Physiology of Breast Milk Production

Regardless of the mothers physical condition, method of delivery (Cesarean section or vaginal delivery) or breast size, milk will be produced. Increase levels of estrogen and progesterone during pregnancy suppresses lactation as increase in the level of these hormones inhibits

prolactin production. However, increase levels of these hormones early in pregnancy stimulate the growth of milk glands in preparation for lactation. This is the main reason why pregnant womens breasts tend to increase in size due to larger glands that result to more fluid accumulation and formation of some extra adipose tissue. Estrogen and progesterone levels drop after delivery that stimulates the production of prolactin. Prolactin is responsible for breast milk production. If the mother wants to suppress lactation, lactation suppressing agents should be given immediately after placental delivery to be effective. The milk ducts become distended when breast milk begins to form. The womans breasts become fuller, larger and firmer. For some this is accompanied by a throbbing pain or feeling of heat in the breasts. The feeling of tension in the breast that most likely occurs by the third or fourth postpartum day is

called engorgement. Relief is achieved when the neonate starts to effectively suck the breasts or for those who have no plans of breastfeeding using a breast pump would be provide immediate alleviation.

The infant has to effectively suck the milk for relief to occur. Effective sucking means the infant is actually receiving milk. A baby can suck the breast without actually swallowing milk but rather swallowing air. One criteria of knowing that effective sucking is done by the baby is when the mother hears a soft ka or ah sound during feeding. This indicates that the infant is swallowing the colostrum or milk. Let-down reflex is the one responsible for pushing the milk outside the breast. This reflex is stimulated by the release of oxytocin. Oxytocin on the other hand, is released when an infant sucks the breast or the mother uses a breast pump. The following sequential pattern occurs during breast milk production: 1. Levels of estrogen and progesterone drops after the delivery of the baby. 2. Decreasing amounts of these hormones stimulates the anterior pituitary glands (APG) to produce prolactin. 3. Prolactin stimulates the foremilk production in the glandular tissues of the breasts. 4. Foremilk is stored in the collecting tubules of the breasts, ready for infant feeding. 5. When the infant sucks the breast or a breast pump is used by a woman, the posterior pituitary gland (PPG) is stimulated to produce oxytocin.

6. Oxytocin causes contraction of the smooth muscles or the collecting tubules. (this is the reason why afterpains are felt by women who breast feed their babies) 7. 7. Contraction causes the ejection of the milk forward and outside the breasts Let-down or Milk Ejection Reflex. 8. Hindmilk is produced.

Advantage of Breast-feeding Little controversy exists about breast-feeding as the best nutrition for human infants, but the ultimate decision to breast-feed should depend on what would please the woman most and make her most comfortable. If she is comfortable and pleased, will enjoy being fed, and will thrive. Breast-feeding is contraindicated in only a few circumstances, such as the following: an infant with galactosemia (such infants cannot digest the lactose in milk) Herfes lesions on a mothers nipples. Maternal diet is nutrient restricted, preventing quality milk

production.

Maternal medications (e.g., lithium, methotrexate) are inappropriate for breast-feeding.

Maternal exposure to radioactive compounds (e.g., during thyroid testing)

Breast cancer A number of situations call for individual planning. Examples include

a mother or an infant too ill for breast-feeding; a mother who has undergone previous breast-reduction surgery, especially if the nipples were detached during surgery; and the mother and infant who are being treated for active tuberculosis or hepatitis or are positive for HIV. Advantage for a mother A woman gains several physiologic benefits from breast-feeding: Breast-feeding may serve a protective function in preventing breast cancer The release of oxytocin from the posterior pituitary gland aids in uterine involution. Successful breast-feeding can have an empowering effect, because it is a skill only a woman can master. Breast-feeding provides an excellent opportunity to enhance a symbolic bond between mother and child. Advantage for a baby

Breast-feeding has a major physiologic advantage to baby. Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, keeping them from being absorbed into gastrointestinal in the infant. Lactoferrin is an iron-binding

protein in breast milk that interferes with the growth of pathologic bacteria. The enzyme lysozyme in breast milk apparently actively destroys bacteria by lysing (dissolving) their cell membranes, possibly increasing the effectiveness of antibodies. Leukocytes in breast milk provides protection against common respiratory infection invaders. Macrophages, responsible for producing

interferon (a protein that protects against viruses), interfere with viruse growth. The bifidus factor is a specific growth-promoting factor for the

beneficial bacteria Lactobacillus bifidus. The presence of L. bifidus in breast milk interfers with the colonization of pathogenic bacteria in the

gastrointestinal tract, reducing the incidence of diarrhea. In addition to these anti-infective properties, the breast milk contains ideal electrolyte and mineral composition for human infant growth. It is high in lactose, an easily digested sugar that provides ready glucose for rapid brain growth. The protein in the breast milk is easily digested, and the ratio of cystein to methionine (two amino acids) in breast mlik favors rapid brain growth in early months. It contains nitrogen in compounds other than protein, so that an infant can receive cell-building materials from sources other than just protein.

Breast milk contains more linoleic acid, an essential fatty acid for skin integrity, and less sodium, potassium, calcium, and phosphorus than do many formulas. Breast milk also has better balance of trace elements, such as zinc. These levels of nutrients is enough to supply infants needs yet they spare the kidney from having to process a high renal solute load of unused nutrients.