Lactation and Breastfeeding Lecture

I. MILK FORMATION

A. Depends on prolactin, regular suckling (can extend for years), proper nutrition, rest

B. Before childbirth

Colostrum - high in proteins and antibodies, low in fat

C. After childbirth and expulsion of placenta

1. Estrogen and progesterone levels fall

2. Prolactin "unblocked" at breast
3. Milk production and secretion begins 2-3 days post partum
4. Initial engorgement of breast

D. Touch receptors on nipples

1. Feedback stimulus of suckling baby to hypothalamus

2. Increased production of PRF
3. Signal to pituitary to increase production of prolactin
4. Breast makes more milk due to higher prolactin levels

E. Cycle of supply and demand

1. Unilateral feeding possible (only stimulate one breast)

2. 5% of women do not make enough due to not enough ducts and lobes
3. Breast augmentation - can still nurse
4. Breast reduction - can cause insufficient production
5. No breastfeeding choice - take bromocriptine which blocks anterior pituitary

II. MILK EJECTION

A. Formation fills aveoli - not available to baby

B. Ejection depends on myoepithelial cells contracting around alveoli

C. Key hormone - oxytocin from posterior pituitary gland

1. Nipple touch receptors feedback on posterior pituitary - release oxytocin

2. Oxytocin causes myoepithelial cells to contract around alveoli
3. Contraction of alveoli moves milk into ducts and nipple
4. All occurs within 1-2 minutes of beginning of suckling
5. Also keyed by cerebral cortex (hearing baby cry, thinking of baby)
6. Stress interferes with cycle

III. EFFECT OF BREASTFEEDING ON FERTILITY

A. High levels of prolactin interferes with estrogen and progesterone levels

1. Estrogen production by follicles in inhibited by prolactin

2. Most women have amenorrhea for several months
3. Less likely to ovulate - rare in first 3 months if frequent
4. Not a reliable method of contraception (ovulation occurs before menstruation)

B. Libido sometimes different (breast as food vs sex)

C. High prolactin levels interfere with estrogen - decreased vaginal lubrication

IV. BENEFITS TO BREASTFEEDING

A. To Baby:

1. Superior product
2. Presence of antibodies
3. No infant intolerance to lactose (all infants have lactase, may go away later)
4. Helps protect against middle ear infections, decreases risk of asthma, food allergies (6
mo or more breastfeeding) and diabetes

B. To woman:

1. Increased uterine tone (due to oxytocin)

2. Return to pre-pregnancy weight sooner
3. Promotes bonding
4. Protects against breast cancer (10% if 6 months or more)
5. Convenient

V. PROBLEMS ASSOCIATED WITH LACTATION

A. Sore nipples (proper position)

B. Milk stasis = plugged ducts (heat and massage releases)

C. Mastitis = infection, 5-10%

1. Caused by bacteria (Staphylococcus or Streptococcus - normal skin flora)

2. Redness and tenderness in one section, fever, chill, aches, flu-like symptoms
3. Painful to nurse
4. Treat with antibiotics, hot compresses and massage
5. Prevention - good nipple care and proper positioning of baby

D. Breast abcess = walling off of infection, no drainage (infrequent)

Same causes as mastitis - but can include others (TB)

Treatment requires antibiotics and surgical drainage

E. Difficult to tell plugged ducts from lumps in high risk women (for cancer)
- mammogram not useful as breastmilk interferes with readability

F. Public acceptance