in the early weeks by activating prolactin receptors

Adequate rest for the mother is essential for successful lactation.


 * Infants should be fed on cue. Restricting the length or frequency of feeds to conform to a schedule is associated with low supply.


 * Pumped milk volume is not an indicator
 * Weighing before and after each feed for 24 hours, in the mother's home, is an accurate way to measure milk intake.
 * Delayed onset of lactation

Domperidone is effective in women whose concentration of prolactin is low. Domperidone has few, if any, side effects. Fenugreek has been shown to be effective.

Domperidone is preferred over metoclopramide because it does not cross the blood-brain barrier, has less risk of side effects, and less of it passes into breast milk.


 * Incidence of actual vs perceived
 * Incidence of delayed onset
 * More common in first-time mothers


 * Use a lactation aid to increase milk transfer and teach the baby how to nurse.
 * If medical issues are the cause, address the underlying issues...
 * Keep the baby fed with supplementation if necesssary. "Feed the baby" as the first rule of lactation consultants.

Supplementation

 * Tricky because supplementation can make the problem worse
 * Appropriate when cause is medical
 * Donor milk vs friend vs formula
 * How to administer: bottle/syringe/lactation aid. When supplementation is done through a lactation aid at the breast, the baby almost always receives some breast milk from the mother.