There are very few clinical conditions that contraindicate breastfeeding, such as galactosemia. However, there are many situations when a woman may wish to discontinue breastfeeding and suppress lactation. Mothers may decide whether or not to breastfeed their newborn or to stop breastfeeding at a time when they feel it is necessary.

There are several methods for the suppression of lactation. As healthcare professionals, we must be aware of all of them and of their limitations, when informing and accompanying a mother-infant dyad.

Physiological inhibition

Physiological inhibition is a process that does not require medication. The woman is offered a series of measures to reduce breast milk supply after the establishment of breastfeeding, a process known as lactogenesis II.

Lactogenesis II is the physiological process in which the ability to secrete milk develops. With the exit of the placenta, the second stage begins. There is a withdrawal of the hormones present during pregnancy and a significant increase in the hormone prolactin, which plays a major role in milk supply.

The maximum peak of lactogenesis II happens 48-72 hours after birth, and it is a hormone-dependent process, which is why lactogenesis II will occur regardless of the mother’s preference for how she wants to feed her baby. Socially this is also known as the “milk coming in.”

In case the woman’s choice is a physiological inhibition of lactation, the following steps should be proposed to the woman, in order to improve her comfort:

• Avoid stimulation of the breasts
• Apply cold to the affected area in case of breast fullness, tension, and/or breast discomfort
• Take anti-inflammatory drugs, if necessary, prescribed by a physician.
• In case of discomfort or pain in the breasts due to an increased milk supply, expressing the right amount of milk is recommended until the patient notices an improvement in the uncomfortable sensations. Milk removal can be done manually or with a breast pump.
• In the case of breast engorgement, it is possible to proceed in the same way as in the case of a pregnant woman. You can find more information in this article.
• As far as possible, it should be proposed to space out the breastmilk removals.

Physical and outdated measures such as bandaging the breasts, avoiding the intake of liquids, and not recommending the removal of breastmilk should never be proposed to the woman.

Pharmacological inhibition

There is limited evidence to support treatment for this purpose, and there is no evidence to indicate that pharmacological suppression is more effective than physiological inhibition.

The most commonly used drug for lactation inhibition in this context is cabergoline, a drug belonging to the drug group that inhibits prolactin secretion. It is given orally immediately after the birth or hours later and has a high efficacy up to 72h after delivery. However given after that time frame, its action decreases. Its purpose is to prevent lactogenesis.

If a woman wishes to receive treatment for lactation suppression, she should be informed of its specifications, side effects, and possible complications:

• Serious adverse reactions such as hypertension, myocardial infarct or seizures have been reported.
• It should not be used in women with pregnancy-related hypertension, and regular blood pressure monitoring would be necessary in case of use.
• It is important to emphasize to the woman that this treatment is not 100% effective and that lactogenesis II can still occur. Therefore, is still necessary to explain to the patient how to perform physiological inhibition of lactation, in case this happens.

It is important to monitor the process of inhibition of milk supply in order to be able to inform and provide timely support to any mother who requires it.