Use of domperidone to enhance lactation: what is the evidence?

A perception of low milk supply is often cited as a reason to stop breastfeeding, though most mothers can produce more than enough with the right support and information. Domperidone may be used to promote lactation, and there is evidence to support its use. However, the many non-pharmacological ways in which a mother may be supported should be tried before considering domperidone.

Breastfeeding Solution Circle.

It is widely accepted and backed by research that breastfeeding is the number one feeding choice for babies, and direct from mothers' breasts is the ideal. However the early days can be challenging. Supporting mothers to succeed with their breastfeeding journey is a rewarding role and being able to advise and guide on overcoming the various hurdles is great. Keeping up to date on the research and advancements in breastfeeding support is vital and a general knowledge of the solutions to help will be of huge benefit to the mothers you are working with. This article examines the problems and some tried and tested solutions.

A Case Study of Biological Nurturing.

INTRODUCTION: This case of a mother and her two children, born 20 years apart, highlights how Biological Nurturing (BN) supported a woman in meeting her personal breastfeeding goals. We know lack of breastfeeding support contributes to early weaning. Applying the principles of BN (unrestricted and laid-back breastfeeding) enabled this mother to return to breastfeeding without supplements. MAIN ISSUE: After giving birth to her first son prematurely in 1997, the dyad was separated, and formula introduced. These interventions, combined with inadequate breastfeeding support, resulted in low milk supply and unplanned weaning by week six. In 2017, a full term sibling baby girl was born, with breastfeeding again beginning with concerns of low milk supply. MANAGEMENT: Consultation with an International Board Certified Lactation Consultant successfully addressed common breastfeeding problems, including vasospasm and insufficient milk supply. Continuous emotional support helped this mother overcome perceived insufficient milk supply. Introducing BN led to breastfeeding without supplementation, by enabling the dyad to experience enjoyment, comfort and feeding autonomy. CONCLUSION: While the repeated experience of insufficient milk supply two decades apart constituted a psychological barrier to exclusive breastfeeding, BN enabled reaching this mother's breastfeeding goals. BN appears to be a powerful tool for both breastfeeding initiation and overcoming breastfeeding difficulties, potentially setting new best practice standards.

Failure to lactate: a possible late effect of cranial radiation.

We conducted a retrospective review of the lactation experience of female survivors who received 24 Gy cranial radiotherapy as CNS prophylaxis for acute lymphoblastic leukemia in childhood prior to 1982 and who attend the Long-Term Follow-Up Clinic at Sydney Children's Hospital, Randwick, Australia. Median time since diagnosis is 28 years (range 25-37 years). Twelve have produced offspring. Ten report minimal or no breast changes during pregnancy and failure to lactate postpartum. All patients remain in remission. These data suggest a high risk of failure of lactation in women treated during childhood with 24 Gy cranial irradiation. Awareness of this possibility can assist in counseling.

Assisting the breastfeeding mother: a problem-solving process.

At the Vancouver Breastfeeding Centre (VBC), breastfeeding is facilitated through a process of assessment, analysis, diagnosis, care and counsel, and evaluation. This process is described and related to phases of breastfeeding kinetics by considering two presenting problems: sore nipples, and inadequate production of milk.

Can magnesium sulfate therapy impact lactogenesis?

This case report describes a patient who ingested magnesium sulfate (MgSO4) for approximately four days as a treatment for pregnancy-induced hypertension. Stage II lactogenesis was delayed until the tenth postpartum day at which point the patient's breasts became fully engorged. No explanation for this delay was found, other than the possibility that magnesium sulfate treatment impeded lactogenesis. Implications for professionals who care for lactating women are discussed.

The occurrence of breast engorgement.

This study describes breast engorgement during days 1-14 postpartum of 114 first and second time vaginal- and cesarean-delivery breastfeeding mothers. Most mothers reported experiencing their most intense engorgement after hospital discharge. Previous breastfeeding experience of the mother is a more critical variable than parity in predicting engorgement. Second time breastfeeding mothers experienced engorgement sooner and more severely than did first time breastfeeding mothers, regardless of delivery method. Anticipatory guidance by the care provider is discussed in an effort to enhance the experience of the breastfeeding dyad.

Breast engorgement: patterns and selected outcomes.

