Dear Doctor,I am a first time mother with a three weeks old baby but I have no breast milk. I eat a lot of porridge and take other healthy drinks but I still don’t have breast milk. I don’t want to give my child baby formula at such a tender age. What should I do to get breast milk?Diana Intwali, Kimihurura-----------------------------------------Dear Diana,First of all, let me congratulate you on your baby. Indeed a baby is nature’s best gift to a couple. But unfortunately your joy is hampered by lactation failure. Lactation is the term used for the mammary glands to produce milk. Human milk has the exact amount of nutrients a baby needs and protects it from infections. It also protects the mother from cancer of the breast and uterus. Besides these benefits, it increases the bond between a mother and child. Milk producing glands start getting ready for production early in the pregnancy and by the 6th month, they are ready. After delivery, removal of the placenta triggers the production of prolactin, the hormone which triggers the production of milk. Then each day as the infant suckles, there is production of more milk, as this stimulates release of oxytocin from the mother’s pituitary gland which stimulates lactation.  A baby’s cry and even thoughts are stimuli which cause release of breast milk. Thus lactation is a result of interplay of hormonal, physical and mental factors. Total lack of milk is very rare.  Though it is difficult to ascertain exact cause, many theories have been proposed.  Sometimes the mental stress after delivery can lead to impaired hormonal production and impaired milk production. Under nutrition in the mother can also result in impaired milk production. Lack of sufficient breast tissue may impair lactation. Some small pieces of placenta may be retained after delivery which may not produce any other symptom but prevent milk production.  If the baby is born preterm, mother may fail to produce milk. Disorders of the thyroid or pituitary gland or diabetes also impair process of lactation.  Ovarian disorders like ovarian cyst or polycystic ovarian syndrome are also causes of failure of milk production.  Alcohol, anabolic steroids, anti allergy, antidepressants, e.t.c. drugs can impair lactation. You need to be completely relaxed mentally. Having a newborn in the family is joyous as well as stressful. You need to try to keep the stress away. Traditionally, porridge with milk, hot milk or beverages like tea/coffee, e.t.c taken just before feeding the infant are supposed to increase breast milk output. In every society there are traditional herbs which are used for augmenting   breast milk production. A short term use of metoclopramide (anti vomiting drug) can help boost milk production. If you have tried them without success, it is better to get yourself investigated for a potential hormonal disorder or retained piece of placenta or mammary hypoplasia. One or several of these may be present. Till you start producing milk, it is vital to give formula milk to your infant for sustaining her. Another option is to take help from a wet nurse, i.e. another woman who is lactating and offers to help you. Make sure of the health and hygienic status of the wet nurse if at all you hire her.Dr. Rachna Pande