29/08/2018 A-MEDEX

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Question ID 1283

Title Identifying the most common cause of lowered milk production in a lactating woman

Last revision 2018-06-05 12:04:57

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A 24­year­old woman presents to a GP clinic with concerns about breastfeeding. She gave birth
to a healthy male child 20 days ago through an uneventful vaginal delivery. She is worried that
she is not producing milk to feed her baby and feels he is always hungry. Which one of the
following conditions could be the most likely cause of decreased mild production?

 A Poor positioning of the baby.

 B Exhaustion of the mother.

 C Short duration of feeding at each session.

 D Decreased frequency of breastfeeding.

 E Insufficient fluid intake by the mother.

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29/08/2018 A-MEDEX

Option D is correct

Although most women are capable of producing more milk than their infants require, more than half of
breastfeeding mothers perceive that their milk supply as inadequate. Results of an online survey of 12 World
Health Organization Western Pacific offices revealed that the second most commonly reported reason women
did not breastfeed was "not having enough milk" (17%).

For some mothers, this is a perceived rather than real issue. In such cases, providing information on what
constitutes ‘normal’ newborn feeding behavior may provide reassurance. For example, it is normal for infants to
have frequent but small amount feeds during a particular time of the day. A change to an infant’s feeding
pattern, such as increased frequency of feeds, or a feeling of softer breasts, may concern the mother; however,
these may be normal changes that are unrelated to decreased supply.

Of the causes that lead to genuine lowered milk production, decreased frequency of breastfeeding is the most
common one. In the human mammary gland, lactation is under autocrine control, in which the frequency and
degree of milk removal by expression regulate an inhibitory peptide present in the milk. This means that if the
milk is not removed, this inhibitory peptide accumulates and subsequently decreases the synthesis of milk. If
the milk is frequently removed, this inhibitory peptide does not accumulate, and milk synthesis increases.

Reference(s)
https://www.racgp.org.au/afp/2016/august/overcoming-challenges-faced-by-breastfee
ding-mothers/ (https://www.racgp.org.au/afp/2016/august/overcoming-challenges-fac
ed-by-breastfeeding-mothers/)
https://emedicine.medscape.com/article/979458-overview#a4 (https://emedicine.med
scape.com/article/979458-overview#a4)

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