From the Guidelines
Frequent breastfeeding or pumping every 2-3 hours, at least 8-12 times daily, is the most effective strategy to manage inadequate breast milk intake in a first-time mother with delayed lactogenesis. This approach is supported by the American Academy of Pediatrics, as noted in a study published in Pediatrics 1, which emphasizes the importance of early skin-to-skin contact, breastfeeding in the first hour after birth, and frequent feeding on demand to decrease newborn weight loss and the need for supplements.
Key interventions to increase milk production and ensure adequate infant nutrition include:
- Ensuring proper latch and positioning
- Using breast compression during feeds to maximize milk transfer
- Supplementation with expressed breast milk, donor milk, or formula, if necessary, using methods that don't interfere with breastfeeding, such as cup, spoon, syringe, or supplemental nursing system
- Considering galactagogues, although the evidence for their effectiveness is not as strong as for frequent breastfeeding or pumping
- Maintaining adequate maternal hydration, nutrition, and rest to support milk production
It's also crucial to identify and address any underlying causes of delayed lactogenesis, such as retained placental fragments, cesarean delivery, obesity, diabetes, or thyroid disorders, as these can impact milk production. Regular weight checks for the baby are essential to ensure adequate intake while working to increase milk supply, as frequent feeding on demand, at least 8 to 10 times in 24 hours, can help decrease newborn weight loss, the need for supplements, and the risk of clinically significant hyperbilirubinemia, as noted in the study 1.
From the Research
Management Options for Inadequate Breast Milk Intake
In a first-time mother with delayed lactogenesis, the following options can be considered:
- Frequent, regular milk removal to increase milk supply 2
- Use of galactogogues, such as domperidone, to increase milk supply 2
- Expression and storage of breast milk to establish lactation and increase milk supply 3
- Supplemental feeding with formula to ensure adequate nutrition for the infant, especially in cases where breastfeeding insufficiencies may cause preventable harm 4
- Early intervention and monitoring to prevent infant complications associated with inadequate nutritional intake 5
Factors Associated with Delayed Lactogenesis
Research has identified the following factors as significant independent predictors of delayed lactogenesis:
- Older maternal age 6
- First live birth 6
- Twins, which may be less likely to continue breastfeeding at 3 months of corrected age 6
Importance of Early Intervention
Early insufficient nutrition and hydration can have long-term effects, including neurodevelopmental consequences, and may substantially contribute to preventable morbidity and mortality in previously healthy neonates worldwide 4. Therefore, it is essential to address inadequate breast milk intake promptly and provide supplemental feeding when necessary.