Support of lactation, prevention and treatment of hypogalactia

Causes

Primary hypogalactia

Primary hypogalactia is a condition that is manifested by a complete lack of milk in a woman who has given birth. It is usually caused by toxicosis in the late stages of pregnancy, bleeding after childbirth, trauma of obstetric origin, and infection of the body. Primary hypogalactia can also be found in mothers who gave birth by cesarean section. It occurs very rarely - only in 5% of women giving birth.

Secondary hypogalactia

With secondary hypogalactia, there is milk, but not enough. Afterwards it either disappears completely or remains in short supply, and the child does not have enough of it.

The causes of secondary hypogalactia may be:

• emotional and physical stress, fatigue;
• cracked nipples or mastitis of the mammary glands;
• woman's illnesses, such as flu or sore throat;
• long periods of time between feeding the baby;
• when feeding, the baby takes in air along with the milk;
• lactation crises, which are a transient reduction in mother's milk. This may last approximately four days;
• other reasons (disturbed diet, too early/late age of the nursing mother), which play a minor role in the development of this problem.

Types of hypogalactia

1. By etiology: - primary - caused by hormonal changes in a woman (diabetes mellitus); - secondary - associated with somatic diseases, after a difficult birth, mental trauma, as a result of poor nutrition and regimen, due to acute inflammatory processes in the mammary gland.
2. By time of occurrence: - early - detected in the first 10 days after birth; - late - detected 10 days after birth.
3. According to the degree of milk deficiency: - I degree - milk deficiency no more than 25% of the daily requirement; — II degree — 26-50%; — III degree — 51-75%; — IV degree — more than 75% of the daily requirement.

Diagnostics

Before you begin treatment for hypogalactia, you need to accept and adhere to several very important conditions:

• You need to keep your child “from hand to mouth.” It sounds strange, but it works. The baby should not receive any food or drink other than breast milk. You need to apply it to your chest at the first call. The process of sucking it provokes a rush of breast milk to the mammary glands;
• There is no need to immediately feed the baby with formula if it is possible to restore the normal lactation process.

A doctor can diagnose hypogalactia after collecting an anamnesis about the patient.

Lactation crisis

In the first year of life, there are periods when the baby may not have enough milk. These are the so-called lactation crises; they occur during periods of the most intensive growth of the child. Lactation crises most often appear at 3 - 6 weeks of life, at 3 - 4 months and at 7 - 8 months of life. The duration of the lactation crisis is approximately 3 - 5 days.

During these periods, you should increase the frequency of breastfeeding. During feeding, place the baby on both breasts. Night feeding is a must. Also, mother should pay attention to herself, normalize her daily routine and nutrition.

Treatment

If a young mother has a problem such as hypogalactia, treatment is carried out through the use of certain drugs and substances:

• a nicotinic acid. Its dose is selected depending on the desired result. If you use nicotinic acid, the woman should feel warm. If this is not noticed, then the dose should be increased by one and a half times. Nicotinic acid is taken twenty minutes before feeding and two hours after meals. Typically, this remedy is indicated to be taken four times a day;
• vitamins "Gendevit". Take one gram three times a day 30 minutes before meals. You can also take vitamin E with them;
• An effective remedy for the treatment of hypogalactia is a drug based on royal jelly called “Apilak”. It is taken three times a day daily. Usually this remedy is prescribed after the mother has taken a course of nicotinic acid;
• After feeding the baby and expressing milk, a hot shower of the mammary glands may be useful. At this time, it is worth doing a breast massage and expressing the milk that is left. It is better to shower several times a day after feeding;
• It should be taken into account that medications for the treatment of hypogalactia are less effective than physical stimulation of lactation.

Prevention

Prevention of hypogalactia, which the expectant mother should take care of before giving birth, includes the following methods:

• physiological birth. Optimal age – 21–35 years;
• the newborn must be put to the breast early;
• before the lactation period, the baby does not need to be bottle-fed;
• do not feed or supplement the child with water and various formulas;
• You need to put your baby to the breast as often as necessary;
• during childbirth, stimulation and anesthesia should be avoided;
• the mother should be in comfort and not be stressed.

Hypogalactia (decreased breast milk production). Laser therapy method.

August 4, 2021

Doctor of Medical Sciences.
prof., head of the clinic of modern medical technologies LLC "MEDEP-regions", doctor of Children's City Clinical Hospital No. 9 named after. G.N. Speransky, head
Department of Rehabilitation and Innovative Medical Technologies of the Interregional Institute for Advanced Studies Gatkin E.Ya. In this article you will find answers to the following questions:

• Why is there little breast milk? • How do you know if your child has enough nutrition? • What to do if there is really not enough milk?

• How to increase milk supply?

Why is there little breast milk?

Any mother knows that breastfeeding is a natural form of nutrition for the baby. The mechanism of milk formation in women was formed during biological evolution, and to this day breastfeeding is considered physiologically adequate nutrition for infants.

But more and more often there are cases when this mechanism malfunctions, as a result of which the woman’s body does not produce enough milk.

