Insufficient milk secretion: how to increase lactation?

Insufficient lactation is one of the main reasons for transferring a child to artificial feeding. Therefore, it is important for a health worker to be able to correctly assess a woman's lactation function and help her establish full lactation.

The situation when a child does not receive enough milk can occur at any stage - in the maternity hospital in the first days after the birth of the baby (especially if the normal establishment of lactation was disrupted for some reason - complications during childbirth and the postpartum period, serious condition of the newborn, etc.), as well as at the stage of the children's clinic in the event of a lactation or hunger crisis.

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Lactation crisis

A lactation crisis is a temporary, short-term decrease in lactation that occurs without any obvious cause. The basis of a lactation crisis is shifts in a woman's hormonal system, which are associated with the periodicity of hormonal regulation of lactation in combination with an increase in the woman's motor activity and the intensive growth of the baby.

Lactation crises occur in the 3rd-6th week, 3rd-4th, 7th-8th months of lactation. Their duration is on average 3-4 days, they are completely reversible and do not pose a danger to the baby's health. In some women, such lactation crises occur several times during the lactation dynamics.

A hunger crisis is a situation when, due to the intensification of the baby's growth processes in certain periods of its development, the volume of milk produced by the mother's mammary glands does not meet the baby's needs. A hunger crisis most often occurs in the 4th week, as well as in the 3rd, 7th, 12th months of lactation.

Like the lactation crisis, this phenomenon is also reversible and, provided the correct tactics are followed, the mother’s mammary glands respond to the increased need for milk by increasing its production.

What to do in case of lactation crisis?

To successfully overcome a lactation or hunger crisis, it is necessary to adhere to the following tactics:

• mandatory informing of the nursing mother about the possibility of such crises to ensure that the woman calmly accepts the temporary decrease in lactation;
• explaining to the mother that in order to overcome the crisis it is necessary to promptly increase the number of times the baby is put to the breast (up to 10-12 times);
• reintroduce night feeding;
• be sure to check the correctness of the feeding technique;
• establish appropriate rest and sleep for the mother, and involve relatives to help during this period.

With this tactic, lactation increases quite quickly (3-4 days). However, if the mother is not prepared for such a situation, then when the first signs of decreased lactation appear, she (even without a pediatrician's prescription) will try to add formula to the baby's supplementary feeding. In order to help a woman who has come with a complaint about insufficient lactation and the baby's starvation, the consultant must first clarify the following questions:

• does the baby really not have enough breast milk or does the mother think so;
• Is the baby's starvation associated with insufficient milk supply to the child during normal lactation in the mother or with a decrease in lactation?

Reliable signs that the baby is not receiving enough breast milk:

• insufficient weight gain - less than 500 g in 1 month or 125 g in 1 week;
• excretion of small amounts of concentrated urine: rare urination (less than 6 times a day); urine is intensely yellow in color, with a strong odor.

Reliable signs that the baby is not receiving enough breast milk:

• the baby is not satisfied after breastfeeding;
• cries often;
• very frequent feedings;
• very long periods of breastfeeding;
• refuses to breastfeed;
• hard, dry, or green stools;
• small amount of loose stools;
• no milk when expressing;
• there is no sensation of milk coming in after childbirth.

If the consultant identifies reliable signs that may be associated not only with the baby not receiving enough milk, but also with other factors, it is necessary to look for absolute signs of underfeeding.

Reasons why a baby may not be getting enough milk:

• factors related to breastfeeding technique:
  • incorrect attachment to the breast;
  • lack of night feeding;
  • long intervals between feedings;
  • insufficiently long breastfeeding;
  • late initiation of breastfeeding;
  • use of pacifiers and bottles for supplementary feeding;
  • introduction of complementary feeding and additional drinking;
• psychological factors in the mother:
  • physical fatigue;
  • lack of confidence:
  • anxiety, stressful situations;
  • negative attitude towards breastfeeding;
  • negative attitude towards the baby;
• factor of the mother's general condition:
  • extragenital pathology;
  • use of contraceptives;
  • pregnancy;
  • alcohol consumption, drug use, smoking;
  • starvation;
  • retained placenta (rare);
  • insufficient development of mammary glands (very rare);
• child's condition:
  • diseases;
  • developmental anomaly.

Reasons why a child refuses to breastfeed

A baby's crying is the only way to communicate any discomfort (hunger, fatigue, dirty diapers, etc.). If a baby cries a lot, this can be an obstacle to successful breastfeeding. Parents most often associate crying with hunger and without timely and proper help from a health worker, they cannot understand the situation, they begin to supplement the baby, which leads to premature fading of lactation and artificial feeding. In addition, if a baby cries a lot, this can disrupt the relationship between mother and baby, causes psychological stress in the family as a result of negative emotions in the woman, and can contribute to a decrease in lactation.

