KULIAH PAKAR DARING

Rabu, 31 Maret 2021

Breastfeeding frequency, psychological stress, and nutritional

status to increase breast milk volume and serum prolactin levels
GIYAWATI YULILANIA OKINARUM, M.Keb.

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 Giyawati Yulilania Okinarum, M.Keb.
(GITA)
Midwifery Lecturer and Researcher
Department of Midwifery Profession Education, Faculty of Health Sciences,
Respati University of Yogyakarta, Indonesia
Phone number: +62 822 1023 7139
E-mail : gitaokinarum@respati.ac.id
gitaajib@gmail.com

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“It’s not about your right to breastfeed,
it’s about your child’s right to eat”

3
 WHY

• Midwives employed in maternal-child settings play a

pivotal role in facilitating and supporting breastfeeding
mothers.

• Therefore, midwives have a moral responsibility in

society as an effort to develop children optimally

• As many as 1.4 million children under five are deaths in

the world per year, which can be prevented by
providing breast milk optimally

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 WHY
The exclusive breastfeeding: 54,3% ; the national target: 80%

did not breastfeed their babies because the milk did not come out was
the proportion of mothers who

65.7% and in the 0-6 month age group who were not breastfed for the same reason was 68.3%

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 WHY

• Hormonal factors (prolactin and oxytocin) and nutritional

are the main factors that influence breast milk supply

• The main hormone that plays a role in lactation is the

prolactin and oxytocin hormone.

• Lack of prolactin levels can inhibit the process of

lactogenesis, it is evident that milk secretion stops within
three to four days after a decrease in prolactin levels. In
addition to producing sufficient milk, a woman must
prepare for puberty and pregnancy

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Understanding of Prolactin Hormone During
Breastfeeding
• Prolactin is necessary for the secretion
of milk by the cells of the alveoli.

• After delivery, levels of progesterone

and estrogen fall rapidly, prolactin is no
longer blocked, and milk secretion
begins.
Understanding of Prolactin Hormone During Breastfeeding
• Prolactin is synthesized by lactotrophs in the anterior pituitary gland. The
number of lactotrophs will increase during pregnancy in response to the
physiological needs to develop breast tissue and prepare for milk
production.

• two main roles are milk production and the development of the milk
glands in the breast tissue. Prolactin promotes the growth of alveoli,
which is a component of the milk glands, where milk is produced.

• The level of the hormone prolactin is very important for a mother's ability
to lactate normally.

• If the mother does not breastfeed her baby, prolactin levels drop to
nonpregnant levels after 1 to 2 weeks
Understanding of Prolactin Hormone During Breastfeeding
• Plasma prolactin levels rise and fall proportionately to
frequency, intensity, and duration of nipple stimulation, and
the secretion of prolactin is greatest when both nipples are
stimulated simultaneously

• The elevated serum prolactin levels are associated with

suckling frequency. Additionally, serum prolactin levels and
the prolactin response to suckling remain higher in fully
breastfeeding women who remain amenorrheic for at least
180 days postpartum compared with fully breastfeeding
women who are not amenorrheic.
 Pattern of Breastfeeding:
Prolactin and Lactating Frequency
• When a baby suckles, the level of prolactin in the blood
increases, and stimulates production of milk by the
alveoli

• However, if the mother stops breastfeeding, milk

secretion may stop too – then the milk will dry up.

• More prolactin is produced at night, so breastfeeding at

night is especially helpful for keeping up the milk supply.

• In the absence of regular removal of milk from the

mammary gland, milk synthesis will cease.
 Pattern of Breastfeeding:
Prolactin and Lactating Frequency

My research study results:

