1. LACTATION

2. 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.

3. 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

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

5. 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

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

7. 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

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

9. 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

10. 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

11. 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)

12. 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

13. 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

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

15. 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

16. 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

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

18. 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)

19. 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

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