Physiology of Breast milk Production

Lactationis used for the breast milk

production or formation in mothers after the birth of baby. Lactation starts following delivery or birth of baby, the preparation of effective lactation starts during pregnancy.

Four stages of lactation

Preparation of Breasts or Mammogenesis

Synthesis and secretion of milk from breast alveloi or Lactogenesis

Ejection of milk outside the breast or Galactokinesis

Maintenance of lactation or Galactopoiesis

mammogenesisPregnancy is associated with a remarkable

growth in the size of breast. The enhanced size of breast in pregnancy is due to the growth of ducts and lobuloalveolar (ducts and segments) systems in breast. An intact nerve supply is not essential for the growth of mammary glands during pregnancy.

Estrogen, Adrenal steroids and Growth hormone affect the ducts during this phase. Progesterone, Estrogen, Prolactin, Adrenal steroids and Growth hormone affect the lobuloalveolar segment of the breast in this phase of breast milk production

LactogenesisSome secretory activity is evident in the

form of Colostrum or early milk during pregnancy or just after child birth. This secretory activity is accelerated following birth of baby. This early form of milk is essential and very good for the health of the baby. Secretory activity refers to secretion of milk in the milk producing unit of breast or in alveoli.

Actual milk secretion starts actually on 3rd or 4th day after the birth of baby. Around this time breasts become engorged, tense, tender and feel warm

Despite the high prolactin level during pregnancy, milk secretion is kept in abeyance. Perhaps the steroids Estrogen and Progesterone that are circulating in the blood of pregnant lady make the breast tissue unresponsive to prolactin presence.

When the circulating Estrogen and Progesterone are withdrawn from the blood after the birth of baby, Prolactin begins its milk secretory activity in previously fully developed and prepared breasts.

This secretory activity is enhanced directly and indirectly by Growth hormone, Thyroxine, Glucocorticoids and Insulin. Nursing effort is not essential for secretion of milk

GalactokinesisDischarge of milk from the mammary glands

of breast depends upon the suction exerted by the baby during suckling. Contractile mechanism also helps by expressing the milk from alveoli into the ducts.

During suckling, a conditioned nervous reflex is set up. The impulses start from the nipples to Supraoptic nucleus in brain and thence along the hypothalamo-pituitary axis to posterior pituitary. It appears to be so complicated and essentially when the love of baby is there, all this is simply a loving privilege of Moms!

GalactopoeisisThe hormone Prolactin appears to be the

single most important factor for maintenance of lactation. Sucking is also essential for maintenance of lactation. Sucking is essential for the removal of milk from the glands in breast but also for the release of Prolactin.

Secretion of milk is a continuous process unless suppressed by congestion or emotional disturbances. Milk pressure reduces the rate of breast milk production. So periodic breast feeding is necessary to relieve the pressure that in turn maintains the secretion of milk inside the breast

Oxytocin is secreted from posterior pituitary which exerts several effects on the uterus and breast. In breasts, there is contraction of the myoepithelial cells of alveoli and ducts containing the milk. This is the "milk ejection" or "milk let down" reflex that forces the milk down into the lactiferous ducts. From lactiferous ducts milk is expressed either by the mother by hand or sucked out by the baby.

A sensation of rise in pressure in the breast is felt by the mother at the begining of suckling. It is called "draught". This effect can be produced artificially by the injection of Oxytocin hormone.

The milk ejection reflex is inhibited by several factors like pain in breasts or body, breast engorgement, psychological upsets. In addition this ejection reflex might be weak for several days following breast feeding and it results in breast engorgement.

Breast FeedingIs the feeding of an infant or young child

with breast milk directly from female human breasts (i.e., via lactation) rather than from a baby bottle or other container.

Human breast milk is the healthiest form of milk for human babies.[1] There are few exceptions, such as when the mother is taking certain drugs or is infected with Human T-lymphotropic virus, HIV, or has active untreated tuberculosis.

Breastfeeding promotes health, helps to prevent disease, and reduces health care and feeding costs. Artificial feeding is associated with more deaths from diarrhea in infants in both developing and developed countries. Experts agree that breastfeeding is beneficial, but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using artificial formulas.

Hormones or substances:

Hormones or substances:docosahexaenoic acid and arachidonic

acid,-- which are known to be linked to early brain development

Breast milk contains several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria) and immunoglobulin A protecting against microorganisms.

Engorgement Breast engorgement occurs in

the mammary glands by expanding veins and the pressure of new breast milk contained within them. It can be a cause of mastodynia

Interventions regarding the patient’s current data

The current literature does not allow assessment of the individual aspects of multicomponent interventions or comparative effectiveness assessments of single-component interventions. The promotion and support of breastfeeding may be accomplished through interventions over the course of pregnancy; around the time of delivery; and after birth, while breastfeeding is under way

Interventions may include multiple strategies, such as formal breastfeeding education for mothers and families, direct support of mothers during breastfeeding observations, and the training of health professional staff about breastfeeding and techniques for breastfeeding support. Evidence suggests that interventions that include both prenatal and postnatal components may be the most effective at increasing breastfeeding duration. Many successful programs include peer support, prenatal breastfeeding education, or both.

RationaleThere is convincing evidence that

breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for women.

Effectiveness of Interventions to Change Behavior

Adequate evidence indicates that interventions to promote and support breastfeeding increase the rates of initiation, duration, and exclusivity of breastfeeding.