Breastfeeding support: improving quality and quantity of breast milk

Townsend Letter for Doctors and Patients,  May, 2005  by Tori Hudson,  Linda Healow

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Most pediatric health advisory organizations and practitioners recommend exclusive breastfeeding for all infants during the first four to six months after birth, with breastfeeding continuing for a minimum of 12 months. Exclusive breastfeeding is defined as an infant receiving only breast milk without addition of water, foods or supplemental formula. Decades of research indicates that breast milk is nutritionally superior to commercial formulas of artificial baby's milk or cow's milk. Infants who are premature or low birth weight, receive additional benefits from the nutritional content and immune properties of breast milk. The antibodies in breast milk help protect the infant against infections.

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A woman's body prepares her breasts for breastfeeding. Along with elevated levels of estrogen, (ductular sprouting) and progesterone (lobular formation), placental lactogen, prolactin and chorionic gonadotropin play a part. Once 16 weeks of gestation is reached, the breast will produce breast milk at delivery. Following delivery of a preterm infant, the breast produces "premie milk" for 6 weeks. This milk contains a higher concentration of immune components than milk produced following a 40 week gestation and also has nutrient and calorie concentrations more conducive to growth of the premature infant. After about 6 weeks, the milk gradually changes to "mature milk," the composition eventually matching that of a woman who birthed a term infant.

Glands surrounding the nipple produce a sebaceous oil that keeps the skin of the nipple area supple. That is why washing the breasts with only water is recommended. Soaps and other "toughening" techniques actually damage tissue and remove this necessary oil. During later pregnancy, hormonal changes cause the nipple tissue to become more elastic.

No external physical preparation is necessary for breastfeeding mothers. While the infant has reflexes that enhance the breastfeeding process, and mothers receive hormonal priming to breastfeed at delivery and throughout lactation, breastfeeding is a learned process for both mothers and infants. When choosing a health care provider for the infant, a new mother might want to ask what specific resources they have for breastfeeding mothers. Hospitals and birthing centers designated "Baby Friendly" are the gold standard for women wishing to receive the best support with lactation. There are a multitude of books available that can serve as a resource for breastfeeding mothers.

One of the most common complaints in the first days of breastfeeding is nipple soreness. There is usually a transient nipple tenderness that passes after an infant has spent roughly 24 hours at the breast. When an infant nurses, the mother should feel a "tug," not a "pinch." Many women and health care professionals think that pain is to be expected. Pain is produced when an infant is not latched on correctly. A proper latch-on has the infant tummy to tummy with the mother, the infant's body in alignment with its head, and limbs in relaxed flexion. The infant's mouth needs to open wide like a yawn, and its tongue needs to drop to take in enough areola to compress the milk sinuses. When latched on properly, the baby's nose will be touching the mother's breast, the baby's chin will be compressing the breast a bit, and both the baby's lips will be flanged outward. There will be movement visible in the infant's cheek muscles, and one will be able to hear audible swallowing in bursts.

Nutritional demands on the physiology of a nursing mother are as important or even more important than during the pregnancy. Continuing a well balanced diet with extra calories and protein (400-500 Kcal a day more) continues to be fundamental, along with a whole foods approach with adequate fluid intake and a prenatal vitamin. A mother's milk does reflect the specific fatty acids found in her diet. Thus, a diet of healthy oils including fish, olive oil, nuts and seeds, and nut butters that do not contain partially hydrogenated oils assures a good fatty acid balance. Nursing also takes extra energy. Along with sleep disruption, it is important to be mindful of rest and relaxation.

Lactation Support with Herbs

For many women, breastfeeding proceeds with no difficulty and a plentiful supply of milk, along with comfort and ease for infant and mother. For other women, it can be more difficult with varying challenges such as lack of adequate milk, pain, difficulty in getting the baby to suckle, fatigue, and medical problems of either baby or mom.

One of the problems that is usually well-addressed by herbal medicine is increasing the milk supply. Fennel has the advantage of not only increasing the breast milk, but easing after-pains and settling the digestion of the mother and the newborn, helping both to dispel gas and treat colic. Fenugreek has been a standard among lactation consultants and within herbal folk medicine to not only improve lactation but to promote digestion and stimulate the appetite, while also improving the taste of the milk. Nettles and raspberry are nourishing herbs that encourage a greater supply of breast milk and supply a source of trace minerals and vitamins to enrich the milk. Blessed thistle and borage seed oil and flower tops encourage the supply while helping the mother with postpartum moods and settling the nerves. Blessed thistle is a bitter herb useful for liver and digestive problems as well as for increasing the flow and richness of milk. Hops can not only increase milk flow but also help to bring normal sleep for the infant. Oatstraw calms a nursing mother and stimulates milk supply as well as supplies some minerals such as silica, zinc and manganese. Goat's rue is used in veterinary medicine for stimulation of milk secretion with reports of increasing the milk supply by up to 50% and the verbenalin in vervain has lactation-promoting properties as well. Milk thistle aids digestion, improves liver metabolism and increases milk supply.