Decreased lactation functions of the mammary glands. (hypogalactia) is expressed:

· in violation of the processes of lactogenesis (the process of milk formation in the mammary glands) and lactopoiesis (the process of maintaining lactation after it has already begun); · in reducing milk production; · shortening the lactation period (less than 5 months).

Hypogalactia is primary

and
secondary
.

With primary hypogalactia, the lack of milk is noticeable from the first days of lactation. This condition occurs only in 2.8%-8% of cases (E. M. Fateeva, Zh. V. Tsaregradskaya).

In such women, the development of the mammary glands is impaired and secretory and motor functions are suppressed. Underdevelopment of some organs and systems that determine sexual function is called “infantilism.” This condition is also caused by some diseases. In infantile women, hypogalactia occurs in approximately 20% of cases.

However, primary hypogalactia can also occur in fully developed women who have had a difficult pregnancy due to late toxicosis of pregnancy. This condition can also occur due to difficult childbirth, obstetric operations, postpartum hemorrhage and infections.

And yet, secondary hypogalactia is very common in medical practice. At first, milk production is in sufficient quantity, but then it decreases, and the baby no longer has enough nutrition.

The causes of secondary hypogalactia are varied:

1. diseases (flu, sore throat, tuberculosis, epilepsy, mastitis, cracked nipples, etc.);

2. incorrect feeding regimen, infrequent attachments and unpleasant sensations for the mother. And here a vicious circle arises: the baby becomes weak and sucks poorly at the breast, especially for premature babies. At the so-called “sluggish suckers” do not have enough strength to do full-fledged work in obtaining milk. Thus, lactation mechanisms are not turned on;

3. such a phenomenon as aerophagia (“aero” - air, “phagia” - eating), i.e. Swallowing air by a baby while sucking at the breast can also be one of the causes of hypogalactia. If the baby swallows more than 10% of the volume of the stomach, this can lead to disturbances in the digestive processes. By filling a large volume of the stomach with air, the aerophagic child does not receive the amount of milk he needs. A distended stomach gives a feeling of fullness, which is why weight loss occurs;

4. Some medications also inhibit lactation - for example, gestagens and androgens (steroidal female and male sex hormones), camphor, ergot and its alkaloids, diuretics, ether anesthesia, etc.

How do you know if your child has enough nutrition?

Infants in the first 3-4 days of life lose 5-7% of their initial weight due to the loss of excess tissue fluid and meconium (intestinal contents formed when amniotic fluid with its protein contents is swallowed). If by 10-14 days the child does not gain weight to the level it was at birth, you need to contact a specialist. If you don't pay attention to this, you can end up with a lot of problems later.

In the first month, the baby’s body weight should increase by about 680 grams - this is an average figure. In life, it is individual for each specific baby.

IMPORTANT: You need to assess weight gain based not on birth weight, but counting from its lowest values.

If you want to determine how much the baby sucks during feeding, then you need to weigh him before and after eating in clothes. The difference in weight will be the amount of what he ate. That is why every home where a baby is born should have scales.

Pediatricians always take into account the weight-height indicator, that is, the relationship between weight and height. Babies grow, on average, 2.5 cm per month.

In the first days of life, the baby's stool is sticky, “tarry”, black or black-green in color. It's called "meconium". In a normally developing baby, on the third day the stool turns green (it is called transitional), and on the fifth day it turns yellow.

After the milk comes in, the baby should have stool approximately 3-4 times a day. In the first days, weeks, and sometimes months, a child can only eat mother’s milk, which contains everything: water, proteins, fats, carbohydrates, immune defense factors, microelements and much more that is necessary to maintain the baby’s vital functions. Babies have a certain volume of stomach that can only hold a certain amount of contents. If you often give a baby water to drink, it will take the place of milk, and the child will not receive enough of everything listed above.

What to do if there really is not enough milk?

What indications may exist for introducing new ingredients into a baby’s diet?

1. in the first 10-14 days the child did not reach the weight at which he was born;

2. weight gain less than 115-140 grams per week (450-680 grams per month);

3. the child gains little/or no growth in height and head circumference (head circumference increases by approximately 1.27 cm per month in the first six months);

4. there are signs of starvation and/or dehydration:

· fontanel – sunken; · skin color – gray; · activity – reduced (drowsiness); · fat layer – loss is in progress; · urine – concentrated (strong odor, dark color) or absent; · stool – absent or small amount

5. the child has lost more than 10% of its weight at birth.

In case of insufficient lactation, artificial nutrition with an adapted formula may be necessary, but with mandatory supplementary breastfeeding

. When introducing formula, you should not stop trying to establish breastfeeding.

Important clarification

There are terms such as "foremilk" and "hind" milk. The anterior one is contained in the cistern, or lacteal sinus. The “back” portion is contained in deeper layers - in the lobules. The “front” portions of milk are thinner and contain fewer nutrients and protective factors. In the “back” the contents are thicker. There are more fats, proteins and carbohydrates. It is formed just while the baby is sucking. If the baby is unable to nurse for long periods of time and therefore does not gain weight, this may mean that he is not getting the “back” portion.

