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3 Common Causes of Breastmilk Shutdown

Estimated reading time: 8 minutes

Hi. It’s Nice to “see” you. Today I’m going to talk about the three most common causes of breastmilk shutdown: sore, cracked nipples; medication use; and insufficient milk supply and how each one is treatable so you can continue to breastfeed. I’ll also throw in a few questions and answers that relate to each of the causes.

Let’s get started.

Cause #1: Raw, Sore, Cracked, Painful Nipples
Studies indicate that up to 30 percent of breastfeeding moms will discontinue breastfeeding because of nipple soreness, pain and cracking.

If you read my last blog, you may remember that I spoke of how 10 years ago I set out to develop a product that would help relieve pain and soreness while also helping to heal cracked nipples, so moms and babies could continue breastfeeding and bonding. What I came up with is a formula that is:

Free of parabens, phthalates and fats
Plant and water based
Safe for mom and baby
World Health Organization (WHO) Code Compliant
Pharmacist formulated
Manufactured by FDA-certified facility
Dual-relief gel that soothes and heals
Contains cooling, soothing natural peppermint
Uses no harmful chemical processes
Cruelty free
You can get more information at: Dr. Nice’s Moisturizing Gel.

Questions & Answers
I thought I’d include two questions that relate to Dr. Nice’s Moisturizing Gel, in the event you had similar concerns. Please feel free to send me an email at drnice@drniceproducts.com if you have a question that’s not answered below or on my website.

Is Your Gel Safe for Use on Severely Cracked, Open Skin?
Question: “It was nice to meet you at the Academy of Breastfeeding Medicine conference. I am the person who interrupted your breakfast the day you left and asked for your help as our previous medication resource (University of Rochester Lactation Center) is no longer in operation. You also provided me with three samples of Dr. Nice’s Moisturizing Gel. Thus far, I have used two of the tubes on patients with sore/cracked nipples. Is it appropriate to use on openly cracked nipples or is used just for sore (intact) nipples?”

My Answer: “I was just thinking about you and was wondering if I was going to hear back from you. To answer your question, yes, Dr. Nice’s Moisturizing Gel is perfect and appropriate for raw, sore, openly cracked, painful, non-intact nipples. It may initially sting somewhat, but, then, the relief is almost immediate. It can also be prophylactic for intact nipples.”

Can Dr. Nice’s Moisturizing Gel be Used on Other Areas of the Body?
Question: “I have a lactation client that is always complaining about her cracked fingertips in the winter. Can I tell her to use your Moisturizing Gel? Where do I buy it?”

My Answer: “I have the same problem with cracked fingers in the winter! My moisturizing gel works great to heal those cracks. Just remember, apply it in a thin layer. If it dries with a white appearance, that’s a sign you used too much. Just wash it off and reapply a smaller amount in a very thin layer. You can now buy Dr. Nice’s Moisturizing Gel at my online store.”

Cause #2: Medication Use
To provide any answer to medication use during breastfeeding, your healthcare professional, including your pharmacist, must do a complete benefit-risk analysis. This benefit-risk analysis does not concern only the medication or drug itself, it also involves the entire breastfeeding experience.

Benefit-Risk Analysis
Benefits of the medication plus the benefits of breastfeeding versus the risks of using artificial formula (not breastfeeding) plus the risks of the drug.

Risks of the drug are important, but make up only one-quarter of the analysis. Most healthcare physicians, dentists, nurses, and pharmacists consider only the risks of the drug. If your healthcare professional practices like that, you need to get a second professional opinion. I am always available for that purpose, if necessary.

Lactation Consultants are the most knowledgeable healthcare professionals on the use of medications during breastfeeding.

My article “Breastfeeding and Medications: Current Concepts”, provides extensive information on how to determine the safety of medications and drugs that might be used while breastfeeding. It provides information to evaluate drug use; tips, techniques, and algorithms for ensuring safe use of medications or drugs during breastfeeding; and multiple resources to do so.