• Frekuensi menyusui memiliki hubungan positif
pada peningkatan volume ASI sebesar 23,4%
(apabila ibu menyusui bayinya >12 kali/hari)
• Semakin sering ibu menyusui bayinya (>10
kali/hari) maka semakin tinggi kadar prolaktin
serumnya.
 Psychological Stress and Breastfeeding:
Pathophysiology of Stress
• The stress response is a dynamic system, which is
sensitive to physiological and environmental
disturbances
• Physical, psychological, and immunological stress
are all perceived by the body through either of
two routes, the hypothalamic-pituitary-adrenal
axis (HPA) or via the sympathetic nervous
system.
• The release of cortisol, a glucocorticoid, interacts
with brain neurons to produce brain-derived
neurotrophic factor (BDNF).
• Various types of stress affect mothers and
offspring differently, especially according to the
developmental stage during which stress is
experienced.
Psychological Stress and Breastfeeding:
Psychological Stress
• Psychosocial stress is the response to perceived
environmental threats, the body and mind’s perceived
ability to cope, and the resulting reaction, which can
impact individuals both biologically and behaviorally.
Psychological Stress and Breastfeeding:
Psychological Effects of Breastfeding in Mothers
My research study result:
• The economic and health situation as an impact of the
COVID-19 pandemic, also the background of young
breastfeeding mothers who lack of experience and
unstable emotions, are the causes of psychological stress
to emerge.

• Basically, there have been a lot of studies that mention

the psychological benefits of breastfeeding.
Psychological Stress and Breastfeeding:
Breastfeeding Impact on Stress in Mothers
• Breastfeeding has been reported to impact mood and stress
reactivity in mothers
• Specifically, breastfeeding mothers report reductions in anxiety,
negative mood, and stress when compared to formula-feeding
mothers.
• breastfeeding mothers have a reduced cortisol response when
faced with social stress
• Breastfeeding mothers also display prolonged and higher quality
sleep patterns than those who feed their infants formula.
• impacts mothers’ responses to emotions in others and may
thereby improve social interactions and relationships.
Psychological Stress and Breastfeeding:
Psychological Stress and Serum Prolactin Levels
My research study result:
• There were significant differences in serum prolactin levels in
the mild, moderate, and severe stress groups.
• the economic and health situation as an impact of the COVID-
19 pandemic, also the background of young breastfeeding
mothers who lack of experience and unstable emotions, are the
causes of psychological stress to emerge.
 Psychological Stress and Breastfeeding:
Psychological Stress and Serum Prolactin Levels
• This is in contrast to several research studies that state that during
periods of stress, prolactin secretion contributes to the modulation of
adrenal ACTH sensitivity and glandular hypertrophy, causing an increase
in serum prolactin levels or so-called hyperprolactinemia

• However, experimental studies in the laboratory investigating the

response of prolactin to psychological stress have shown inconsistent
results because both increases and decreases have been reported,
because the role of prolactin in modulating adrenal innervation is
controversial
Sekilas mengenai proses penelitian saya >>>
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 Blood sampling process
and measurement of serum prolactin levels

• Laboratorium Patologi
Klinik RSUD Sleman
• Lab Biomedik FKKMK UGM

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Nutritional Status and Breastfeeding
• Nutrients are required for milk synthesis and stimulate
the hormone's supply involved in the production and
milk secretion.

• This is related to the nutritional status of a woman

who needs special attention because nutritional status
determines the quality breastfeeding process

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Nutritional Status and Breastfeeding
• The nutritional status of lactating mothers reflects the
adequacy of nutrition and the mother's health during
breastfeeding.

• Lactating mothers with good nutritional status have

sufficient nutritional reserves so that they can produce
breast milk smoothly with sufficient nutritional
content

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 Nutritional Status and Breastfeeding
• Research Study #1: • Research Study #2:
• severe underweight mothers will • a maternal diet can both
experience a decrease in the improve maternal
quantity and quality of breast macronutrient intake and
milk, also milk may be a key to the nutritional status of
target for growth promotion breast milk
among undernourished children.

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Nutritional Status and Breastfeeding
• The increase in maternal weight will affect the volume
and nutrient content in breast milk, while the increase
in tricep fat thickness will affect the increase in the
concentration of fat and energy in breast milk.

• Lactating mothers who have a good immune system

have more protective substances in breast milk than
lactating mothers with impaired immunity

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Nutritional Status and Breastfeeding
My research study results:
• there were differences in serum prolactin levels in the
underweight, normoweight, and overweight group.

