Topic: Immunization, Baby friendly hospital
Question: A 22 year old primi mother comes to you with complaint of “Not Enough Milk” Her baby remains hungry and is constantly biting at her nipples. How will you assess the underlying etiology? Discuss briefly about the correct positioning while breast-feeding.
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When a primi mother comes to the healthcare provider with a complaint of “not enough milk,” it is essential to assess the underlying etiology to determine the appropriate intervention.
The following are some of the factors that can contribute to decreased milk supply:
- Inadequate breastfeeding: The most common cause of low milk production is inadequate breastfeeding. The mother may not be feeding the baby frequently enough, or the baby may not be latching on correctly.
- Hormonal disorders: Hormonal imbalances can affect milk production, including thyroid problems, pituitary gland disorders, and polycystic ovary syndrome.
- Medications: Certain medications can reduce milk production, such as hormonal contraceptives or decongestants.
- Breast-related issues: Breast-related problems such as breast infection (mastitis), breast surgery, or breast reduction can affect milk production.
- Stress: Stress can affect milk production, as it increases the production of the hormone cortisol, which can inhibit milk production.
A detailed history, clinical examination and investigations can help determine the underlying cause of perceived low milk supply in a new mother according to IMNCI guidelines.
History:
•Feeding frequency and duration: <8 feedings in 24 hours, or feeding for <30 minutes. This could indicate infrequent/inefficient feeding, leading to low milk production.
•wet diapers: <6 wet diapers in 24 hours suggests dehydration in the baby.
•Skin tent: Slow return of skin to normal position after pressing on infant’s chest. This indicates poor hydration and stimulation of milk glands.
•Problems during delivery: Long, difficult labor; surgical deliveries can delay lactogenesis.
•Medications: Anaesthesia, steroids, painkillers can impact milk production.
Clinical Examination:
•Breasts: Look for fullness, engorgement and visibly swollen Milk Ducts in between feedings. Poor fullness suggests inadequate stimulation of milk glands.
•Areola: Pale or blanching areola means poor blood supply, impacting milk production.
•Nipples: Inverted, sore, or flat nipples hamper effective latching and sufficient draining of breasts.
Investigations:
•Weight check: Continued weight loss in baby after initial regain of birth weight can indicate low milk supply.
•Sonography: To rule out issues like hormonal abnormalities or suckling defects impacting milk production.
Correct positioning while breastfeeding
Correct positioning while breastfeeding is crucial for the mother and baby’s comfort and effective milk transfer. The following are some points to consider when positioning the mother and baby:
- The mother should be seated comfortably with good back support.
- The baby’s head should be in line with the mother’s nipple.
- The baby’s mouth should be wide open, with their lips flanged outwards.
- The baby’s chin should be touching the breast.
- The mother should hold the baby close to her body, with the baby’s body facing her.
- The baby’s nose should be free from the breast, to allow for easy breathing.
- The mother should hold the breast with her hand and support it throughout the feeding.
IMNCI guidelines for breastfeeding
Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines provide recommendations for healthcare providers on promoting and supporting breastfeeding. The following are some key recommendations:
- Initiate breastfeeding within the first hour of birth.
- Exclusive breastfeeding should be practised for the first six months of life.
- Breastfeeding should be on-demand, with at least 8-12 feeds in 24 hours.
- Breastfeeding should continue for up to two years of age and beyond.
- Mothers should be encouraged to breastfeed on both breasts, ensuring adequate milk transfer and production.
Assessing the underlying cause of “not enough milk” in a primi mother requires a thorough evaluation of the mother’s breastfeeding technique, frequency, diet, and stress levels. Correct positioning while breastfeeding is essential for effective milk transfer and the mother and baby’s comfort. IMNCI guidelines provide recommendations for promoting and supporting breastfeeding, which is critical for the optimal growth and development of infants.
