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Excessive nursing can produce nipple wine and mastitis. The greatest cause of difficulty with nursing or milk supply is anxiety. This anxiety may be secondary to fears of inadequacy related to breast size, to concern about the ability to produce sufficient milk (usually for the first pregnancy or if such a problem arose in nursing a previous infant), or to cerebral palsy woman speaking or conscious negative feelings about nursing.

The stress and anxiety caused by these feelings are associated with increased catecholamine production, which augmentin 875 mg 125 mg the augmentin 875 mg 125 mg of the myoepithelial cells by ramp and causes vasoconstriction that diminishes the supply of both oxytocin and prolactin to the acinar cells of the breast.

The treatment for this difficulty is counseling, education, and support. Such groups as the La Leche League, Nursing Mothers, and Childbirth Education Association are extremely useful support groups for the young nursing mother or the mother having difficulty nursing. The support provided by such groups augmentin 875 mg 125 mg usually all that is necessary to promote successful breast-feeding. Similarly, the theophylline content of coffee cardura tea in moderation can stimulate prolactin production and increase milk secretion.

Augmentin 875 mg 125 mg frustrated, anxious mother and a hungry infant are a bad combination. Good prenatal education and support from a sensitive nurse-midwife or support group are highly recommended for the mother who is nursing for the first time.

In addition to anxiety, there are several other, less common causes of inadequate milk supply. Combination birth control pills have been implicated augmentin 875 mg 125 mg diminishing milk supply and may be detrimental to the infant, although the standard moderate- or low-dose combination pills in use today have not been shown to diminish milk supply in quality or quantity or to cause any untoward effects in the infant.

The high-dose estrogen pills formerly used did diminish milk secretion to some extent. The heavy smoker (one or more packs per day) has circulating nicotine levels sufficient to inhibit prolactin synthesis and release. Significant concentrations of nicotine are also found in the breast milk and are undesirable in the developing infant. Therefore, cigarette smoking is contraindicated for the nursing mother. Occasionally, a mother has an inadequate milk supply as a result of inadequate dietary intake of calories and nutrients.

Dietary restrictions may result in insufficient caloric intake to meet the 3000 calorie-per-day requirement for lactating women (Table 1). If there is concern about decreased milk supply, it is important augmentin 875 mg 125 mg consider the woman's dietary habits.

Recent studies indicate that a modest weight loss (less than 2 kg monthly) and exercise do not augmentin 875 mg 125 mg milk volume or composition.

This failure may occur as a result of hypothalamic-pituitary disease or postpartum pituitary necrosis. If this condition is suspected, a series of provocative tests are required to determine pituitary sufficiency. A corticotropin-releasing hormone (CRH) stimulation augmentin 875 mg 125 mg determines the responsiveness of the pituitary-adrenal axis. Similarly, a thyrotropin-releasing hormone (TRH) stimulation test determines whether the pituitary gland can produce and release thyroid-stimulating hormone and prolactin.

If the prolactin level in the blood at least doubles, the pituitary lactotrophs are intact. One of the most common conditions arising during lactation is nipple soreness. Nipples can become cracked or bruised and can bleed.

Prenatal preparation can reduce soreness. Grasping the areola, gently pulling outward, and rolling the nipple between the thumb and forefinger prepares the breast for suckling and reduces soreness. Once breast-feeding has begun, soreness can be decreased by using proper infant positioning, limiting nonnutritive suckling time, avoiding breast engorgement, and applying a commercially available breast-feeding ointment. Blocked ducts, manifesting as a tender lump in the breast, can occur with incomplete emptying of the breast.

Heat and massage, along with frequent nursing, may help promote duct drainage. Management includes regular feeding from both breasts and the use of a pump or manual expression before feeding.

If discomfort is significant, analgesics may be required. There is no need to stop nursing during treatment, and nursing should continue from both breasts.

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