There is a simple way: you can feed the baby with “fore milk”. Then pump a little and bring the baby to the breast when the “hind” milk comes into the mammary sinus. It takes about 10 minutes for the back portion of milk to reach the tank.

If the mother gives the child only what is easy for him to suck, transferring from one breast to another, the child eats the more liquid part of the milk, which lacks the necessary ingredients.

The result is poor weight gain, loose, greenish or green stools with foam. If a mother tries to accustom her child to “order” and allows 15-20 minutes for feeding (so that he does not “hang” on the breast longer), this can also trigger the development of hypogalactia. Immediately after birth, the baby's intestines are normally sterile. If the mother feeds him immediately after birth, then normal microflora appears in the baby’s gastrointestinal tract. He also receives protective factors that fight pathogenic flora and help grow saprophytic (useful). If, after birth, a child is fed something else, especially artificial formulas, the intestines are not seeded with what the baby needs for normal development. When a child feeds on mother's milk, his stool is liquid and yellow in color, with whitish inclusions in it.

How to increase your milk supply?

IMPORTANT:
The best prevention of hypogalactia is placing the newborn on the mother’s breast as early as possible.
Unfortunately, this is not always possible due to the poor condition of the mother after childbirth or the transfer of the child to the intensive care unit. From the first days of life, it is necessary to frequently give the baby breastfeeding to stimulate lactation and minimize additional feeding and feeding of the baby.

You should drink water or tea before feeding. The diet should be varied. I tell nursing mothers that it should be delicious. Sometimes, due to postpartum depression, the mother has no appetite during the first two weeks. But you don’t have to force yourself to eat, so as not to develop unhealthy eating behavior. After some time, the body will begin to take in as much food as is required for lactation.

Eating very fatty foods can increase the fat content of milk, not for the better. 11% of fat in it is constant, and an increase in its content can lead to constipation in the baby. Therefore, the mother’s diet should include complete protein and carbohydrate dishes, and it is recommended to eat less fat, while giving preference to vegetable oils. This will help you not gain weight during this period.

Stimulation of lactation should be achieved with massage, a balanced diet, special medications and physiotherapy, in particular with the help of therapeutic lasers. After the start of normal lactation function, you need to gradually remove artificial nutrition from the baby’s diet and transfer it to the mother’s breast milk.

It should be borne in mind that medications have less effect than methods of physiological stimulation of lactation, which increase blood circulation in living tissues.

laser therapy at home

.

After it, a good effect is recorded.

I know this from my own experience.

In my daily work at the clinic of modern medical technologies MEDEP-Regions LLC, I use laser therapy devices RIKTA-ESMIL (2A), of which I was a co-developer for many years. Now these are portable multifactor devices with powerful laser emitters (up to 50 W per pulse), red and infrared LEDs, and a constant magnetic field (inductance - at least 35 mT). These devices also have electrical stimulators, the power of the current supply in which can be adjusted according to the woman’s sensations. The combination of all these factors gives a wonderful effect.

Positive changes are observed after just a few sessions.
Lactation increases after 1 course and remains at a sufficient level throughout the entire feeding period, which is prolonged (increased) against the background of these physical influences. It must be said that at the same time, the quality characteristics of breast milk also improve: the amount of proteins, fats, carbohydrates, microelements, immunoglobulins, and cellular immunity factors increases. In other words, mother's milk becomes more useful and nutritious for the baby, which has a beneficial effect on his health. Contraindications . Laser therapy methods should not be used if cancer is suspected.

Prevention of hypogalactia

1. A nursing mother needs to create satisfactory material, living, hygienic conditions, as well as a state of mental comfort;
2. The daily and nutritional regimen of a nursing mother: sleep at least 7 hours a day, naps during the day, walks in the fresh air for at least 1.5-2 hours, a nutritious and varied diet with the obligatory consumption of fermented milk products. Walnuts, mushroom suras, and pike perch stimulate milk production. You can include in your diet special mixtures for nursing mothers, such as Galakton, Enfamil Mama, Femilak and others. 20-30 minutes before feeding, it is recommended to drink a glass of hot drink (weak tea, milk, green tea);
3. The correct feeding regime for the child. More frequent breastfeeding, night feedings. Breastfeeding should be continued for as long as possible. If there is a need for supplementary feeding, then give the amount of breast milk substitute that is necessary for adequate growth. Substitutes should be given by cup, avoiding bottles and nipples if possible. Be sure to continue breastfeeding;
4. Expressing breast milk. Pumping is especially important in the first month of a baby’s life, when he sucks out a small amount of milk. Expression is carried out until the breast feels completely empty. On average it takes 10-15 minutes. Expressing with an electric suction is most effective. After expressing, the mammary gland should be rinsed with warm water;
5. Breast massage. The massage is done with stroking movements, with both hands for 3 - 5 minutes, 2 times a day. They start from the top of the mammary gland from the middle of the sternum towards the shoulder, then from the bottom of the chest towards the axillary region (these are the lymph outflow pathways). You can do circular strokes, but without touching the nipples and areolas. Light compression of the gland is also performed with both hands from above and below.

If there is no effect, medications are used.