Description

• Lactation is the production and secretion of milk by the mammary glands for the purpose of providing infant nutrition.
• Lactation suppression is carried out when the mother chooses not to or cannot breastfeed, infant loss, or weaning is desired:
  • Termination of physiologic milk production
  • Medical contraindications to breastfeeding include an infant diagnosed with galactosemia or a mother who has been infected with HIV, is taking antiretroviral medications, has untreated or active TB, is infected with human lymphotropic virus type I or II, is using an illicit drug.
  • Chemotherapy agents, such as antimetabolites or radiation therapies, are medical contraindications to breastfeeding. Nuclear medicine therapies only require a temporary interruption.
  • Prescription medications should be reviewed on a case by case basis for contraindications, although many are compatible.
• Infant benefits of breastfeeding include a reduced risk of gastrointestinal tract infections, necrotizing enterocolitis, late-onset sepsis in preterm infants, type I and type II diabetes, childhood leukemia and lymphoma, childhood obesity, respiratory and urinary tract infections, otitis media, sudden infant death syndrome, and infant mortality. Maternal benefits of breastfeeding include a reduced risk for breast and ovarian cancers, significant reduction in hypertension and cardiovascular disease, and decreased postpartum bleeding and menstrual blood loss.

Epidemiology

Statistics from U.S. CDC (data from 2014 to 2016 births) indicate the following:

• Ever breastfed: 82.5%
• Breastfed at 6 months: 55.3%
• Breastfed at 12 months: 33.7%
• Exclusive breastfeeding through 3 months: 46.6%
• Exclusive breastfeeding through 6 months: 24.9%

Etiology and Pathophysiology

• Most women lactate spontaneously after a normal pregnancy.
• The breast responds to the hormones of pregnancy by proliferation of the ductal system and development of the alveoli, which become lined with cells that produce milk.
• Breasts increase in size; nipples and areolae become more prominent.
• After 16 weeks’ gestation, the breast will produce milk when the fetus and placenta are delivered.
• Production of milk will increase via feedback from emptying of breasts to meet needs of infant.
• Abnormalities in breast development:
  • Asymmetric breasts
  • Glandular hypoplasia
  • Other anatomic variations
  • Postsurgical problems
    • Reduction mammoplasty
    • Augmentation
    • Other surgical scarring of the torso

Genetics
No known genetic link for lactation failure

Risk Factors

• Maternal history of failure to breastfeed a previous child
• Chronic medication or supplement use
• Infertility
• Breast surgery or trauma
• Cranial or chest irradiation
• Domestic or intimate partner violence
• Obesity
• Low socioeconomic status
• Ethnicity
• Lack of family support for breastfeeding
• Lack of adequate support in the hospital
• Lack of workplace support in working mothers
• Outside pressure in a bottlefeeding culture

Commonly Associated Conditions

• Diabetes
• Thyroid conditions
• Polycystic ovary syndrome
• Sheehan syndrome or other pituitary insufficiency
• Retained placenta