The first hours and days after birth are critical for mother and infant to initiate and build milk supply effectively. Providing mothers with appropriate support and counselling during this period is key to help them initiate and maintain an adequate milk supply.
Mothers are more likely to stop breastfeeding when they feel their milk supply is inadequate. Mothers whose infants are unable to breastfeed effectively or have lactation risk factors require extra support to establish a milk supply. The use of hospital grade pumps to stimulate the breasts can provide valuable support in such cases. It is therefore helpful to identify and monitor women with risk factors for delayed secretory activation who could benefit from early pump use, to initiate and build an adequate milk supply.
Lars Bode, Professor of Pediatrics and Director of the Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California, San Diego, USA
With all the changes in clinical practice, we need to empower parents with evidence-based information so they demand the appropriate support for initiation and breastfeeding in the hospital to ensure long-term adequate milk supply.
Initiation of milk production
All mothers experience the same lactation processes to reach an adequate milk production, whether delivering at term or prematurely. This milk production journey can be described as being a continuum of four stages:
- Develop – the breast tissue
- Initiate – milk production
- Build – milk production
- Maintain – milk production
As the stages are clearly interrelated, it is important to get things right from the start as this will have a substantial impact on long-term milk production success.
Guidance for health care professionals: Breastfeeding and pumping during COVID-19
Based on up-to-date evidence from the WHO and UNICEF, this infographic provides healthcare professionals with answers to the most frequently asked questions when women are breastfeeding with Coronavirus – whether suspected or confirmed of having COVID-19 and are either breastfeeding or pumping for their term infant or infant in the NICU.
Click here for helpful tips for mothers to build breastfeeding confidence
At-risk conditions that impact breastfeeding initiation
There are factors to consider when determining the risk of delayed secretory activation. Three of these risk factors can be assessed before birth (maternal age, gravida, weight), and the fourth one, delivery, just before birth or during the birthing process (unplanned caesarean). The proper clinical intervention at the right time can offer a mother the best chance to achieve her breastfeeding goals. As such, mothers with these conditions should be educated with regard to their potential breastfeeding challenges.
Improving delayed lactogenesis and suppressed lactation in at-risk mothers
The ability to initiate, build and maintain breast milk volumes sufficient to meet an infant’s needs are dependent on complex interwoven factors. Additionally, there are multiple maternal risk factors for delayed milk production and suppressed lactation.
In many lactation situations, interventions are not started until a mother reports problems. By identifying mothers who are at risk for delayed or suppressed milk production, especially those mothers with multiple risk factors, clinicians can increase surveillance of infant feeding progress and intervene proactively.
Getting it right: The critical window of opportunity to establish lactation and improve patient satisfaction
Professor Diane Spatz, PhD, RN-BC, FAAN, presents evidence-based strategies to address suboptimal lactation issues related to maternal lactation risk factors and to implement practice changes that impact maternal lactation outcomes.
