The early failure of breast feeding a clinical study of its causes and their prevention

Abstract

The main principle put forward is that an easy start of breast feeding depends on milk pressure within the breasts not rising to an excessive height. If it does so rise, and if it is not speedily lowered, a rapid decllne in production follows by reason of alveolar distension and compression of the secreting cells. This is claimed to be the chief reason for the statement by so many women that their milk fails soon after they get up from childbed. The frequency of high milk pressure at the outset of the first lactation is attributed to certain anatomical defects of the nipples and the terminal ducts, a claim for which there is ample clinical evidence but which needs confirmation by other and more exact means. A controlled experiment is described in which half the women used were taught the daily removal of colostrum during the last three months of pregnancy, and their breast feeding compared with that of the other half who were not so taught, both groups receiving identical management during the lying-in period. Excessive milk pressure occurred in 25 percent. of the 'pupils' and in 56 per cent. of the controls, while at the end of six months 83 per cent. of the former were still successfully breast feeding as against 42 per cent. of the latter. For this result it is suggested that the preliminary removal of colostrum facilitated the initial outflow of milk by stretching and enlarging the terminal part of the duct system. A simple means to improve the nipple's range of protraction is also described. POSTSCRIPT. Since the experiment described here, the preparatory technique has as far as possible been taught to all primigravidae and those who have had experience of lactation difficulties. Replies to a questionnaire sent to 300 primiparae delivered consecutively in the early months of 1945 show that 79.3 per cent. were fully breast feeding at six months. In 5 per cent of this series stilboestrol was used as here described to control milk tension.