Chapter 7: Nutrition During Lactation: Conditions and Interventions

Nipple pain and trauma prevention rely primarily on correct maternal positioning and infant latch technique rather than other interventions. Plugged ducts, a mechanical complication of milk stasis, respond well to frequent milk removal through nursing or expression combined with gentle massage and heat application. Low milk supply represents the most frequent reason mothers discontinue breastfeeding and is managed by increasing feeding frequency to ensure adequate milk removal stimulation, with supply typically improving within days to weeks of increased emptying sessions. Galactogogues such as pharmaceutical agents or herbal supplements including fenugreek may be considered but require careful evaluation due to insufficient safety evidence and potential adverse effects. Most maternal medications are compatible with breastfeeding and cessation is rarely medically necessary; clinicians should consult evidence-based resources like LactMed to assess individual drug safety profiles and infant exposure risk. Neonatal hyperbilirubinemia management emphasizes frequent breastfeeding at eight to twelve times daily combined with early stooling to facilitate bilirubin elimination through the gastrointestinal tract; routine supplementation with water or dextrose is not recommended as it may interfere with breastfeeding establishment. Specialized populations require modified nutritional approaches including preterm infants who benefit from human milk fortification to meet elevated energy and micronutrient demands. Maternal HIV infection presents a significant contraindication to breastfeeding in resource-rich settings due to transmission risk, necessitating safe formula feeding practices. The chapter concludes with practical guidance on aseptic collection techniques, proper home storage protocols for expressed milk, and the role of human milk banks in providing processed donor milk for vulnerable neonatal populations unable to receive maternal milk.