Hello Doctor,I am a breastfeeding mother with a two months old baby. I am extremely frustrated because I hardly have any breast milk. I feel like am starving my baby because he always suckles and finds only a few drops. I am tempted to introduce him to formula milk but I’ve been told it isn’t good for a two months’ old baby but at the same time I can’t just sit and watch him go hungry. What should I do?                        Josiane, 25, Gacuriro resident--------------------------------------------------

Dear Josiane,Accept my heartfelt congratulations on the new arrival. You have not specified if you have other babies and have had this problem before.By the 6th month of pregnancy, milk glands start getting ready in the breasts and are fully set by delivery. Removal of the placenta starts lactation i.e. production of milk each day as the child suckles it leads to production of more milk. A baby’s cry and even thoughts of the baby are said to produce more milk.  Thus lactation is a complex interplay of physical, emotional and hormonal factors. Breast milk provides necessary nutrition and strength to fight infections in the newborn and also creates bonding between mother and child.Usually a first delivery is followed by lots of stress, both physical as well as mental. Lactation is also affected and reduced by stress. Under nutrition of the mother also affects breast milk production.  At times the breast tissue may not be sufficiently developed so as to carry on lactation smoothly.  Small residual pieces of placenta if not expelled will lead to decreased prolactin levels and reduced lactation.Alcohol and other abusive substances also affect breast milk production. Anabolic steroids, anti allergy and anti depressant drugs are also responsible for hampering milk production. Hormonal disorders like disorders of thyroid or pituitary gland, even diabetes can also impair lactation. Lactation is also impaired if there are ovarian disorders like ovarian cyst or polycystic ovarian syndrome.Try to relax completely physically as well as mentally. For this purpose in many communities, traditionally, women are kept away in isolation for a few weeks after delivery. Also review your diet. Try taking more legumes, fresh fruits, whole grains, cereals, fish, milk and milk products. Consuming porridge with milk also stimulates milk production.  Drinking lots of water, hot tea, coffee or milk before feeding a baby is beneficial in improving the production of breast milk.Do not take any drugs for allergy or depression unless absolutely necessary. You can try these measures for about 2 to 3 weeks and you shall surely get sufficient milk. If the problem persists, you can undergo tests to exclude any hormonal disorders. Meanwhile if these simple measures do not help you try taking anti vomiting drug metoclopramide for a short while as it would augment milk production, but take it only after consulting your doctor.Regarding the formula feeds for the baby, though not considered very healthy, it is needed for sustenance of the baby. An alternate is using a wet nurse (another woman who is lactating and can feed your baby). But I presume that in today’s busy urban life, it is very difficult to find a wet nurse.Dr. Rachna Pande