Practical breastfeeding tips are available from a range of sources, which sometimes makes it difficult to identify what is actually important for mothers. We therefore reviewed common breastfeeding tips according to scientific knowledge, giving an overview about positioning and attachment, frequency of breastfeeding, adequate hydration, as well as relaxation and self-confidence. With this knowledge, mothers can avoid the occurrence of breastfeeding problems before they occur and improve their breastfeeding experience.
Along with the breastfeeding tips, natural measures to improve breast milk supply can be introduced. Galactogogues – which are either synthetic or plant molecules that are able to induce, maintain, and increase breast milk production – are particularly effective to this end (Wilinska et al, 2015). In contrast, the recommendation of using breast pumps to increase lactation is not scientifically justified (Marcellin and Chantry, 2015). More information about galactogogues and other natural helpers are available under NaturScience.
Although most mothers would like to breastfeed, unfortunately, not every mother can breastfeed as she had intended – either initially or after a certain period of time. From a medical point of view, mastitis (an inflammation of the breast), is one of the most common reasons why mothers stop breastfeeding (Amir et al, 2014; WHO, 2000).
Reasons to stop breastfeeding stated by mothers vary widely and are often not based on diagnosed medical conditions (Li et al. 2008). Factors for breastfeeding cessation include lactating, nutritional, psychosocial, lifestyle, and infant self-weaning aspects.
Although breastfeeding a baby is a vital and emotionally fruitful experience and it is recommended to exclusively breastfeed for the first six months (WHO, 2009), at some point a mother needs to stop breastfeeding. Reasons behind breastfeeding cessation are various – ranging from medical reasons and inconvenience in social life through to babies’ growing need for nutrients. In many cases, this goes along with the difficulty of figuring out how to wean the baby. However, often an even bigger obstacle lies in the challenge of stopping inherent milk production.
Good positioning and attachment
The key for successful breastfeeding is a close and confident hold of the newborn while the baby’s mouth is properly attached to the breast. In this way, mastitis may even be prevented because the milk can be removed efficiently and milk stasis is avoided (Amir et al, 2014). Face-to-face support of mothers either by professionals or by experienced family members and friends are especially effective in giving mothers the confidence needed when it comes to correct positioning and attachment (McFadden et al, 2017; WHO, 1993).
Frequency – individual and on demand
Frequent breastfeeding throughout the day is conventionally mentioned in tips on how to initiate breast milk flow. A high breastfeeding frequency simulates the secretion of the hormone oxytocin, which in turn increases lactation. This may give the mother the impression that she is breastfeeding around the clock (cluster feeding). A study by De Carvalho et al. (1983) investigates the effect of frequent nursing on milk production and babies’ weight gain in the first weeks after birth. In the period of 15 days from birth onwards, both milk intake and weight gain are significantly higher in the group with frequent feedings per day (on average 9.9 vs. 7.6 per day). However, after 35 days, these differences disappear despite the number of feeds still differing amongst the groups. Consequently, breastfeeding should be conducted on demand and the individual needs of the baby as well as the mother’s well-being should be considered (Kent et al, 2006). In order to prevent mastitis, it is recommended not to restrict feeds, and to express breast milk by hand or with a breast pump if the baby is satisfied before the breast has been relieved (Amir et al, 2014).
Another valuable piece of advice to promote breastfeeding is to drink adequately - or ‘drink a lot’, as often stated in breastfeeding guidelines. However, data is scarce and therefore, scientifically speaking, the effect of additional fluids ingested by breastfeeding mothers remains unknown. Once more, priority should be placed on the mother’s well-being, since some studies even show negative effects of excessive drinking such as diuresis and nausea (Ndikom et al, 2014). Nevertheless, breastfeeding mothers’ diets should be balanced, which includes adequate fluid intake to meet her physiological needs. Ideally, breastfeeding mothers should choose water for consumption and avoid coffee, coke, and most importantly, alcohol (WHO, 2009).
Relaxation and self-confidence
As already previously suggested, breastfeeding depends on the mother’s well-being and feelings – about herself, but also her confidence in her ability to breastfeed (WHO, 1993). Stress can suppress the secretion of prolactin, the hormone essential in producing breast milk (Chatterton et al, 2000). Along with specific stress-relief techniques which prove to have positive effects (Fotiou et al, 2018), a mother’s environment in general should facilitate breastfeeding (McFadden et al, 2017). For example, the father should be involved in the baby’s care to ensure the mother has time to rest (WHO, 2017).
Mastitis is reported by 3-20% of breastfeeding mothers and consequently is a frequent reason to stop breastfeeding (Amir et al, 2014). Mothers suffer from a painful inflammation of the breast, which becomes obvious by a hot, swollen, and reddened area, typically in one breast only. This is accompanied by fever, chills, and flu symptoms, and may or may not include a bacterial infection. Usually, mastitis occurs in the first six weeks after childbirth (Amir et al, 2014), and results from an insufficient or late management of breastfeeding complications (Viduedo et al, 2015).
