para>Some women excrete a small amount of colostrum in the last few weeks of pregnancy.
Breasts should not be massaged or pumped, as this may stimulate premature uterine contractions.
There is insufficient evidence regarding benefits and risks of antenatal breast expression, which is intended to prepare the breasts for lactation after delivery (2).
Medication
First Line
Metoclopramide and domperidone have been shown to increase maternal breast milk output (as much as 93 " 96%) but have known side effects (3)[A].
Second Line
- Herbal galactagogues, including
- Fenugreek
- Milk thistle
- Shatavari
- Torbangun
- Limited evidence that they increase milk supply, but the studies are few and limited in design.
- Insufficient evidence to recommend for or against (4)[A]
Alert
When mother is medicated for concurrent conditions, consider secretion in breast milk.
Issues for Referral
Consider referral to certified lactation consultant early on if any difficulties with breastfeeding.
Surgery/Other Procedures
Only emergency surgery should be performed on the breasts during pregnancy.
Complementary & Alternative Therapies
Insufficient evidence regarding herbal galactagogues (4)[A]
Inpatient Considerations
- Consider medication use in patients who are breastfeeding and drug content in breast milk.
- Consider appropriateness of supplying mother with a breast pump while admitted.
- Milk can be stored to be given to infant or discarded if unsafe; discarding allows milk production to continue so as to allow for resumption of breastfeeding on recovery.
Ongoing Care
Follow-up Recommendations
- Exclusive breastfeeding until 6 months of life
- Duration thereafter should be as long as is mutually desired by mother and infant.
Diet
2010 USDA guidelines for pregnant and breastfeeding women
- 8 " 12 oz seafood per week from a variety of seafood sources
- Limit white (albacore) tuna to 6 oz per week.
- Avoid completely tilefish, shark, swordfish, and king mackerel (mercury content).
Patient Education
- Breastfeeding Helpline. Available at: http://www.4woman.gov/Breast-feeding/index.cfm?page=ask
- Breastfeeding for Parents. Available at: La Leche League http://www.lalecheleague.org/nb.html
- Meek JY. New Mother 's Guide to Breastfeeding. New York, NY: Bantam Books; 2002.
Complications
- Mastitis (see separate chapter)
- Engorgement
- Skin breakdown
- Early into initiation
- Increased risk with poor latch
References
1.Oladapo OT. Fawole B. Treatments for suppression of lactation. Cochrane Database of Syst Rev. 2012;(9):CD005937.
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2.Chapman T, Pincombe J, Harris M. Antenatal breast expression: a critical review of the literature. Midwifery. 2013;29(3):203 " 210.
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3.Ingram J, Taylor H, Churchill C, et al. Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012;97(4):F241 " F245.
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4.Mortel M, Mehta SD. Systematic review of the efficacy of herbal galactogogues. J Hum Lact. 2013;29(2):154 " 162.
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5.Thiele DK, Senti JL, Anderson CM. Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review. J Hum Lact. 2013;29(2):163 " 170.
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Additional Reading
- American Academy of Pediatrics; the American College of Obstetricians and Gynecologists. Breast-feeding Handbook for Physicians. Washington, DC: American Academy of Pediatrics; 2006.
- Hale TW. Medications and Mothers ' Milk. 13th ed. Amarillo, TX: Hale Publishing; 2008.
- Lawrence RA, Lawrence RM. Breast-feeding: A Guide for the Medical Profession. 6th ed. Philadelphia, PA: Elsevier-Mosby; 2005.
- La Leche League International. http://www.llli.org/faq/positioning.html. Accessed October 30, 2014.
Codes
ICD09
- V24.1 Postpartum care and examination of lactating mother
- 676.50 Suppressed lactation, unspecified as to episode of care
- 676.90 Unspecified disorder of lactation, unspecified as to episode of care
- 676.80 Other disorders of lactation, unspecified as to episode of care
- 676.40 Failure of lactation, unspecified as to episode of care
ICD10
- Z39.1 Encounter for care and examination of lactating mother
- O92.5 Suppressed lactation
- O92.70 Unspecified disorders of lactation
- O92.79 Other disorders of lactation
- O92.3 Agalactia
SNOMED
- 278413009 Lactation management (procedure)
- 30506002 suppressed lactation (disorder)
- 58219009 Lactation problem (finding)
- 290122005 Finding of lactation (finding)
Clinical Pearls
- Maternal vitamin D levels are commonly too low to allow for adequate vitamin D transfer into the milk; therefore, breastfed infants should receive vitamin D supplementation (5).
- The most commonly reported reason for early breastfeeding cessation is the perception of inadequate milk production (4).