Breastfeeding weaning for medical reasons
Weaning refers to the process of transferring the baby's dependence on the mums milk production to other sources of nutrition. Very occasionally, sudden weaning may be required due to maternal illness, maternal medication or as a result of prolonged separation of the mother and baby. Unlike baby-led or mum-initiated weaning over several months, abrupt weaning can cause difficulties for both the mother and baby in terms of psychological adjustment. It can also cause considerable breast discomfort and place mothers at increased risk of mastitis. If possible, abrupt weaning should be avoided and gradual mum-led or baby-led weaning should be implemented instead.
Physiological changes during abrupt weaning
During weaning, the composition of milk changes dramatically, especially after abrupt weaning. Although the secretory capability of the breast reduces, the involuting mammary tissue remains partially functional for a long period (approximately 45 days). From days 1-45 the concentration of lactose and potassium decreases, while the concentration of sodium, fat and total protein increases. In addition, milk becomes increasingly salty because of the increase in protein content (lactoferrin, immunoglobulin A, IgG and IgM, albumin, lactalbumin and casein).
Hormonal changes as a result of sudden weaning may also be apparent, especially during the newborn period, where higher levels of prolactin are present.
General guidelines when weaning for medical reasons
- If weaning for medical reasons is suggested, access to support from a medical professional who is knowledgeable about lactation is recommended. The medical professional should be able to help determine whether other options are available (for example, whether an alternative maternal medication is available)
- Mothers should use manual or electric methods of milk expression to relieve breast fullness until they feel comfortable – however, this should not be done to the extent that milk production is stimulated
- Other methods may help, including wearing a supportive, comfortable bra and being alert for the signs of plugged ducts or breast infection.
- Adequate emotional and social support may be needed for some mothers during weaning, especially if they are prone to depression
- Other guidelines for physiological weaning may also help
Lawrence, R. A. and Lawrence, R. M. Breastfeeding: a guide for the medical profession (Elsevier Mosby, Maryland Heights, MO, 2011).
Li, R., Fein, S.B., Chen, J., Grummer-Strawn, L.M. Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year.
Hartmann, P.E., Kulski, J.K. Changes in the composition of the mammary secretion of women after abrupt termination of breast feeding. J Physiol. 1978 Feb;275:1-11
American Academy of Pediatrics and The American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians (2006).