Breast Feeding

Signs of low breast mild supply

• Less than 3 wet nappies per 24 hours after 72 hours age
• Less than 5- 6 after day 5
• Concentrated urine
• Decreased breast milk stools
• Weight loss > 10% birth weight, or continuing after day 4
• 20g weight gain per day after day 4
• Failure to regain birth weight by 2 weeks
• Reduced lactogenesis, breast fullness
• Limited evidence of milk transfer
• Prolonged/continuous feeding, without satiety
• Jaundice, sleepiness, lethargy, dry mucus membranes
• Excessive crying or weak cry

• Weigh all full term neonates on day 4-6
  • If Weight loss greater than 10%:
  • Refer to Lactation Consultant
  • Observe, supervise and document a full breastfeed.
    • positioning
    • attachment
    • sucking pattern and milk transfer
    • breast changes, milk supply, nipple damage, breast surgery
  • Review baby’s feed chart since birth
  • Check for birthing history that may have delayed/interfered with Lactogenesis (obese, and diabetic women, as well as those who have a prolonged second stage of labor (greater than 2–3 h for nulliparous women), stressful labor or delivery, cesarean section, higher birthweight infant 
  •  Assess oral assessment

Increase milk supply

• Skin to skin
• Frequently – 2-3 hrly
• Attachment
• Switch feed – offer each breast twice
• Express after feeding – stimulates and drains
• Compress or massage to assist with flow/drainage
• If need extra – given expressed milk preferably
• Domperidone 10mg TDS

• Other suggestions
  • Reassure about changes in breast milk, baby’s weight
  • Check positioning, attachment and feeding
  • Encourage to continue
  • Lactation consultant
  • Drain breast for hind milk
  • Recommend demand feeding, or more frequent feeding
  • Consider/investigate post-natal depression/anxiety
  • Review 1-2 weeks to assess progress

Cease breastfeeding

• Cabergoline 1mg – stat dose – most effective in first 12 hours after miscarriage

Nipple pain

• Attachment difficulties
• Infection – bacterial, candida
• Nipple vasospasm
• Eczema/dermatitis
• Blocked ducts
  • Address causes of poor drainage – pressure
  • Consider if can lift the blister
• daily dab of steroid ointment