Cyclical process of milk synthesis and secretion Activated by prolactin, oxytocin, TSH, and human placental lactogen (hPL) › Prolactin: milk production › Oxytocin: milk secretion Inhibited by progesterone and estrogen
Initiates milk production Elicited by suckling Produced by anterior pituitary gland Stimulates mammary glandular ductal growth and epithelial cell proliferation
Milk ejection or letdown Suckling activates touch receptors that stimulate dorsal root ganglia via intercostal nerves (4, 5, 6) to release oxytocin in a pulsatile fashion Secreted by posterior pituitary gland Causes contraction of myoepithelial cells that line the ducts of the breast
Moderate contraceptive effect › Dependent on suckling intensity and frequency › Equivalent to OCP (98%) only in amenorrheic women who exclusively breastfeed at regular intervals for first 6 months › With menstruation or after 6 months, chance of ovulation increases › Supplemental feeding increases chance of ovulation
Intrauterine contraception › Does not affect milk volume or composition Progestin-only contraceptives › Historically preferred method of hormonal contraception › Does not affect milk volume or composition Estrogen-progestin contraceptives › Traditionally thought to suppress milk production › Recent study shows no effect on breastfeeding duration or infant growth
Double-blind RCT examining the effect of progestin-only compared with combined hormonal contraceptive pills on rates of breastfeeding continuation Similar breastfeeding continuation rate at 8wks, contraceptive continuation, and infant growth parameters
Case-control study examining association between breastfeeding and postneonatal death, N=1204 Ever breastfed, OR 0.79 Longer breastfeeding associated with lower risk Decreased incidence of infectious cause (OR 0.76), injury (OR 0.59), and SIDS (0.84)
Postpartum bleeding Menstrual blood loss Risk of Breast CA Risk of Ovarian CA Risk of osteoporosis and hip fractures (post- menopausal) Type 2 DM Postpartum depression Postpartum weight loss
Annual healthcare costs in United States Cost for public health programs, i.e. WIC Parental employee absenteeism Environmental burden
Solutions: › Frequent breastfeeding every 1.5-2 hours during the first few days › Galactogogues (milk production enhancers): Herbal: fenugreek, fennel seeds, milk thistle, goat’s rue Medical: Reglan, Domperidone
Sore nipples: due to improper latching › Encourage mother to place areola/nipple in infant’s mouth Cracked nipples › Begin breastfeeding on less-affected side › Place a drop of milk on each nipple and allow to air-dry after breastfeeding › High-grade lanolin or nipple shields › Avoid coarse fabric, bras w/ seams
More common in engorged breasts Presents with flu-like symptoms Most common pathogens: S. aureus, streptococcus, E. coli Treatment: ibuprofen, dicloxacillin, cephalexin, clindamycin Continue to breastfeed while taking antibiotics Frequent emptying
Rare – incidence of 0.1% Requires incision and drainage, antibiotics Pump affected side Continue to breastfeed on unaffected side
Centers for Disease and Control, Breastfeeding Report Card – United States, 2010. http://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed March 13, 2011. Chen A, Roga, WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004; 113:5 e435-e439. Chung M, Raman G, Trikalinos T, Lau J, Ip S. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008 Oct 21;149(8):565-82. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007 Feb;109(2 Pt 1):479-80. Dewey KG, Heinig MJ, Nommsen LA. Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr. 1993 Aug;58(2):162-6. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, Eidelman AI; American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005 Feb;115(2):496-506. Kaunitz A. Postpartum and postabortion contraception. Up to Date, Inc. http://www.uptodate.com/contents/postpartum-and-postabortion- contraception?source=search_result&search=contraception+postpartum&selectedTitle=1%7E150#. Accessed Feb 8, 2012. Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H. Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey. Pediatrics. 2005 Sep;116(3):628-34. Speroff L, Fritz MA (2005). The Breast. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 625- 633. Philadelphia: Lippincott Williams and Wilkins. Wagner, C. Counseling the Breastfeeding Mother. Pediatrics: Cardiac Disease and Critical Care Medicine, Dec 14, 2010. Wagner, C. Human Milk and Lactation. Pediatrics: Cardiac Disease and Critical Care Medicine, Dec 14, 2010.
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