Weaning

Firstly, we will deal with how to wean where a baby has died during the pregnancy, at birth or soon after, before being breastfed. You may also use some of these suggestions if you have been breastfeeding your baby for some time. Or you may prefer to suppress your milk supply more gradually.

Suppressing the milk supply at the start of lactation

If your breasts are firmly supported and you don’t express milk more than needed for comfort, your milk supply will gradually decrease.

Firm Bra Support• Wearing a firm bra both day and night supports your breasts and keeps you more comfortable. You may need a larger size for a while.
• Use breast pads to soak up leaking milk. These can be either the disposable or reusable type. Change them as they become wet.
• Sometimes a bra feels too tight as your breasts fill up. You may prefer to use a length of soft fabric, such as towelling or stretch cotton. Wrap this around your chest just tightly enough for firm support. Your breasts should be lifted up and in. The wrap should be supportive but not be uncomfortably tight. In the past, some mothers used a ‘breast binder’, a very tight wrapping around the chest, designed to put pressure on the breasts. This was very uncomfortable but people believed it helped stop milk production. Breast binders are no longer used as it is now known that extra pressure does not suppress lactation.
• Relieve pain and swelling by putting cold/gel packs in your bra or inside a wrap, or use cold compresses after a shower or bath.
• Cold cabbage leaves worn inside the bra can also be soothing. Wash and dry the leaves before use and cut out any large, bumpy veins.

Keep them in the fridge as they need to be cold. Change the leaves every 2 hours or when they become limp. Continue using the leaves until the breasts stop feeling overfull.

• Handle your breasts very gently as they can bruise easily.
◦ Whenever your breasts feel too full, express a little milk. Remember that the more you express, the more milk you will make. So express only enough to make you comfortable. Warmth and being relaxed will help your milk to let down.
◦ If your breasts are sore and full, have a warm shower or bath. This may be enough to allow some milk to leak out. Start with lukewarm water and slowly increase the temperature. Take care as it is easy to burn yourself, especially when the skin is stretched tight. Use a plastic chair or stool in the shower if you cannot stand for long.
◦ If you don’t wish to undress fully, or can’t use a shower or bath, place your breasts into a large wide-mouthed bowl of very warm water (or two bowls). Take care that the water is not too hot. Sit the bowl/s on a table, bench or bed tray, at breast height. Lean forward, so both breasts are fully into the water. You might also be able to do this in the bathroom basin or kitchen sink.
• Mild painkiller medications may help relieve pain. Your doctor will be able to advise you about this.
• Drink when you are thirsty. Cutting down fluids will not help reduce your milk supply.
• For the first few days you may be uncomfortable lying in bed because your breasts are so full. Try lying on your back or on one side with an extra pillow supporting your breasts. If you like to lie on your front, place a pillow under your hips and stomach to ease the pressure on your breasts. Place a soft towel or cloth nappy across your breasts to soak up any leaking milk.
• There are some prescribed drugs that have been used to suppress lactation.
Most of them act by reducing prolactin, the hormone involved in making milk. For this reason they only work in the early stages of lactation when prolactin levels are high. They are much less effective if used after weeks or months of breastfeeding. Bromocriptine (or Parlodel) was often used in the past, but has been withdrawn from routine use because it was found to have a number of side effects, some quite serious. In many cases, lactation starts again when the mother stops taking this medication.

Cabergoline (or Dostinex) is sometimes used now. It also has side effects but is considered better than bromocriptine. It is possible to suppress lactation without medication. Talk over the pros and cons of using lactation suppression drugs with your doctor before making a decision about whether they are necessary in your case.

Most mothers will be able to wean by limiting the volume of milk removed, wearing a firm bra, using cold packs or cabbage leaves and medication for pain and inflammation if required.