Lactation suppression

Lactation suppression refers to the act of suppressing lactation in postpartum women by chemical or other means.

After birth, some women may desire to stop the production of breast milk, for example when the mother decides to bottle feed from birth, or in the case when the infant dies or is surrendered at birth. There is very little information available on the subject of lactation suppression for women who are not breastfeeding their babies. Spitz et al.^[1] in a 100-year review of all available information concluded that there was nothing new or helpful to assist with the mammary involution or milk suppression process or to treat the pain or discomfort of severely engorged breasts. The abrupt weaning process may lead to severe engorgement, extremely painful breasts, and possibly to other severe medical conditions. Up to one third of women who do not breast-feed and who use a brassiere or binder, ice packs, or analgesics may experience severe breast pain. Specific studies of nonpharmacologic methods of lactation suppression were limited and inconclusive. Available data suggest that many women using currently recommended strategies for treatment of symptoms may nevertheless experience engorgement or pain for most of the first postpartum week.

In the past, hormonal therapies, such as diethylstilbestrol and bromocriptine were used, but these are no longer recommended due to side effects (e.g. DES is a known carcinogen). In some countries, cabergoline (dostinex) is used for this purpose. Estrogen containing birth control pills may have the same side effect. There is no currently recommended medications to suppress lactation. There are no FDA approved medications for this purpose. Drugs that have been used in the past have shown severe potential side effects such as thromboembolism, cerebral accident, and myocardial infarction have been reported with their use and are not recommended for lactation suppression.

Other methods that have been used to assist with lactation suppression

By simply not stimulating the breasts after birth, after a few days the production of milk will cease. Women may experience pain and discomfort from engorgement. These discomforts can be treated with analgesics, cooling packs and chilled cabbage leaves. However, as much as one third of all women will experience severe pain in this process.

By binding the breasts by use of tight-fitting bras or ace bandages. Swift et al. concluded that breast binding should be discontinued as a method of lactation suppression and use of support bras encouraged.^[2] This breast binding approach should be discouraged as this may cause blocked milk ducts and mastitis.

By using cabbage leaves. The Cochrane review of two studies on this subject concluded that there was no statistically significant evidence that interventions were associated with a more rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment.^[3]

References

1. Spitz, AM; Lee, NC; Peterson, HB (December 1998). "Treatment for lactation suppression: little progress in one hundred years". American Journal of Obstetrics and Gynecology 179 (6 Pt 1): 1485–90. doi:10.1016/s0002-9378(98)70013-4. PMID 9855585.
2. Swift, Kathy; Janke, Jill (May 2003). "Breast Binding . . . Is It All That It's Wrapped Up To Be?". Journal of Obstetric, Gynecologic, and Neonatal Nursing 32 (3): 332–339. doi:10.1177/0884217503253531. ISSN 0884-2175.
3. Mangesi, Lindeka; Dowswell, Therese (2010). Mangesi, Lindeka, ed. "Treatments for breast engorgement during lactation". Cochrane Database of Systematic Reviews (9): CD006946. doi:10.1002/14651858.CD006946.pub2. PMID 20824853.

Moore DB, Catlin A. Pediatr Nurs. 2003 Sep-Oct;29(5):383-4. Lactation suppression: forgotten aspect of care for the mother of a dying child.