Lactation

Lactation

The process by which milk is synthesized and secreted from the mammary glands of the postpartum female breast in response to an infant sucking at the nipple.

Provides ideal nutrition and passive immunity for the infant
Encourages involution
Induces a substantial metabolic increase

Breastmilk provides:

Prolactin

Instrumental in the establishment and maintenance of breast milk supply

5th week

At what week, the prolactin levels increase by 10–20x pre-pregnancy concentration

10–20x

5th week: levels increase by ____ pre-pregnancy concentration

Late pregnancy

At what week, the prolactin levels plateau, initiating milk production

After childbirth

At what week, the prolactin levels drops sharply but spikes during each feeding

Estrogen

Progesterone

Other placental hormones

What are the inhibitors in prolactin production

GG

Explain the diagram on how brain produces oxytocin.

4

3.8

8.8

Energy Yield (per gram) of Breastmilk:

• Protein:

• Carbohydrates:

• FaT

753 kcal

What is the kcal of mature milk?

500

An intake of ______ g/day in 2nd year of infant’s life = 30% energy, 45% Vit A, 95% Vit C needs

30% energy

45% Vit A

95% Vit C needs

An intake of 500g/day in 2nd year of infant’s life convers?

Lactose, fat, proteins, minerals, vitamins

Components of breastmilk?

Iron

What constituent of breastmilk prevents microbial growth, protects against GI infections and IDA

Enzymes

Growth factor

Hormones

What constituent of breastmilk helps in development of gut and nervous system

3 months

Cell number are highest in colostrum and gradually decline during the first __ months to a steady level

Immune cells

Colostrum are known for immunity because they are rich in what type of cell?

Colostrum

Thick, yellowish substances

High in protein, low in fat/glucose, immunoglobulin-rich

What is the comparison of colostrum in comparison with mature milk?

48 to 72 hours

Colostrum is secreted during the first ______ of postpartum

3 oz

How many oz of colostrum is released on the first 24 hours?

protein

immunoglobulins

fat

lactose

Human colostrum is rich in ___ and ____ for newborn immunity.
Mature breast milk has more ____ and ____ for energy and growth.

Transitional milk

After 3 days, what milk is produced?

3 days

Transitional milk is released after

10 days

When will mature milk manifest?

Foremilk

Hindmilk

2 stages of mature milk?

Foremilk

Type of milk that is watery, lactose/protein-rich, quenches thirst

Hindmilk

Type of milk that is creamy, fat-rich, satisfies appetite

Leakage

Soreness

Enlargement

During the first few weeks of breastfeeding, the mother may feel:

1.5

After the mother go thru the first few weeks of breastfeeding, it will stabilize and produce _____ liters per day of milk for a single infant

1

Lactation can occur for years, but it will reabsorb if the breastfeeding stops for ___ week

Bilirubin

It is from the breakdown of erythrocytes that its processed in the liver and secreted in bile

GI tract

Stool

Where does bilirubin enters and exits?

Bilirubin

High concentration of ______ in blood can cause jaundice

Jaundice

High concentration of bilirubin in blood can cause?

Hyperbilirubinemia

Most common condition requiring medical attention in newborns

Higher risk of diabetes, celiac, Crohn’s, asthma, atopic disease

Non-breastfed infants may cause:

2.5

25

3

Half

• Exclusive breastfeed child have at least __ times fewer illness episodes

• Infants are as much as ___ times less likely to die from diarrhea in first 6 months

• Under 1 year, __ less likely to die of respiratory infections

• Exclusively breastfeed for 4 or more times have ____ the mean of acute otitis media episodes

Facilitates uterine contraction, reduces hemorrhage

Natural contraceptive for 6 months
Saving of iron stores
Reduces breast/ovarian cancer, weight, and osteoporosis
Supports bonding and self-esteem

Advantages of breastfeeding to mother

Lactation amenorrhea

What is combined with breastfeeding for natural contraceptives?

Mammogenesis

Lactogenesis

Galactopoesis

Involution

What are the stages of lactation?

Mammogenesis

A stage in lactation where, breast are formed (birth, puberty, and through pregnancy).