For 14 days following birth, 114 breastfeeding mothers rated their level of breast engorgement twice daily, using a six-point engorgement scale. Individual engorgement ratings were plotted by intensity over time to provide a visual display of each subject's breast engorgement experience. Four distinct patterns of breast engorgement emerged; mothers experienced either a bell-shaped pattern, a multi-modal pattern, a pattern of intense engorgement, or a pattern of minimal engorgement. Characteristics of mothers and infants, and feeding frequency were similar across the four breast engorgement patterns.

Assessing infant suck dysfunction: case management.

Based on this more thorough assessment, the lactation consultant may be able to identify all of the factors contributing to this complex case. In some situations, her skilled interventions will suffice once the underlying problem is addressed. Occasionally, she will identify a factor that falls outside of her area of expertise; when this happens, she must make the appropriate referrals. For example, a referral to a physician for a frenotomy or suspected neurological or other medical problem is appropriate. It is clear that because Baby E's problems were not resolved after 6 weeks of concerned effort, something was missed. It would certainly be appropriate for the lactation consultant to refer the dyad to another lactation consultant who has more expertise in handling clinically challenging breastfeeding problems. If possible, the referring lactation consultant should accompany the dyad so that she can improve her clinical skills. Assuming Baby E does not have underlying medical problems, the most likely causes of Baby E's difficulties are anatomical variation and/or sucking dysfunction. Because the baby is so fussy, it also would be wise to consider the possibility of allergies or food tolerance. Our first rule is " Feed the baby." The second rule is " Correct or work on correcting the problem or problems." Our goal is to achieve exclusive breastfeeding or as close an approximation as possible. We almost never give up on this goal, but we do educate the mother and work professionally with her choices. Until the baby is breastfeeding well, the lactation consultant will probably need to instruct the mother to continue using a pump ( preferably a hospital-grade, electric, bilateral pump). The mother should use the pump physiologically, pumping as many times a day as the baby would breastfeed. As soon as the situation improves, the mother should be instructed to wean gradually from the pump and any other breastfeeding equipment she is using. The goal should always be to help the mother and baby acheive a breastfeeding relationship, preferably without the use of any devices. We usually suggest that the mother avoid all rubber nipples and pacifiers during this learning period. Babies have a strong need to suck. Correct sucking helps the baby organize and be soothed. Whenever possible, we prefer infants to use their mother's breasts for pacification, warmth, love, smell, and food rather than artificial nipples and devices. Mothers almost always want to know how much work and time is involved before committing to following suggested treatment plans. As a general rule, we have found that it will take approximately the same number of weeks as the baby's age to solve the problems completely. In this case, it will probably take about 6 weeks until mother and baby graduate from "breastfeeding school." The first 2 weeks would most likely be very intense for the whole family, with the mother getting very little sleep. VJ is likely to cry when talking to the lactation consultant during this period of intense change. It is helpful during these times to listen to the mother, reinforce that you know how hard she is working and that what she is feeling is normal. Giving the mother a hug and complimenting her mothering efforts go a long way toward encouraging her to continue. It is not a time to give up. The second 2 weeks typically are easier, as everybody is used to the workload and required skills. The focus becomes refining skills. The last 2 weeks is usually a time to reduce and then wean off the equipment and exercises. This timing is just a guideline and must always be individualized. Although it is a tremendous amount of work for the mother, baby, family, and lactation consultant to correct well-established but incorrect breastfeeding behaviors, we have never met a mother who was sorry that she chose to tackle the problem. Even if she tries and then gives up or achieves only a partial milk supply or partial breastfeeding relationship, she can take pleasure in knowing that she left no stone unturned. Unfortunately, mothers and babies with presentations similar to that of VJ and Baby E all too often fail to establish an exclusive breastfeeding relationship. Not only are patience, dedication, time, and skills needed, but there are often multiple underlying problems that need to be solved. With a thorough assessment and appropriate use of skills and equipment by the lactation consultant, success is much more likely. This particular dyad should be able to acheive an exclusive breastfeeding relationship.

Relief of breast engorgement for the Sabbath-observant Jewish woman.

