Organization of breastfeeding and hypogalactia

Principles of successful breastfeeding management

The overwhelming majority of women are physiologically capable of breastfeeding. To ensure successful lactation, it is important to follow these basic rules:

• Psychological mindset: establishment of the lactation reflex and mindset in the mother.
• Early initiation: should occur right in the delivery room (within the first 20–30 minutes) to obtain colostrum and colonize the infant with the mother's microbiota.
• Avoiding pre-lacteal feeds: formula or water should not be given to the infant prior to the first breastfeeding.
• Feeding on demand: offering the breast at the first signs of restlessness, maintaining nighttime feedings without fail (to stimulate prolactin secretion).

Up to 4–6 months of age, an infant requires exclusive breastfeeding without supplementation with water. In infants, the thirst and satiety centers in the hypothalamus are located close to each other, so water creates a false sense of fullness, which reduces suckling activity and milk production. In cases of hypergalactia (excess milk), it is recommended to offer only one breast per feeding so that the infant receives both the watery "foremilk" and the fat-rich "hindmilk".

Hypogalactia and lactation crises

Hypogalactia is secretory insufficiency of the mammary glands.

• Primary (true): rare (3–5%), caused by severe neuroendocrine disorders.
• Secondary: occurs in healthy women due to a complex of stress, social, and biological factors (lack of lactation mindset, delayed first attachment, scheduled feeding, sleep deprivation).

Lactation crisis is a transient (temporary) decrease in milk volume associated with hormonal regulation. It occurs approximately once every 1.5 months and lasts 3–4 days (rarely up to 6–8 days). The infant becomes restless and requests the breast more frequently.

Management Strategy:

• The main rule when milk volume decreases (both during a crisis and in cases of suspected hypogalactia) is to increase the frequency of feedings, including during nighttime hours.
• During a crisis, both mammary glands are offered during a single feeding.
• Immediate introduction of formula supplementation is strictly prohibited, as this exacerbates the decrease in lactation.

Contraindications and management of complications

There are absolute maternal contraindications to breastfeeding:

• Infections: HIV, acute hepatitis A, open tuberculosis, particularly dangerous infections. Local herpes on the nipple is a temporary contraindication. Viral hepatitis B and C are not absolute contraindications, but feeding must be performed strictly using silicone nipple shields.
• Severe pathologies: eclampsia, massive intrapartum and postpartum hemorrhage, severe decompensation of chronic diseases.
• Psychiatry: acute mental disorders.
• Medications: use of drugs with teratogenic or toxic effects. At the same time, most standard medications (antipyretics, many antibiotics) pass into milk in trace concentrations and are compatible with lactation.

Nipple fissures and breast engorgement are not grounds to stop breastfeeding (shields are used). In cases of mastitis, feeding from the healthy breast continues, while feeding from the affected breast is suspended only upon confirmed high bacterial contamination (over 250 CFU/mL; in such cases, the milk is gently expressed and discarded).

Class and exam questions

What else to study on this topic

• Benefits of natural breastfeeding for maternal health
• Physiology of early ("foremilk") and late ("hindmilk") milk
• Peculiarities of lipid component digestion in breast milk
• Influence of maternal nutrition on the qualitative composition of breast milk

Other topics in "Chapter 3. Adaptation, Early Childhood Nutrition, Rickets"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.