Reasons from the child's side	Reasons from the mother's side
Effects of sedatives Difficulty coordinating sucking	Excess milk in the mammary glands
Changes that may upset a baby (especially at 1-2 months): Separation from mother A new face or many new faces looking after the baby Changes in the family environment	Menstruation Changes in body odor Changes in milk odor
Apparent refusal: newborn "takes aim" Baby aged 4-8 months turns away - something distracts his attention	After a year - excommunication from work
Acute infectious (respiratory or intestinal) disease Traumatic brain injury (pressure on the site of injury) Thrush Teething	Incorrect attachment to the breast Bottle feeding, including pre-lactation feeding Breast engorgement Pressure on the head from behind during attachment to the breast Incorrect support of the breast during feeding Limited frequency of feedings (long intervals between feedings)

To eliminate the reason why a child refuses to breastfeed, a woman should:

• be constantly close to the baby: take care of the baby yourself, not only during breastfeeding, but also at any other time hold him in your arms (for children in the first months - close skin contact), involve other family members in performing other family duties (cooking, washing, cleaning, caring for older children, etc.), if the mother went to work - take temporary leave;
• Breastfeeding should be on demand. The mother should provide the baby with the opportunity to suckle as often as possible. Some children in this situation suckle more actively after spoon feeding, and not when they are very hungry. You can try feeding in different positions. If the mother feels that the oxytocin reflex is triggered, she should also offer the baby the breast;
• help to latch on to the breast as follows: express a small amount of milk into the baby's mouth, use loose swaddling, comfortably position the baby near the breast and allow him to examine the mother's breast, avoid pressure on the baby's head from behind and properly support the mammary gland, carry out correct attachment to the breast, which will ensure effective sucking of milk;
• if necessary, feed from a cup between breastfeedings: express breast milk and give it from a cup or spoon. If there is not enough lactation, give formula also from a cup or spoon. Avoid using bottles with nipples for supplementary feeding, as well as the use of artificial sedatives (pacifiers).

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How to increase lactation?

It is recommended to carry out the following measures to resume lactation:

• rest for at least 48 hours (no heavy work, house cleaning, laundry, cooking, receiving visitors);
• temporarily increase the frequency of feedings to 10-12 times a day if the baby is calm and can withstand intervals between feedings of 3-3.5 hours, even during a lactation crisis, wake him up, offer the breast every 2-2.5 hours;
• Give both breasts during each feeding.
• temporarily introduce night feedings to stimulate prolactin production;
• express milk after each feeding;
• practice close contact between mother and child (for newborns, direct skin contact) for 6-8 hours;
• use relaxation techniques (massage, autogenic training, music therapy) to improve the emptying of the mammary glands;
• if supplementary feeding is necessary, do not use any imitations of the mother's nipple, use alternative means for supplementary feeding (cup, spoon, pipette);
• use lactogenic foods and herbal preparations (decoctions, infusions and drinks from herbs and seeds - lemon balm, thyme, dill, caraway, anise, fennel, walnuts, carrot juice with milk, etc.).

Juices, infusions and teas for increasing lactation, homemade

• a drink made from lemon balm, nettle, and oregano. The herbs are mixed in equal proportions. One tablespoon of the mixture is washed down with 2 glasses of boiling water and infused in a thermos for 2 hours. Drink 1/2 glass 2-3 times a day;
• dill seed infusion. Pour one tablespoon of dill seeds with a glass of boiling water and leave in a thermos for 2 hours. Strain and drink 1-2 tablespoons 3-6 times a day (depending on tolerance);
• anise infusion. Pour a glass of boiling water over two teaspoons of seeds and leave for 1 hour. Cool and strain. Drink 2 tablespoons 3 times a day half an hour before meals;
• caraway drink. To prepare 0.5 l of the drink, take 10 g of caraway seeds, 50 g of sugar, and the juice of a medium-sized lemon. Pour water over the caraway, cook over low heat for 5-10 minutes, strain, add sugar and lemon juice. Drink half a glass 2-3 times a day;
• Nut milk is an effective means of increasing secretion and improving the quality of milk. Peeled nuts are ground with sugar until a dough-like mass is obtained, the mass is put into boiled milk, stirred and infused for 2 hours. To prepare one portion of the drink, you need 0.5 l of milk, 100 g of peeled nuts, 25 g of sugar. Take 1/3 cup 20 minutes before each breastfeeding;
• carrot juice Freshly prepared juice is drunk half a glass 2-3 times a day. To improve the taste, milk, honey, fruit and berry juices can be added to carrot juice (1-2 tablespoons per 1 glass of juice);
• Milkshake with carrot juice: 125 ml of milk (sour milk or yogurt), 60 ml of carrot juice, 10 ml of lemon juice and 15 g of sugar, beat with a mixer immediately before use and drink 1 glass 2-3 times a day. In the evening, instead of lemon juice, you can add 1-2 teaspoons of honey to the cocktail (to relieve nervous tension and sleep well). Sometimes a good result is given by prescribing a woman medicinal vitamin and general tonic preparations (apilak, multivitamins, mineral complexes, nicotinic acid, dry yeast extract), as well as physiotherapy procedures (UV on the mammary glands, ultrasound, massage, acupuncture).

It is necessary to explain to the woman that excessive fluid intake does not lead to increased lactation, since there is an idea among mothers that this remedy helps to increase lactation.

Excessive fluid intake may indeed temporarily increase the amount of milk, but it will decrease the nutrient content, increasing the load on the mother's body, which will lead to a subsequent decrease in lactation.

Relactation is the resumption of completely extinguished lactation. Such a situation may arise, for example, in the following cases:

• in case of temporary separation of mother and child due to the mother’s departure, during which she did not maintain lactation;
• the baby is bottle-fed, but the mother wants to breastfeed;
• temporary illness of the mother, during which she did not feed the child or express milk;
• the baby is not suitable for artificial feeding and there is a need to resume breastfeeding;
• The mother adopted the baby and wants to feed him with her milk.