Lactogenesis

A stage in lactation where, mother start to adequately produce milk

Stage 1

What stage of lactogenesis is when mid-pregnancy to 2 days postpartum

Stage 2

What stage of lactogenesis is when day 3 to Day 8 postpartum

Mid pregnancy to day 2 postpartum

Day 3 postpartum to day 8

What days stage 1 and stage 2 of lactogenesis

Galactopoesis

A stage in lactation where sustaining of milk happens (day 9)

Involution

A stage in lactation where the breast stop to produce milk after weaning

Autocrine system

What system control the galactopoesis

500

23

18

750-1000

Increase

RENI: +____kcal/day
Protein:

• +___g/day (first 6 months)

• +____g/day (second 6 months)

Fluid: +______ ml/day

Vitamins/minerals from food _____

4–6

Lactiferous ducts, alveoli, and colostrum

Prolactin

Suckling

Oxytocin

Summary of Lactation Process

• The lactating mother supplies all the hydration and nutrients that a growing infant needs for the first_____ months of life.

• During pregnancy, the body prepares for lactation through the development of _______, ______, and _______, stimulated by hormones like ______.

• After birth, infant ______ triggers ______, causing milk ejection from alveoli to nipple pores.

Congestion/increased vascularization 

Accumulation of milk

Edema 

Three basic components of breast engorgement

Late initiation of breastfeeding

Infrequent breastfeeding

Restriction on duration/frequency of breastfeeding

Use of complementary foods

Babies with poor suck

Causes of Breast engorgement

3rd to 5th

Causes of breast engorgement may occur in ___ to ____ day after delivery

Swollen, painful, shiny breasts; flat nipples

Signs of breast engorgement

Physiological engorgement

Pathological engorgement

2 types of breast engorgement

Early, frequent feeding; proper technique, avoid supplements

How to prevent breast engorgement

Manual expression

Regular breastfeeding

Massage

Anti inflammatory drugs

Well fitting bra

Warm compress and Cold compress

What is the treatment for breast engorgement

Poor latching

Sucking issues

Nipple shape

Misuse of nipple pump and cover

What are the cause of nipple trauma

Erythema, blisters, white or yellow spot, edema, fissures, ecchymosis

Signs of nipple trauma

Proper technique

Air dry nipples

Avoid harsh products

Breastfeed on demands

Manually express milk

Slip finger into infants mouth

Avoid nipple shields

How to prevent nipple trauma?

Start with less affective area, change position, use breast shells, oral systemic analgesics, dry and wound healing

Treatment for nipple trauma

S. aureus

Nipple infection is caused by?

Topical mupirocin at 2% or systemic antibiotics (e.g., dicloxacillin)

Treatment for nipple infection

Burning, shiny red nipples; infant with white oral patches

Signs for candidiasis

Keep nipples dry, boil pacifiers

Prevention for candidiasis

Topical antifungals; systemic fluconazole if needed; treat both mom and baby

Treatment for candidiasis

Cause: Nipple vasospasm from cold or trauma

Signs: Pale, painful nipples (burning/twinging)

Treatment: Warm compresses, medications (nifedipine, B6, calcium)

Raynaud’s Phenomenon:

• Cause

• Sign

• Treatment

Cause: Incomplete emptying, tight bras

Signs: Painful lumps, no infection signs

Treatment: Regular feeding, warm compress, massage, express milk

Plugged ducts :

• Cause

• Sign

• Treatment

Cause: Milk stasis → inflammation/infection

Signs: Red, swollen, hot breast; fever, chills

Treatment: Continue breastfeeding, antibiotics, empty breast fully

Mastitis:

• Cause

• Sign

• Treatment

Cause: Untreated mastitis

Treatment: Surgical drainage, continue breastfeeding/pumping

Prevention: Early mastitis treatment

Breast abscess:

• Cause

• Prevention

• Treatment

• Cause: Milk-filled cyst from plugged duct

• Treatment: Aspiration or surgical removal

Galactocele:

• Cause

• Treatment

• Often due to: Perceived low supply, not actual

• Signs: Unsatisfied baby, poor weight gain, few wet diapers

• Solutions:

  • Improve latch, increase feeding, empty both breasts

  • Avoid pacifiers/bottles

  • Stay nourished and rested

  • Meds: Domperidone, metoclopramide if needed

Insufficient Milk Supply

• Often due to:

• Signs:

• Solutions:

  • Meds:

Lactiferous ducts

It transport the milk in mammary glands

Breast alveoli

It is the milk structure of the mammary glands

Lactocytes

It secrete the milk

Myoepithelial cells

It contracts to move the milk

Montgomery glands

It secrete oil for nipple protection

Mammary glands

Modified sweat glands

1

Prolactin spikes every __ hour of feeding

Myoepithelial contraction

What does oxytocin stimulates

Laxative properties of breastmilk

It help expel meconium and clear bilirubin

Bilirubin

Meconium

What does laxative properties of breastmilk expel?