In particular, stagnation of milk in the breast (milk stasis), can lead to breastfeeding complications ending up in mastitis. In some cases, anatomical characteristics such as a mother’s flat or inverted nipples or a baby’s tongue’s short frenulum can complicate the baby’s attachment to the breast and hinder effective suckling. Trying different positions may help (WHO, 2009). In general, a proper attachment of the baby to the breast, effective suckling, and adequate length and frequency of feeds are essential to remove a sufficient amount of milk from the breast. In addition, a good attachment to the breast also prevents sore nipples and nipple pain. Milk stasis may occur in only part of the breast, which is often referred to as a blocked milk duct. Another serious consequence of such breastfeeding complications is a breast abscess, which manifests itself as lumps filled with pus (WHO, 2000). This again underlines the importance of correct breastfeeding technique and routine.
In case of the appearance of any symptoms related to mastitis, the WHO (2000) recommends bed rest, using warm compresses, feeding from the affected breast as often as possible, and massaging the breast while the baby is drinking to support milk flow. However, if the situation does not improve, a healthcare professional should be consulted the following day.back
Along with medical reasons, self-reported data from 1,323 mothers show that mothers stop breastfeeding on a variety of other grounds (Li et al, 2008). As one of the most frequent reasons, mothers have the perception that breast milk alone does not seem to satisfy her baby. This concern appears to be of high relevance, independent of the age of the child. Overall, the agreement amongst mothers reaches approximately 50% in each age group until the age of nine months.
Other reasons are less consistent and change over time: With babies of less than one month old, the two major reasons for stopping breastfeeding are “My baby had trouble sucking or latching on” and “I had trouble getting the milk flow to start”. However, the relevance of these points strongly decreases with the baby’s age. In contrast, psychosocial factors such as “I wanted or needed someone else to feed my baby”, lifestyle factors such as “I wanted my body back to myself”, and the infant’s self-weaning factors such as “My baby lost interest in nursing or began to wean himself or herself” become more relevant the older the baby gets.
These results demonstrate that it is important to target supporting measures for breastfeeding problems according to the baby’s age and the individual mother-baby-dyad (McFadden et al, 2017).back
Breastfeeding is a rewarding exercise for both mothers and babies and considered the best strategy for healthy child development. Despite all the benefits that breastfeeding is associated with – such as baby nourishment, health benefits for both the mother and the baby, and an intimate emotional experience – there always comes a time when the well-being of the mother and her baby requires the suppression of lactation. The cause can be either optional (e.g. lifestyle choices or going back to work), forced (e.g. medical reasons), or even because it is already time for the child to start weaning without resorting to breast milk. Generally, the World Health Organization (WHO) recommends exclusively breastfeeding for the first six months and thereafter to start feeding meals in addition to breast milk (WHO, 2009). Accordingly, after six months, the reduction of breast milk production becomes essential. A baby’s demand for breast milk is directly related to a mother’s milk supply: Baby suckling stimulates the breast and causes the release of prolactin, which is responsible for the growth of alveoli in the breast and increased breast milk production (WHO, 2009). As a consequence, when breast stimulation is decreased or ceased, milk will gradually be produced in less quantity and will eventually stop on its own. However, this process is not sudden and in the meantime a woman can experience breast engorgement, leakage of milk, discomfort, and pain.
Healthcare professionals may provide intervention advice or treatment options to reduce these symptoms and ultimately cease maternal milk production. Lactation suppression is addressed using two different approaches: non-pharmacological and pharmacological methods. Non-pharmacological approaches have been used for several centuries and, for instance, include emptying of the breast by massage. More recent methods include the avoidance of tactile breast stimulation and the application of external agents (e.g. cabbage leaves, jasmine flower or ice packs) (Oladapo and Fawole, 2012). Peppermint and sage are two examples of herbs which are commonly known to decrease milk production (Walls, 2009). These approaches are still in use today and are considered the best and safest approach, although data indicate that efficacy is still low (Oladapo and Fawole, 2012). Pharmacological methods are drug treatments with the objective of lowering prolactin levels and therefore reducing breast milk production. Several drugs have been evaluated throughout the years: i) bromocriptine; ii) oestrogen preparations (e.g. diethylstilbestrol and quinestrol); iii) combinations of testosterone and oestrogen; and iv) other pharmacological agents (e.g. clomiphene, tamoxifen, prostaglandins, oxytocin, and homeopathic preparations) (Oladapo and Fawole, 2012). In most cases, bromocriptine is considered when women choose to undergo pharmacological treatments – mainly due to its efficacy in lowering prolactin levels. However, this drug is only available in certain countries because of its potential life-threatening side-effects such as cardiovascular disorders (particularly ischaemic disorders), and, to a lesser extent, neurological and psychiatric disorders (Bernard et al, 2015).
Despite the fact that two possible approaches to managing overextended milk production exist, no evidence proves that pharmacological treatments are a better option over non-pharmacological methods (Oladapo and Fawole, 2012). Studies cannot clearly identify a good combination of efficacy and an absence of side-effects for pharmacological alternatives. Consequently, non-pharmacological approaches remain thebest option to suppress or cease lactation and avoiding the discomfort and pain that continuous milk secretion may cause.back