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Prepared is Powerful: Managing Lactation Risk Factors for Mothers


Managing lactation risk factors is an important step in your breastfeeding journey. You experience so many changes within your body just to nourish your newborn. In this guide, you’ll learn about what happens within your breasts during pregnancy and following delivery. Knowing the different stages your body goes through helps manage expectations, troubleshoot concerns, optimize feeding, and provide reassurance that you’re not alone.


We’ll also cover the different lactation risk factors that influence breastfeeding and milk production like primiparity and mother-infant separation. Then we’ll wrap up with the steps we use at Baby Experts to minimize the impact of lactation risk factors.


Remember: This guide is just the beginning. Breastfeeding doesn't always come easy. If you need help beyond this guide, please reach out to us.


What are the stages of lactation?

Lactation is the process your body goes through to produce milk for your baby. There are two main stages: during pregnancy and after delivery.


During Pregnancy

During pregnancy, hormonal shifts trigger the development of milk-producing structures within your breasts. As early as the second trimester, you might begin producing colostrum, a thick, yellowish pre-milk brimming with antibodies and immune-boosting factors to give your newborn a head start.


After delivery

After delivery, colostrum changes into transitional milk, a richer concoction produced before the mature milk. Transitional milk lasts about two weeks as your body produces and adjusts the composition of your milk to meet your baby's growing needs.


Finally, around the one-month mark, your body produces mature milk. This substance changes over time, ensuring your baby receives the perfect blend of nutrients, fats, carbohydrates, and antibodies for optimal growth and development.


Why is it important to know the stages of lactation?

Knowing the stages of lactation is crucial for several reasons for both mothers and healthcare providers:


Manages Expectations: Understanding the changes in breast milk consistency, volume, and feeding frequency throughout lactation helps mothers anticipate what's normal and avoid unnecessary worry. For instance, the initial drop in milk volume after colostrum is replaced by transitional milk is a natural part of the process—not a sign of low supply.


Troubleshooting Concerns: Knowledge of the lactation stages allows for earlier identification of potential issues and managing lactation risk factors. For example, if a mother experiences continued engorgement or low milk volume after the transitional milk stage, it might indicate a latching problem or insufficient milk removal.


Optimizes Feeding: Knowing the stages can guide feeding practices. For instance, during the colostrum phase, frequent feeding cues from the baby are essential to stimulate milk production. Later, understanding the foremilk and hindmilk composition within mature milk can ensure babies get the balance of nutrients they need. 


Provides Reassurance: Lactation can be an emotionally demanding time. Knowing the stages, what to expect, and managing lactation risk factors empowers mothers and fosters confidence in their breastfeeding journey.


What factors influence breastfeeding?

Breastfeeding is a natural process, but it doesn't always come easy—which is normal. This is especially true for first-time mothers (primiparous women) who may encounter various hurdles through their breastfeeding journey. Below are some common challenges faced by moms and if you’re struggling with any of these, please reach out to us.


Primiparity

Primiparity simply means being a first-time mother. It refers to the fact that a woman has never given birth before. The opposite of primiparity is multiparity, which means having given birth to two or more children. First-time mothers have been shown to have “lower breastfeeding self-efficacy with limited prior breastfeeding exposures.”


Obesity

Obesity can make breastfeeding difficult. Extra breast tissue may hinder latching and hormonal factors can delay milk production. Despite these challenges, many women in this category breastfeed successfully with help from lactation consultants or healthcare providers.


Breast Surgery

Breast surgery can reduce milk production if it severs milk ducts or disrupts nerves. Nipple sensation changes from surgery can make latching difficult. Breast reduction surgery has the biggest impact, while implants and lumpectomy have less risk. Talk to your doctor and a lactation consultant before surgery if you plan to breastfeed.


Polycystic Ovary Syndrome

PCOS may affect milk supply due to hormonal imbalances and insulin resistance. Breast development can also be impacted. Despite this, many women with PCOS breastfeed successfully.


Diabetes

With diabetes, blood sugar fluctuations can affect milk production and cause low blood sugar in your baby. Breastfeeding mothers with diabetes might experience delayed milk production or yeast infections but working with a lactation consultant can ameliorate this.


