Lactation suppression

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Lactation suppression refers to the act of suppressing lactation by medication or other non pharmaceutical means. The breasts may become painful when engorged with milk if breastfeeding is ceased abruptly, or if never started. This may occur if a woman never initiates breastfeeding, or if she is weaning from breastfeeding abruptly. Historically women who did not plan to breastfeed were given diethylstilbestrol and other medications after birth to suppress lactation. However, its use was discontinued, and there are no medications currently approved for lactation suppression in the US and the UK. Dopamine agonists are routinely prescribed to women following a stillbirth in the UK under the NHS. [1]

Contents

Reasons

After birth, some women may desire to stop the production of breast milk, for example when the mother decides to bottle feed from birth, or in the case when the infant dies [2] or is surrendered at birth. Additionally, women who are breastfeeding may need to stop breastfeeding abruptly, for instance if she is taking medication contraindicated for breastfeeding or undergoes surgery. The abrupt weaning process may lead to severe engorgement, extremely painful breasts, and possibly mastitis. Up to one third of women who do not breast-feed and who use a brassiere or binder, ice packs, or analgesics may experience severe breast pain. Specific studies of nonpharmacologic methods of lactation suppression were limited and inconclusive. Available data suggest that many women using currently recommended strategies for treatment of symptoms may nevertheless experience engorgement or pain for most of the first postpartum week.[ citation needed ]

Methods

Medication

Dopamine agonists are currently the preferred medication for suppressing lactation, which work by suppressing prolactin production. [3] Cabergoline (Dostinex™) is currently most effective option currently available, as it is available as a single dose (as opposed to bromocriptine which must be taken twice daily for 2 weeks.) [4] It may be prescribed in the case of breast abscess. Although the preferred method of treatment for breast abscess and mastitis is actually to continue breastfeeding, if the decision is made to stop breastfeeding, then chemical lactation suppression is indicated, particularly for severe cases. Carbergoline is not indicated for treatment of discomfort caused by engorgement. [4] In the UK dopamine agonists are routinely prescribed following a stillbirth. [1] Pre-eclampsia is a contraindication for prescribing dopamine agonists. [1]

In the past, hormonal therapies such as diethylstilbestrol were routinely used in the postpartum period, but these are no longer recommended due to side effects such as nausea and vomiting, [4] and severe potential side effects such as thromboembolism, cerebral accident, and myocardial infarction. [5] Estrogen containing birth control pills may have the same side effect, but like diethylstilbestrol is inappropriate for use in the postpartum period due to the risk of side effects.

Pseudoephedrine may also suppress lactation, as it is known to cause low supply. [6]

In the US. Spitz et al. [7] in a 100-year review of all available information concluded that there was nothing new or helpful to assist with the mammary involution or milk suppression process or to treat the pain or discomfort of severely engorged breasts.

Other methods

By simply not stimulating the breasts after birth, after a few days the production of milk will decease.[ citation needed ] If breastfeeding has already been established, the production of milk typically takes longer to decrease and may take several weeks. Women may experience pain and discomfort from engorgement. This discomfort is may be relieved by hand-expressing milk or the use of a pump to reduce engorgement and prevent mastitis. [8] The discomfort can also be treated with analgesics. However, as much as one third of all women will experience severe pain in this process.[ citation needed ]

Historically, binding the breasts by use of tight-fitting bras or ace bandages was used, but this is now discouraged as this may cause blocked milk ducts and mastitis. [4] Fluid restriction is also not recommended as it is likely ineffective and unnecessary. [9]

Cabbage leaves are a common recommendation to reduce discomfort from engorgement. However, a Cochrane review of three studies on this subject concluded that there was no statistically significant evidence that interventions were associated with a more rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. [10]

According to the Cochrane review other interventions such as hot/cold packs, Gua-Sha (scraping therapy), acupuncture, and proteolytic enzymes may be promising for the treatment of breast engorgement, but there is insufficient evidence to justify widespread implementation. [10]

See also

Related Research Articles

Hyperprolactinaemia Medical condition

Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Normal levels average to about 13 ng/mL in women, and 5 ng/mL in men, with an upper normal limit of serum prolactin levels being 15-25 ng/mL for both. When the fasting levels of prolactin in blood exceed this upper limit, hyperprolactinemia is indicated.

Mastitis Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

Domperidone Peripheral D2 receptor antagonist

Domperidone, sold under the brand name Motilium among others, is a dopamine antagonist medication which is used to treat nausea and vomiting, certain gastrointestinal problems like gastroparesis, and to induce and promote breast milk production. It may be taken by mouth or rectally.

Breast engorgement Medical condition

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis.

Nipple discharge Medical condition

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

Breast pain is the symptom of discomfort in the breast. Pain that involves both breasts and which occurs repeatedly before the menstrual period is generally not serious. Pain that involves only one part of a breast is more concerning. It is particularly concerning if a hard mass or nipple discharge is also present.

Breast diseases make up a number of conditions. The most common symptoms are a breast mass, breast pain, and nipple discharge.

Breastfeeding difficulties Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

Breastfeeding Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months and 58% of mothers continue breastfeeding up to the age of two years and beyond.

A postpartum disorder or puerperal disorder is a disease or condition which presents primarily during the days and weeks after childbirth called the postpartum period. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long term health problems are reported by 31% of women.

Prolactin modulator

A prolactin modulator is a drug which affects the hypothalamic–pituitary–prolactin axis by modulating the secretion of the pituitary hormone prolactin from the anterior pituitary gland. Prolactin inhibitors suppress and prolactin releasers induce the secretion of prolactin, respectively.