• there was a significant difference in the adequacy of energy,

carbohydrates, protein, and fat on serum prolactin levels

• To produce milk in the first 6 months of the postpartum

period, lactating mothers require 500 kcal/day extra energy
• (a total energy intake of 2380-2480 kcal/day in lactating
mothers at 0 to 6 months)

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 Nutritional Status and Breastfeeding
• Body Mass Index (BMI) and nutrition are biological/clinical factors that affect prolactin
secretion
My study research results:
• In Indonesia, the mean daily energy intake of mothers
during lactation is lower than intake during pregnancy.

• Five percent of lactating mothers who include in the

underweight group of this research said that their
inadequate energy intake since weariness in caring for their
babies and the impact of the economic crisis during the
pandemic

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 Nutritional Status and Breastfeeding
Eating a healthy diet based on WHO recommendations and balanced nutrition
guidelines is an important way to maintain and enhance immunity and health in
the long term.

A healthy diet consists of a variety of foods from each type

of food group to ensure adequate intake of all essential
nutrients

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 Nutrition Recommendation During Breastfeeding:
Calories for Breastfeeding
• Breastfeeding mothers need up to 500 extra calories per day (remember: pregnancy was
about300 extra calories)

• Recommended that about 330 calories come from food and the remaining calories come
from fat stores in most women

• Activity level will affect how many calories she needs

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Nutrition Recommendation During Breastfeeding:
Protein

• Perkembangan otot, tulang, dan berbagai jaringan lain pada

bayi
• Protein bagi ibu menyusui: 71 g/hari
• Ibu menyusui hendaknya membatasi makanan laut dengan
mengonsumsii tidak lebih dari 2 kali per minggu untuk
menghindari risiko paparan merkuri (CDC, 2018)

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 Nutrition Recommendation During Breastfeeding:
Carbohydrate
• Membantu memberikan energi untuk mendukung pertumbuhan
dan perkembangan bayi

Fat
• Mendorong pertumbuhan dan perkembangan
otak serta sistem saraf bayi.
• Batasi asupan lembak hingga 30% atau kurang
dari asupan kalori harian

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 Nutrition Recommendation During Breastfeeding:
Calsium
• Membatu membangun tulang dan gigi yang kuat bagi ibu
dan bay, serta berpern penting dalam menjaga fungsi
kesehatan sistem peredaran darah, otot, dan saraf
• Asupan kalsium untuk ibu menyusui: 1000 mg/ hari

Folic acid
• Dibutuhkan ibu bahkan sejak sebelum masa kehamilan
• Membanu perkembangan otak dan sumsum tulang
belakang bayi yang sehat, membuat sel darh merah dan sel
darah putih

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 Nutrition Recommendation During Breastfeeding:
Iron
• Mencegah anemia pada ibu menyusui
• Mencegah kekurangan zat besi pada ibu setelah melahirkan
• Pertahanan pertama ibu untuk mengatasi kelelahan
pascasalin
• 9 mg/hari selama masa menyusui
Vitamin C
• Berperan penting dalam pertumbuhan dan memperbaiki
jaringan, serta perkembangan tulang dan gigi bayi.
• Membantu tubuh menyerap zat besi dan menjaga daya
tahan tubuh ibu pascasalin

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 Nutrition Recommendation During Breastfeeding:
Vitamin B12
• Pembentukan sel darah merah bayi serta perkembangan
dan fungsi otak

Vitamin D
• 600 IU/hari pada busui
• Mengoptimakan kandungan nutrisi dalam ASI
• Membantu penyerapan kalsium tubuh untuk kesehatan
tulang dan gigi bayi

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Update: Breastfeeding and COVID-19
• tidak mendeteksi SARS-CoV-2 RNA dalam ASI
yang diproduksi oleh ibu menyusui dengan
COVID-19 ringan hingga sedang.
• ASI mengandung antibodi anti-SARSCoV-2 dan
konsentrasinya berkorelasi dengan
kemampuan ASI untuk menetralkan
infektivitas SARS-CoV-2 secara efektif.

• rekomendasi: mendorong pemberian ASI pada

busui dengan penyakit COVID-19 ringan hingga
sedang

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 THANKS A MILLION
“It’s not about your right to breastfeed,
it’s about your child’s right to eat”

39