Training for perfect breastfeeding or metoclopramide: which one can promote lactation in nursing mothers?

BACKGROUND One of the most common complaints of nursing mothers in a few days after delivery is insufficient lactation. This is known to be partly due to the mothers' deficient knowledge of proper breastfeeding and often results in the beginning of bottlefeeding, which finally diminishes or ceases their breastfeeding. Considering the valuable effects of breastfeeding on nutritional, immunologic, and emotional aspects of infants' health, we planned this study to find out whether training of nursing mothers for breastfeeding can enhance their lactation; also, we tried to compare the effects of metoclopramide on lactation with those of training. METHODS Throughout 2006, we consecutively enrolled 20 primipara nursing mothers who were referred to Tabriz Children's Hospital, Tabriz, Iran for counseling about prescription of infant formula as a response to their complaint of insufficient lactation during a couple of months after parturition. Only those mothers were included in this study whose newborns had failed to gain appropriate weight, determined by their age and birth weight. First, all newborns were weighed, and all mothers passed a short training course about "perfect practice of breastfeeding"; then we randomly allocated them in two equal groups of 10 mothers-one group received a metoclopramide tablet (10 mg/dose every 8 hours), and the other just placebo, both for a period of 15 days. Thereafter we weighed the newborns again and compared the two recorded weights of each infant and the average weight of the two groups with each other to assess the sufficiency of breastfeeding and effects of training and galactogogue. RESULTS Eighteen of the 20 newborns studied (90%) showed an appropriate weight gain: 12 newborns gained 385-415 g (mean, 400 +/- 15 g), six neonates gained 270-315 g (mean, 292.5 +/- 22.5 g), but the remaining two newborns gained 150-235 g (mean, 192.5 +/- 42.5 g). Statistical analysis revealed that training of nursing mothers for perfect breastfeeding (with or without metoclopramide consumption) has a significant improving role in infants' weight gain (p < 0.001); however, there was no statistically meaningful difference between the two treatment groups (with and without administration of metoclopramide, p = 0.68). CONCLUSIONS Counseling nursing mothers for proper lactation before delivery and their continued training thereafter are the main clinical pathways toward a successful and sustained breastfeeding.