What is the treatment for failure of lactation?

Treatment for Failure of Lactation

First-line treatment for lactation failure should include non-pharmacological approaches such as frequent breastfeeding or pumping, proper positioning and latch techniques, and adequate maternal nutrition and hydration, with pharmacological interventions reserved for cases that don't respond to these measures.

Causes of Lactation Failure

• Lactation failure can be due to insufficient glandular development of the breast, which may present with absence of typical breast changes during pregnancy and failure of postpartum breast engorgement 1
• Other causes include improper breastfeeding techniques, insufficient suckling stimulation, and maternal factors such as stress, fatigue, or inadequate nutrition 2
• It's important to distinguish between true lactation failure (physiological inability to produce adequate milk) and breastfeeding cessation due to social, emotional, mental, or commercial factors 3

Non-Pharmacological Interventions

• Frequent and effective breastfeeding or breast pumping to stimulate milk production through increased nipple stimulation 2
• Proper positioning and latch techniques to ensure effective milk transfer 2
• Adequate maternal nutrition and hydration to support milk production 4
• Use of supplemental nursing systems (such as lact-aid) to maintain infant at the breast while supplementing 5
• The "drop and drip" method can help overcome nipple confusion and baby frustration in cases of complete lactation failure 5

Pharmacological Interventions

First-Line Medications

• Metoclopramide can be used to enhance lactation, although studies show that relactation is possible in most mothers without lactagogues when proper support and frequent suckling are ensured 5
• When medications are needed to support lactation, they should be selected with consideration for their safety during breastfeeding 6

Medications to Avoid

• Diuretics such as furosemide, hydrochlorothiazide, and spironolactone may reduce milk production and should generally be avoided in breastfeeding women 6
• If a mother is taking medications for other conditions (such as hypertension), medications compatible with breastfeeding should be selected to avoid further compromising lactation 6

Special Considerations

• For mothers with complete lactation failure who wish to continue breastfeeding, supplementation with formula will likely be necessary 1
• Even with supplementation, continued breastfeeding provides benefits and should be encouraged if the mother desires 1
• Psychological support is crucial, as mothers may experience significant distress when experiencing lactation difficulties 1
• In cases of primary lactation failure due to insufficient glandular tissue, it's important to communicate that the failure is not due to the mother's breastfeeding performance 1

Relactation Protocol

• Relactation (reestablishing milk production after it has decreased or ceased) can be successful in up to 98% of cases with proper support 5
• Key components of successful relactation include:
  • Motivation and education about exclusive breastfeeding 5
  • Strong professional support from skilled healthcare workers 5
  • Repeated suckling at the breast 5
  • Addressing initial problems such as nipple confusion, small/retracted nipples, or sore/fissured nipples 5

Follow-up and Monitoring

• Regular weight checks for the infant to ensure adequate nutrition 5
• Assessment of maternal breast conditions and addressing any ongoing issues 5
• Gradual reduction in supplemental feeding as milk production increases 5

Common Pitfalls

• Failing to distinguish between true lactation failure and breastfeeding difficulties that can be overcome with proper support 3
• Premature introduction of formula without adequate attempts to establish or increase milk production 2
• Inadequate professional support during the critical early period of lactation 5
• Not addressing psychological aspects of lactation failure 1