Human Lactation Physiology and Management
Mammary Gland Development and Function
An overview of mammary gland development from embryonic stages through puberty, pregnancy, and lactation. Focus on alveolar development, hormonal influences (prolactin, oxytocin, estrogen, progesterone), and the anatomy of the lactating breast.
Lactogenesis: Milk Production Initiation
Detailed explanation of Lactogenesis I (during pregnancy: mammary cells differentiate) and Lactogenesis II (after delivery: copious milk secretion begins). Discussion of hormonal shifts following placental delivery and their impact on milk production.
Galactopoiesis: Milk Production Maintenance
Description of the processes required to maintain milk production beyond the initial surge. Emphasizes the role of frequent and effective milk removal in maintaining prolactin levels and sustained milk synthesis.
The Milk Ejection Reflex (Let-Down)
Explanation of the neuroendocrine reflex involving nipple stimulation, oxytocin release, and contraction of myoepithelial cells surrounding the alveoli, resulting in milk ejection. Discussion of factors that can inhibit or facilitate the let-down reflex.
Composition of Human Milk
An overview of the nutritional components of human milk (proteins, fats, carbohydrates, vitamins, minerals, immune factors). Description of colostrum and its unique properties.
Assessment of Milk Transfer
Objective indicators of adequate milk intake in the infant, including weight gain, stooling patterns, and urine output. Differentiation between perceived and actual supply issues.
Strategies to Support Lactation
- Frequent and Effective Milk Removal: Importance of breastfeeding on demand and complete emptying of the breasts.
- Proper Latch and Positioning: Guidance on achieving a comfortable and effective latch to optimize milk transfer.
- Addressing Breastfeeding Challenges: Management of common difficulties such as nipple pain, engorgement, and mastitis.
- Nutritional Considerations for the Lactating Parent: Recommendations for a balanced diet and adequate hydration.
- Medications and Lactation: Considerations regarding the safety of medications during lactation.
- Galactagogues: Discussion of herbal and pharmaceutical galactagogues and their evidence base. Emphasize the importance of addressing underlying causes before using galactagogues.
- Professional Support: The role of lactation consultants, healthcare providers, and support groups in providing assistance and guidance.
Factors Affecting Milk Supply
Discussion of factors that can negatively impact milk production, including maternal health conditions (e.g., thyroid issues, postpartum hemorrhage), hormonal imbalances, certain medications, insufficient glandular tissue, retained placental fragments, infrequent or ineffective milk removal, and stress.
Supplemental Nursing Systems
Description of supplemental nursing systems and their use in situations where supplementation is necessary while promoting breastfeeding.