Relief of breast engorgement on the Sabbath is a challenge for the Sabbath-observant Jewish client. Many Sabbath laws limit the methods of care for the engorged breastfeeding woman. With a familiarity of the laws of the Sabbath, the health care provider can better address the needs of the engorged Sabbath-observant Jewish woman. In this article, interventions are proposed that mitigate or preclude violation of the Sabbath.

Breast augmentation & lactation outcome: a case report.

This article contains two case reports that illustrate the difficulty two mothers experienced when they mechanically expressed their milk for their very preterm infants. Each of the mothers was enrolled in a separate research study and had previously undergone surgery for breast augmentation. Neither of the mothers was able to provide an adequate milk supply for her preterm infant. Preoperative counseling and informed consent for breast augmentation is vital if the mother desires to exclusively provide mother's milk for the infant.

[A systematized procedure for the technical nursing care of puerperae with breast engorgement]. / Procedimento sistematizado de assistência técnica de enfermagem à puérperas com ingurgitamento mamário.

This research approaches a systematized Procedure of Nursing Care to puerperas with mammary engorgement. The author verified the kind of engorgement most frequent, mammary sector most affected and some interference factors in the evolution of mammary engorgement.

Realities, difficulties, and outcomes for mothers choosing to breastfeed: primigravid mothers experiences in the early postpartum period (6-8 weeks).

OBJECTIVE: to develop an understanding of primiparous women's experiences and challenges of breast feeding in the early postpartum period at two BFI accredited hospitals in the East Midlands in the UK that has lower rates of sustained breast feeding. DESIGN AND SETTING: a hermeneutic or interpretive phenomenology study was conducted across two hospitals in the East Midlands, UK. DATA COLLECTION: 22 primigravid women completed a daily written diary maintained for six weeks post birth. In addition, interviews were conducted with 13 women, nine who had completed a diary and four who did not return a diary but wanted to be interviewed, providing 26 different women's perspectives on their breast feeding experiences either from a diary or interview. FINDINGS: three main themes emerged from the interviews and written diaries: (1) mothers experience a 'roller coaster' of emotions in relation to trying to establish breast feeding, (2) mothers perceive health care professionals as the 'experts' on breast feeding and (3) mothers had difficulties in breast feeding their infants in public, including in front of family and family and when away from their homes. CONCLUSIONS: women were ill prepared for the realities of breast feeding despite their antenatal intention to breast feed. Mothers had a preconceived idea that breast feeding would be 'natural' and without difficulty. When problems occurred, they perceived this to be a breast feeding problem and so choose artificial milk. Mothers require ongoing support to breast feed, especially in the early postpartum period, but more realistic messages about breast feeding need to be included. IMPLICATIONS FOR PRACTICE: there is a clear need for antenatal education to focus on preparing women for the realities of breast feeding, including newborn behaviour, which may affect women's perceptions of breast feeding. Local health care professionals need to draw upon national breast feeding strategies but develop a localised approach in order to address the regional variance.

Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae.

OBJECTIVE: To examine associations between doula care, early breastfeeding outcomes, and breastfeeding duration. DESIGN: Prospective cohort. SETTING: Regional hospital in northern California. PARTICIPANTS: Low-income, full gestation primiparae receiving doula care (n=44) or standard care (n=97). MEASURES: Birth outcomes and newborn feeding data obtained from the hospital record. Follow-up interviews conducted at day 3 to record the timing of onset of lactogenesis and breastfeeding behavior and at 6 weeks to obtain current breastfeeding status. RESULTS: Adjusting for baseline differences, women receiving doula care were significantly more likely to have a short stage II labor, a noninstrumental vaginal delivery, and to experience onset of lactogenesis within 72 hours postpartum (timely onset of lactogenesis). Overall, 68% of women receiving doula care and 54% of women receiving standard care were breastfeeding at 6 weeks. In the subset with a prenatal stressor (n=63), the doula care group was more than twice as likely to be breastfeeding at 6 weeks (89% vs. standard care, 40%). Breastfeeding at 6 weeks was also significantly associated with timely onset of lactogenesis and maternal report that the infant "sucked well" at day 3. CONCLUSIONS: Doula care was associated with improved childbirth outcomes and timely onset of lactogenesis. Both directly and as mediated by timely onset of lactogenesis, doula care was also associated with higher breastfeeding prevalence at 6 weeks.