The postpartum physiological changes are those expected changes that occur in the woman's body after childbirth, in the postpartum period. These changes mark the beginning of the return of pre-pregnancy physiology and of breastfeeding. Most of the time these postnatal changes are normal and can be managed with medication and comfort measures, but in a few situations complications may develop. Postpartum physiological changes may be different for women delivering by cesarean section. Other postpartum changes, may indicate developing complications such as, postpartum bleeding, engorged breasts, postpartum infections.

Cracked nipple is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base. Cracked nipple develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.

A blocked milk duct is a blockage of one or more ducts carrying milk to the nipple for the purpose of breastfeeding an infant that can cause Mastitis. The symptoms are a tender, localised lump in one breast, with redness in the skin over the lump. The cause of a blocked milk duct is the failure to remove milk from part of the breast. This may be due to infrequent breastfeeding, poor attachment, tight clothing or trauma to the breast. Sometimes the duct to one part of the breast is blocked by thickened milk. A blocked milk duct can be managed by improving the removal of milk and correcting the underlying cause.

In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

Fertility while breastfeeding is controlled by the hormonal effects induced by breastfeeding during the postpartum period. Hormones associated with lactation and breastfeeding can inhibit processes necessary for conception. Because of the high variation of this process, breastfeeding is not recommended to be a method of contraception by medical providers, although correct use of breastfeeding as contraception, termed Lactational Amenorrhea Method (LAM), is as effective as hormonal contraceptive pills for the first six months after birth.

Breastfeeding and mental health

Breastfeeding and mental health is the relationship between postpartum breastfeeding and the mother's and child's mental health. Research indicates breastfeeding may have positive effects on the mother's and child's mental health, though there have been conflicting studies that question the correlation and causation of breastfeeding and maternal mental health. Possible benefits include improved mood and stress levels in the mother, lower risk of postpartum depression, enhanced social emotional development in the child, stronger mother-child bonding and more. Given the benefits of breastfeeding, the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) suggest exclusive breastfeeding for the first six months of life. Despite these suggestions, estimates indicate 70% of mothers breastfeed their child after birth and 13.5% of infants in the United States are exclusively breastfed. Breastfeeding promotion and support for mothers who are experiencing difficulties or early cessation in breastfeeding is considered a health priority.

Delayed onset of lactation

Delayed onset of lactation (DOL) describes the absence of copious milk secretion within the first 72 hours following childbirth. It affects around 20-40% of lactating women, the prevalence differs among distinct populations.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

Establishment of breastfeeding

Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organisation(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.

References

  1. 1 2 3 "What happens if your unborn baby dies". nhs.uk. 2018-02-12. Retrieved 2019-05-08. After a stillbirth, your body may start producing breast milk, which can cause discomfort and distress. Medicines (dopamine agonists) can stop your breasts producing milk. They cause few side effects and may also help you feel better emotionally, but they aren't suitable if you have pre-eclampsia.
  2. ↑ Moore DB, Catlin A (2003). "Lactation suppression: forgotten aspect of care for the mother of a dying child" (PDF). Pediatric Nursing. 29 (5): 383–4. PMID   14651312. S2CID   45057467. Archived from the original (PDF) on 2018-03-24.
  3. ↑ Oladapo, Ot; Fawole, B (2006-04-19), "Treatments for suppression of lactation", in The Cochrane Collaboration (ed.), Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, doi:10.1002/14651858.cd005937
  4. 1 2 3 4 Kataria K, Srivastava A, Dhar A (December 2013). "Management of lactational mastitis and breast abscesses: review of current knowledge and practice". The Indian Journal of Surgery. 75 (6): 430–5. doi:10.1007/s12262-012-0776-1. PMC   3900741 . PMID   24465097.
  5. ↑ Veurink, Marieke; Koster, Marlies; Berg, Lolkje T.W. de Jong-van den. (June 2005). "The History of DES, Lessons to be Learned". Pharmacy World & Science. 27 (3): 139–143. doi:10.1007/s11096-005-3663-z. ISSN   0928-1231. PMID   16096877. S2CID   12630813.
  6. ↑ Aljazaf K, Hale TW, Ilett KF, Hartmann PE, Mitoulas LR, Kristensen JH, Hackett LP (July 2003). "Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk". British Journal of Clinical Pharmacology. 56 (1): 18–24. doi:10.1046/j.1365-2125.2003.01822.x. PMC   1884328 . PMID   12848771.
  7. ↑ Spitz AM, Lee NC, Peterson HB (December 1998). "Treatment for lactation suppression: little progress in one hundred years". American Journal of Obstetrics and Gynecology. 179 (6 Pt 1): 1485–90. doi:10.1016/s0002-9378(98)70013-4. PMID   9855585.
  8. ↑ Smith LJ (1998). "Guidelines For Rapid Reduction of Milk Supply". BFLRC Ltd. Archived from the original on 2018-08-10. Retrieved 2018-03-24.
  9. ↑ Swift K, Janke J (2003). "Breast binding... is it all that it's wrapped up to be?". Journal of Obstetric, Gynecologic, and Neonatal Nursing. 32 (3): 332–9. doi:10.1177/0884217503253531. PMID   12774875.
  10. 1 2 Zakarija-Grkovic, Irena; Stewart, Fiona (18 September 2020). "Treatments for breast engorgement during lactation". The Cochrane Database of Systematic Reviews. 2020 (9): CD006946. doi:10.1002/14651858.CD006946.pub4. ISSN   1469-493X. PMC   8094412 . PMID   32944940.
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