Breastmilk production

Q: Do you have any suggestions to encourage production of breastmilk? Am doing frequent feedings but not so good about using the breast pump. My son was born 3 weeks ago and I do not have enough breastmilk to sustain him and am having to use supplement-Similac Advance. I am B+ and he is A+. He is getting progressively fussier, gassier, and sleeping less deeply for shorter periods of time. He came home with jaundice and we had to do the billi-lights for several days. I am a 42 year old first time mom. I have had great success with the ER4YT personally and would appreciate your assistance. Thank You. Alice.

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A: There are many theories on the evolution of the mammary gland and mammalian lactation, one paper suggests that the process is an evolution of the innate immune system, and may have partly evolved as an inflammatory response to tissue damage and infection, the nutritional function of milk arising subsequent to its protective function.[1] It is one of the marvels of human physiology that a mother can carry throughout pregnancy and produce the perfect milk for a baby with a different blood group to her own.

When an infant has problems feeding there are usually three possible explanations:

1. The baby is not latching on correctly either due to a problem with the baby's suckling mechanism or the feeding position

2. There is a problem with milk production

3. The baby has a digestive disturbance

Failure to produce sufficient milk can relate to any of these three, as when the baby does not take enough milk it does not stimulate the mother's breast enough to lactate properly, creating a vicious circle.

Research by a midwife suggests that the mother's feeding position is significant in successful breastfeeding,[2] with mothers who recline having more success than mothers who sit at 90 degrees (being the position often shown in books to be 'correct' for breastfeeding). In addition, a biological nurturing position, with the baby's stomach in contact with the mother, can help to increase suckling and reduce the incidence of sore nipples, thereby enhancing milk flow.[3] A midwife experienced in breastfeeding or a member of La Leche League[4] may be able to advise further.

If the baby has difficulty latching on due to a problem with swallowing or a mechanical disturbance in the jaw, osteopathic manipulative medicine in the form of osteopathy in the cranial field may be helpful. Premature babies or those with other neurological delays in jaw development may benefit from a check with an osteopath skilled in this field of treatment.[5]

Difficulty with lactation other than the above can be due to maternal emotional stress, a very hungry baby, a baby who has been separated from his or her mother for the first hour immediately after birth (i.e. due to a caesarian birth or neonatal incubation) or whose mother has been subjected to certain anaesthetics such as pethidine during delivery.[6] A breast pump may help to increase production, but the device is not always easy to use. There are certain herbs that have traditionally been used to stimulate milk flow, and this approach is now being recognised by midwives.[7]

Some of the following herbs have been used historically to promote milk supply:[8]

* Milk thistle (Silybum marianum)

* Blessed thistle (Cincus benedictus)

* Fennel seeds and powder combined (Foeniculum vulgare)

* Fenugreek seeds and powder combined (Trigonella foenum-graecum)

* Dandelion leaf (Taraxacum officinale) - best eaten as a fresh green cooked vegetable

Auricular or ear acupuncture, was discovered outside China by a French doctor, and is founded on the principles of reflexology, a therapy that the biomedical establishment does not consider scientific.[9] Treatment of the mother using this method has been found to resolve hypogalactia (increase milk flow).[10][11]

Breastfeeding is not just good for the baby. Research by the Society of Obstetricians and Gynaecologists of Canada Breast Disease Committee found that there is evidence that the risk for premenopausal breast cancer is reduced in mothers who have breastfed, and the more breastfeeding she has done the greater the protective effect.[12]

Despite the benefits of breastfeeding for baby and mother, formula milk does sometimes have to be used, and may be helpful when weaning early. There are various types of formula milk available, it is a good idea to check for the one that is compatible with the baby's blood group, and also to ensure that weaning is done according to blood group.[13] Baby formula can be expensive, costing over $200 a week in the U.S. There is obviously big money to be made, and most of the mothers on the WIC free formula programme (see previous column[14]) are likely to be receiving the minimum wage. A writer skeptical about infant problems with cows' milk[15] is also suspicious of the association between the Act Against Allergy, the "interactive communication program"[16] and SHS International, the company who make Neocate, a hypoallergenic infant formula. This interactive communication program is also supported by the British Dietetic Association, and tricked BBC news into thinking Act Against Allergy is a "medical task force" that polled doctors - the BBC later changed their news page to reflect the fact that they are sponsored by a formula milk manufacturer.[17]

Incidentally, some studies have reported that mothers taking supplemental vitamin B6 may cause suppression of the pituitary hormone prolactin, which is raised after giving birth and responsible for milk production.[18][19] Other studies contradict these findings,[20] saying that 'nutritionally relevant' levels of B6 do not affect milk production. The 'nutritionally relevant' dose of vitamin B6 in thePediatrics study (no effect) was up to 4 mg per day, whereas the Italian study (significant effect) investigated the influence of vitamin B6 in 2 doses of 300 mg in one day. The method of action is believed to be through inhibition of pituitary cell proliferation and hormone secretion, in part mediated through pyridoxal-induced cell-cycle arrest and apoptosis.[21] Anyone taking large doses of vitamin B6 should be monitored by a healthcare professional.