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Physiology of Lactation New
Physiology of Lactation New
Lactation
Adapted from the course on Breastfeeding : Advocacy & Practice Malaysia 2008
Stages of Lactation
(Criteria devised by Peter Hartman )
Lactogenesis
Lactogenesis I
Lactogenesis II
starts at 3-4 days after delivery
- removal of placenta, progesterone &estrogen = stimulates milk synthesis Blood flows to breast increases
Transition milk comes in Copius production of mature milk starts
Lactogenesis II
removes
Involution
When other feeds / foods satisfy appetite baby suckle less, production decreases milk cells die Milk in the breast is reabsorbed. Last milk produced is more like colostrum with many protective bodies
Role of Hormones
(primes mammary glands)
Estrogen growth of ducts
Progesterone growth of alveoli Placental Lactogen - growth of milk producing cells in the alveoli Prolactin helps growth of ducts and alveoli /stimulates alveoli cells to produce milk
: Prolactin Reflex
Prolactin in blood
Baby suckling
Prolactin Levels
Prolactin blood levels: Menstruating woman: End of pregnancy: ng /ml 8 14 200 500
Baseline during lactation: - From delivery to 10 days: - 10 90 days: - 90 180 days: - 180 days 1 year:
200 60 100 50 30 40
Oxytocin reflex
Oxytocin in blood
Baby suckling
help reflex
hinder reflex
Worry
Stress Pain Doubt
Milk production
Milk production
Milk production starts: low and increases (up-regulation) in most women high and decreases (down-regulation) in some women until it adjusts to the needs of the baby.
Milk production at this time is not related to size of baby
Milk production
(Ingram 99, Allen 91,Neville 88)
By 4 6 weeks, production adjusts to babys needs Milk production is now related to size of baby
- regulated by babys demand - babys fat or calorie intake controls appetite and hence demand
If supplements are given appetite is satisfied demand is less
3 months
6 months
800
Suckle effectively
To suckle effectively a baby must be:
to breast size.
Feedback Inhibitor of Lactation (FIL) It is chemical inhibitor Is an autocrine or local regulator of breastmilk synthesis Is a protein made in the breast itself If not removed it collects in the alveoli and blocks milk secretion in the mammary cells
Factors that impair milk production 1. Inefficient milk removal due to: - Poor attachment - Insufficiently suckling - Addition of supplements - Infrequent feeds - Short feeds - No night feeds
(temporary)
6. Lack of prolactin
- Sheehans syndrome (after postpartum haemorrhage) - Primary deficiency - (very rare) - Smoking (nicotine may lead to lower prolactin levels) 7. Physical abnormality (breast agenesis) 8. Severe malnutrition
INVOLUTION
Breastmilk output continues at about the same level while baby breastfeeds exclusively and on demand When other foods are given, the babys appetite are satisfied and he may suckle less. Breastmilk production decreases, milk cells die Milk which remains in the breast is reabsorbed.
Involution
The last milk produced is more like colostrum, with many protective factors, which may continue to help protect baby against some infection.