C-Section

C-sections can make breastfeeding initiation trickier due to delayed skin-to-skin contact, pain medication, and fatigue. But with support, moms who deliver via C-section can still breastfeed successfully. Focus on early skin-to-skin contact, comfortable feeding positions, and frequent breastfeeding.


Premature Delivery

Premature birth can make breastfeeding challenging. Mom's milk production may be delayed, and separation from your baby in the NICU can disrupt establishing breastfeeding. Preemies may also have weak sucking reflexes. Despite these hurdles, breast milk is still recommended for its many benefits. Talk to a lactation consultant for help.


Stressful or prolonged labor and delivery, psychosocial stress/pain

Stressful deliveries can delay milk production due to hormonal interference and exhaustion. It can also make initiating breastfeeding right away more difficult. However, again, with support, mothers can still breastfeed successfully.


Postpartum hemorrhage (PPH)

PPH can make breastfeeding difficult due to a mom's recovery needs, fatigue, and potential emotional distress.


Mother-infant separation

Mother-infant separation can disrupt milk supply due to less frequent suckling, triggering stress hormones that inhibit milk production, and make latching and breastfeeding more difficult for both mom and baby. This can lead to moms feeling less confident and giving up on breastfeeding sooner.


Delayed first breastfeeding or milk expression or Infrequent breastfeeding or milk expression

Delayed or infrequent breastfeeding creates a supply-demand mismatch. Your body makes milk based on how much is removed. Less nursing means less milk production, making it harder for your baby to be satisfied. Newborns also need frequent feedings to stay hydrated and avoid issues like jaundice.


While various factors like primiparity, medical conditions, and delivery complications can present challenges for breastfeeding, they don't necessarily prevent it. With proper support from healthcare providers and lactation consultants like The Baby Experts, most mothers can breastfeed successfully and enjoy its benefits for themselves and their babies.


Steps to minimize the impact of lactation risk factors

Baby Experts follow The Mother's Own Milk Initiation Protocol (MOM-I). It’s a comprehensive program designed to optimize support for at-risk mothers and babies, prioritizing the use of their own breast milk.


1. Implement Mother's Own Milk Initiation Protocol

Goal: Optimize resources and improve support for at-risk mothers and babies by prioritizing their own milk production.

Implementation:

●     Collaborate between all units (Labor & Delivery, Maternity, and NICU) to establish a standardized protocol promoting early and frequent milk feeding or expression.


2. Expand Staff Education

Goal: Empower staff to ensure optimal support for mothers and babies with lactation risk factors.

Implementation:

●     Stages of lactation: Educating staff and new mothers about the physiological process of milk production to equip staff to guide mothers through each stage effectively.

●     Risk factors for inadequate milk supply: Teaching staff and new mothers about the lactation risk factors that hinder milk production.

●     MOM-I Protocol strategies: Train staff and educate new moms on the strategies outlined in the MOM-I protocol to prioritize maternal milk volume. This ensures consistency and effectiveness in lactation support.


3. Empower Parents Through Prenatal Education

Goal: Build a strong foundation for successful breastfeeding by expanding prenatal education for both mothers and their families.

Implementation:

●     Stages of lactation: Help moms understand the natural progression of milk production so parents can anticipate changes and navigate any challenges due to lactation risk factors.

●     Benefits of mother's own milk: Teach parents about the unique immunological and nutritional properties of breast milk and set clear expectations for their baby's health.

●     Risk factors for milk production issues: By understanding potential challenges, parents can feel more prepared for interventions that may be necessary to support milk production in the early postpartum period.



4. Screen Proactively

Goal: Identifying mothers at risk for milk production challenges early so we can be proactive in successful breastfeeding.

Implementation:

●     Proactively prepare mothers: Helping mothers know their risk factors and allowing them to ask questions and participate actively in establishing a milk supply. 

●     Optimize staff interventions: With early identification, staff can tailor support strategies from the very beginning, ensuring timely and appropriate interventions for lactation risk factors.