Questions & Answers
Here are some typical questions I have consulted. These are representative of the information that must be analyzed and provided to allow the breastfeeding mom to make an intelligent decision on whether to breastfeed or not while taking her medication.

Pump and Dump?
Question: “Hi Dr. Nice! It is I again. I have a mom who takes Zoloft, unisom and fioricet . She takes the unisom and fioricet as needed. I said that the combination of all 3 might be too sedating for the newborn. Then the Dad asked if she would need to take all 3 – then what? Should she pump and dump? And for how long? Your advice on this would be much appreciated!”

My Answer: “This is doable and has been done. I have some caveats that I would like for you to present to the mom and dad. If she needs to take all three at once, she and the dad should be able to monitor the baby for any potential sedation and respiratory depression and know what to do. It probably will not occur, but it is possible. That being said, the Zoloft is fine. That plus Fioricet as needed, increases the possibility for sedation, but it should not occur but still be monitored.

As for the Unisom, please emphasize to the mom and dad that neither of them will be getting a whole lot of sleep with the baby breastfeeding around the clock and that the mom needs to be alert at all times, even in her sleep. She should have no need for the Unisom at this time, even as needed. If she really feels she needs something for sleep, I would recommend 3 to 5 mg of melatonin instead and/or warm milk at bedtime (whenever that is with a newborn!).

In any case, do NOT pump and dump. Keep breastfeeding the baby on demand. Continue to breastfeed as often as needed and sacrifice the sleep instead of breastfeeding. The mom and baby will benefit now and for a long time to come. As the father of breastfeeding children, I know of which I speak. Please do all you can to help the mom and dad understand this, as these times will soon pass.”

Cause #3: Insufficient Milk Supply
Insufficient milk supply questions concern the use of herbal galactogogues and the drug, domperidone. I have provided complete information on the use of herbal galactogogues in two articles: Selection and Use of Galactogogues and Common Herbs and Foods Used as Galactogogues.

In addition, available for purchase in paperback or Kindle is the recipe book my wife, Myung, and I wrote together:

The Galactagogue Recipe Book

The Galactagogue Recipe Book by Frank J. Nice, RPh, DPA, CPHP & Myung H. Nice
Finally, if you’d like to read up on the use of domperidone, I’ve put together two handouts: One in English and one in Spanish.

Questions and Answers
Does Domperidone Cause Cardiac Issues with NICU Patients?
Question: “I have been struggling with some patients whose babies are also admitted in NICU with congenital cardiac issues. Our neonats are conservative in having the mom to be put on Domperidone due to cardiac issues. I understand their position as most of our tiny babies are very fragile. Do you think the cardiac effects, if there would be, would affect the babies? I have so much success with patients on Domperidone whose babies were term and healthy but this is the dilemma I’m facing working in NICU.”

My Answer: “There is simply such an insignificant amount of domperidone that gets into breast milk that it is not an issue with breastfed babies, with even less insignificant amounts getting into feedings with the small colostrum volume intake. 32 premature infants who received dose of 0.75 mg/kg/day orally had mean plasma peak and trough concentrations of 25.3 ng/mL and 15.4 ng/mL. Prematurity had no influence on domperidone elimination. This suggests that plasma levels will be lower in pediatric patients compared to adults.“

In Short…
I hope I’ve helped shed some light into the the three preventable, treatable causes of breastmilk shutdown. As always, please feel free to contact me at drnice@drniceproducts.com with questions or concerns.

I am available almost anytime and happy to provide free consultations on medications and breastfeeding and all related topics, unless I am on a medical mission in Haiti (check out the non-profit I support with all of my personal proceeds from the sales of Dr. Nice’s Moisturizing Gel). If I don’t know the answer, I will find the breastfeeding expert needed to help you.

Until next time, thanks for reading and remember: Never give up!

Dr. Frank J. Nice
Frank J. Nice, RPh, DPA, CPHP


DISCLAIMER: The information contained in this blog is advisory only and is not intended to replace sound clinical judgement or individualized patient care. The author disclaims all warranties, whether expressed or implied, including any warranty as the quality, accuracy, safety, or suitability of this information for any particular purpose.