LACTATION
COMPOSITION OF THE COLOSTRUM:
- Deep yellow serous fluid, alkaline
- High specific gravity
Components:
- IgA
- Complements
- Macrophages
- Lymphocytes
- Lactoferrin
- Lactoperoxidase
| Protein | Fat | Carbohydrate | Water | |
| Colostrum | 8.6 | 2.3 | 3.2 | 86 |
| Breast milk | 1.2 | 3.2 | 7.5 | 87 |
REQUIREMENTS DURING PREGNANCY:
- Additional protein:25 gm
- Additional Calcium600 mg
- Folic acid:150 microgram/day
- Required more during lactation as compared to pregnancy : Energy, Vitamin A, thiamin, riboflavin, Vitamin C, niacin, and Vitamin B12.
- Same requirment in pregnancy and lactation : Fat, calcium, zinc, magnesium, and vitamin B6.
PHYSIOLOGY OF LACTATION:
Mammogenesis:
- Pregnancy is associated with remarkable growth of both ductal and lobuloalveolar systems.
Lactogenesis:
- Milk secretion actually starts on 3rd or 4th postpartum day
- Steroids — estrogen and progesterone circulating during pregnancy make the breast tissues unresponsive to prolactin
- Prolactin begins its milk secretory activity when estrogen and progesterone withdrawn following delivery
- Prolactin, insulin, growth hormone and glucocorticoids
- Prolactin is Highest during pregnancy and fall during lactation
Galactokinesis:
- Oxytocin is the major galactokinetic hormone
- FATORS:
- Suckling
- Contractile mechanism
- DURING SUCKLING, A CONDITIONED REFLEX IS SET:
Nipple and areola
↓
Thoracic sensory (4, 5 and 6) afferent neural arc
↓
Ascending tackle impulses
↓
Paraventricular and supraoptic nuclei of hypothalamus
↓
Synthesize and transport oxytocin
↓
Posterior pituitary
↓
Released (efferent arc via blood)
↓
Myoepithelial cells of alveoli & ducts contraction
↓
Milk ejection
↓
Forced down into ampulla of lactiferous ducts
MILK EJECTION REFLEX INHIBITORS:
- Pain
- Anxiety
- Breast engorgement or adverse psychic condition (depression).
Galactopoiesis:
- Prolactin:galactopoietic hormone.
- Frequency of suckling (>8/24 hours) is essential
MILK PRODUCTION:
- 500–800 mL of milk/ day using 700 Kcal/day
STIMULATION OF LACTATION:
- Put the baby to the breast at 2–3 hours interval from the 1st day
- Plenty of fluids to drink
- Avoid breast engorgement
- Early (½ – 1 hour) and exclusive breastfeeding in correct position
INADEQUATE MILK PRODUCTION:
- Endogenous suppression of prolactin:
- Ergot preparation
- Pyridoxin
- Diuretics or retained placental
- Infrequent suckling
Galactogogues:
- Sulpiride (dopamine antagonist)
- Domperidone
- Intranasal oxytocin
Lactation suppression:
Methods:
- Stop breastfeeding
- Avoid pumping or milk expression
- Wear breast support
- Ice packs to prevent engorgement
- Analgesics (aspirin) to relieve pain
- Tight compression bandage is applied for 2–3 days
Exam Important
- The hormone responsible for lactation is Prolactin
- Initiation of lactation is affected by Progesterone, Prolactin & HPL
- Strongest stimulus of lactation is by Suckling
- Galactokinesis means Ejection of milk
- Prolactin is Highest during pregnancy and fall during lactation
- Most common immunoglobulin secreted by mother in milk and colostrum is IgA
- Colostrum is rich in Proteins as compared to breast milk
- Daily additional requirement of protein in lactation is 25 gm
- Folic acid requirement during lactation is 150 microgram/day
- Calcium requirement above the normal during the first six month of lactation is 600mg/day
- Daily additional requirement of protein in lactation is 25 gm
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