5. Prioritize Early and Frequent Breastfeeding

Goal: Minimize initiation delays and promote optimal breastfeeding practices.

Implementation:

●     Early and Frequent Breastfeeding Support: Trained staff will help encourage and support early and frequent breastfeeding sessions, aligning with the natural newborn feeding cues.

●     Minimizing Initiation Delays: Prioritizing immediate skin-to-skin contact and offering prompt lactation support after birth to avoid unnecessary delays in breastfeeding initiation.

●     Providing the Right Tools: Providing hospital-grade breast pumps that mimic the natural sucking patterns of a newborn. This clinically proven technology can help them achieve and maintain sufficient milk production even through lactation risk factors.


6. Maximize Milk Output Through Evidence-Based Practices

Goal: Incorporate a multi-faceted approach to maximize milk production for mothers who are managing lactation risk factors.

Implementation:

●     Double Pumping: Teach moms about the double pumping method, which can help increase milk volume.

●     Hand Expression: Teach moms about hand expression. While hand expression alone may not be sufficient for long-term supply, it can be a valuable technique, particularly when used with pumping, to remove milk and stimulate production.

●     Hospital-Grade Pump Technology: Provide clinically proven hospital-grade pumps with suction patterns to mimic a newborn's suck.

The MOM-I protocol offers a comprehensive approach for breastfeeding success for at-risk mothers and babies. Prenatal education empowers parents, while early intervention with skin-to-skin contact, hospital-grade pumps, and evidence-based techniques like double pumping optimize milk output. This multi-faceted program fosters a supportive environment for breastfeeding from day one, benefiting both mothers and babies.


A Client Story

One of our clients had many risk factors: Diabetes, hyperthyroidism, and first baby at almost 40. She wanted to breastfeed as it was likely her one and only, but nobody told her she’d need help.


She’s well-educated but of course, she was sad the system failed her in the beginning. One week postpartum she was lost. Here’s her story of battling with lactation risk factors and how Baby Experts have a successful breastfeeding experience:


“I wish I knew how difficult breastfeeding was. I wasn't prepared for it to be a challenge, nor my medical conditions to hinder breastfeeding. Everyone talks about pregnancy and how hard it is to ‘have a normal life’ once the baby comes, but NO ONE talks about breastfeeding - the good, the bad, the ugly. I wish I knew that no matter your situation, you need to latch as much as possible, and to pump asap, and every 1-2 hours the first few days. Information that would have helped mentally is that even if you only get a few drops the first few days - that's okay! That's normal! You'll also need the support of someone for the first month to help focus on breastfeeding and milk supply in order to set yourself up for the future.


In my opinion, had I been given this information on the first day I would have been in a better position. I am VERY grateful for you, your experience, and the knowledge you bring.


For new moms, a single sheet or brochure with the following information, I think, would be best as we are inundated with information and dealing with the possible trauma of delivery. None of the documents provided at the hospital helped with delayed lactogenesis.


1. Pump early, pump often: within the first hour or two, then every 2-3 hours using a medical grade machine set to initiate, regardless of any small amounts. This will help increase your supply over time.

2. Common risk factors that may affect initiation... therefore, it is even more important to pump early, pump often.

3. Don't worry if you only manage a few drops in the first few days: pump early, pump often to increase milk supply.

4. Flange should be 2-3mm larger than your nipple.


My experience at the hospital tells me that nurses, lactation consultants, and doctors need this information as well (not just NICU nurses). I was judged more for not being able to produce milk, rather than being given the support to help me produce milk. I was also inaccurately assessed for inverted nipples and nipple size by the lactation consultants. Doctors, nurses and consultants were judgmental of the fact that I could not breastfeed, rather than giving me the support to help me breastfeed/increase milk supply - they were focused on all the issues that I had in my way, and not helping me actually make my way to producing milk.


Thank you for sharing this information!”


Her situation is common in that she did get some LC help, but they neglected the important things and misdiagnosed her.


While this is a simple guide to help you learn about managing lactation risk factors, we encourage you to reach out to Baby Experts for a lactation consultation. We’re always happy to help.


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