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    When Breastfeeding Seems Impossible


    Women who have had breast implants and reconstructive surgeries -- which cause trauma to breasts -- may have difficulty breastfeeding, says Joan Downey, MD, MPH, who directs labor and delivery at Barnes-Jewish Hospital and is assistant professor of pediatrics at Washington University School of Medicine in St. Louis.

    "But there are very few cases where a woman cannot lactate. Very often, it's just a case of misconception or misinformation," Downey tells WebMD.

    Mothers who must take medications often worry about drug exposure to the fetus and newborn infant -- and therefore are reluctant to breastfeed, says Downey. "We review the fetal exposure literature as well as neonatal exposure literature about the specific drugs, whether they are antibiotics, heart medicines, over-the-counter cold and sinus medicines. There's very good reference material on this," she says. "In general, there are very few medications for mothers that are not advised during breastfeeding."

    In some cases, a mother may be advised to vary the medication schedule -- with her doctor's approval -- so that she is not pumping or breastfeeding at the medicine's peak time. "You can individualize the process to maximize her ability to breastfeed," Downey tells WebMD.

    Also, when babies are latching on well but they're still not gaining enough weight, it may be that the mother just isn't producing enough milk, says McCoy. Solutions to increase milk supply? Pumping between feedings -- or putting baby to breast much more often than mothers think the baby should need to nurse.

    One volume-building prescription medication -- Reglan -- has been used by mothers in Downey's neonatal intensive care unit to help them maintain volume when they are exhausted and under stress. "It's been very effective in 5- to 10-day treatment periods," she says.

    As far as dietary supplements sold through health food stores, "I just can't endorse them," says McCoy. "The American Academy of Pediatrics still has some skepticism about them."

    Supplementing with formula is certainly appropriate when things just aren't working, says McCoy. "There is nothing like breast milk, but we have to look out for the baby's overall nutrition and weight gain," she says. "I'm always amused by formula manufacturers who say that theirs is more like breast milk. You can change the proteins and fat to be more like breast milk, but you can't give formula the antibodies and white blood cells and other proteins that have protective factors that keep viruses from binding to the lining of the intestine."

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