LACTATION

INTRODUCTION After delivery ,lactation is established in the breasts and the mother can start breastfeeding the child. Some secretory activity is present during pregnancy and accelerated following delivery Unlike other mammals, in humans milk is secreted only by the end of the 2nd or 3rd day of puerperium ,till then what is secreted is the colostrum.

COLOSTRUM Deep yellow/serous fluid Alkaline in reaction Higher specific gravity/higher vit A/higher protein/ NaCl (minerals) Lower Carbo /fat /K+ Contains immunoglobulin- IgA,G,M

COLOSTRUM- contd Microscopically Fat globules Colostrum corpuscles (large polynuclear leucocytes) with lactalbumin /lactoglobulin Acinar epithelial cells Advantages Laxative action Antibodies provide immunity

Colostrum and breast milk – a comparison protein fat carbo Water Colostrum 8.6 2.3 3.2 86 Breast milk 1.2 7.5 87

HUMAN MILK Milk is a suspension of fat and proteins in carbo-mineral solution opaque/slightly yellow Slightly Alkaline Sweetish Characteristic odour Specific gravity-1025-1035 Fluid portion- transudate containing sugar ,protein,milk ,salt and water

Contd- Protein in milk is 1/3 casein and 2/3 lactalbumin Sugar is lactose Rich in minerals-calcium Phosphate /potassium carbonate/NaCl/Fe LOW All vitamins except vitamin K Compliment/macrophage/ lc / lactoferrin/ lysozymes/EGF / prolactin

Factors affecting milk secretion Diet Hormones Mental conditions Drugs Emotions Age/parity/state of health of mother

Contd- Most drugs the mother takes is secreted in the milk. Quantity= 600ml/day Calorie requirement=+600 cal When to start breast feeding? As soon after a normal delivery 1 hour after a cesarean section

Advantages of breast feeding Ideal food (good nutrients ,immunological factors ,antibacterial properties ,promote cellular growth ,cognitive function improved) Convenient Sterile Economical Emotional bonding Uterine involution fastened

PHYSIOLOGY OF LACTATION 4 stages Mammogenesis (preparation of the breast) Lactogenesis (synthesis and secretion from the breast alveoli) Galactokinesis (ejection of milk) Galactopoiesis (maintenance of lactation)

MAMMOGENESIS Growth of ducts and lobuloalveolar systems Under influence of the hormones estrogen and progesterone Other hormones- cortisol ,HPL ,insulin, Intact nerve supply is not essential for the growth of mammary glands during pregnancy

LACTOGENESIS Following delivery there is a fall in the level of estrogen and progesterone . During pregnancy these hormones keep the tissue unresponsive to the action of prolactin. Following delivery prolactin causes milk secretion in an already well developed mammary gland

Contd- Secretion is increased by GH/ thyroxine /insulin/ glucocorticoids Nursing effort is not essential for milk secretion.

GALACTOKINESIS Depends not only on the suckling mechanism of the baby but also by the contractile action which will express milk from the alveoli into the ducts. This contraction is brought about by the action of Oxytocin Milk let down reflex/milk ejection reflex Inhibited by psychic condtn /pain /breast engorgement

GALACTOPOIESIS Prolactin is the hormone for maintenance of lactation And suckling is essential for maintenance of milk secretion Periodic breast feeding relieves pressure in the ducts and promotes more secretion

Tips to improve lactation Care of the breast /nipples during pregnancy Post natally frequent breast feeding Avoid breast engorgement Plenty of fluids Good diet

SUPPRESSION OF LACTATION INDICATIONS Intrauterine death Neonatal death Mother do not want to breast feed Contraindications for breast feeding (HIV/ Hep B/ infant with galactosemia / untreated TB / breast cancer treatment / CMV / alcoholics-drugs)

Contd- Methods Drugs Bromocriptine(2.5mg BD for 2 weeks) Cabergoline Ethinyl estradiol(0.05mgTDS for 5 days) Mechanical Tight breast binder Do not express milk Cold compresses/analgesics

Special considerations Contraception during lactation POP Depot MPA LNG IUD Breast fever Up to 39 C Distended nodular breast Subsides in 16hours time