PHYSIOLOGY OF LACTATION

 Breast feeding is infant’s suckling milk at the breast

 Lactation is the maternal process of making milk

 Breast feeding + Lactation Bio - Psycho -

socio -cultural Processes
 Multiple sites are involved in process of lactation

i) Breasts
ii) Functioning of endocrine glands
iii) Emotional response of mother
iv) Cultural context
 Anatomy of Mammary Gland
 Breasts are paired mammary gland (modified
exocrine glands)
 Having a ductule system, secreting outward 14 to

the surface of organ

 Glands are anchored to the overlying skin and to the

pectoral muscles by suspensory ligaments of cooper

 Three major structures of breast are

i) Skin
ii) Subcutaneous tissue
iii) Body of the breast
i) Skin : General skin, nipple and areola are visible
externally
 Areola or Areola mammae is pigmented area

surrounds the nipple

 Montgomery’s glands are present in Areola (raised

projections)-sebaceous glands secretes the areola

and nipple
 The Nipple (papilla mammae)

* Raised projection in the center of areola

* External opening where the milk comes out
* Contains smooth muscle fibres and sensory nerve
endings cause it to become erect when stimulated
ii) Subcutaneous tissue

 Subcutaneous tissue consist of gland, fat, connective

tissue
 Size of a woman’s breast reflects the amount of fat
and connective tissue, not glandular tissue
 Size of the breast nothing to do with functionality
iii) Body of the Breast (corpus Mammae)
 Corpus mammae is Latin word

Body mamma (breast) glandular organ

 Breast is made up of two parts

a) Glandular tissue b) Supporting tissue

(Parenchyma) (Stroma)
a) Glandular Tissue
 Consists of lobular, ductular and alveolar structures
 The breast has 15-25 Labi (singular lobus) each
separated by connective tissue from one another
 The duct from lobus goes to the nipple
 Lobi are subdivided into lobuli (20-40 in the breast)
and each labuli subdivided in to 10-100 alveoli
contd…
 10-100 alveoli
forms
Lobi (20-40 in the breast)

forms the duct

Enter into nipple

- The alveolus (plural, alveoli) smallest functioning

unit of the mammary gland
  Alveolus

Made up of 2 types of cells

Secretary epithelial cells Myoepithelial cells

Synthesize fat and Surround the secretary

Protein into milk epithelial cells
responsible for
Milk ejection
b) Stroma
- Contains the connective tissue, fat, blood
vessels, nerves and lymphatics

- Duct system is located with in the

connective tissue and fat
The process of making human milk
i) Hormones associated with milk production

ii) Stage of mammary function

 Hormones associated with milk production
i)

Hormones govern Birth, pubertal growth,

conception, pregnancy, delivery and also lactation

During pregnancy

Prolactin level
but
Estrogen and Progesterone – inhibiting hormone
Suppress
The activity of Prolactin
contd…
 Sed Estrogen
helps
Progesterone for Proliferation of glandular tissue and
ductule development during pregnancy
 PCL, HCG, Human Chorionic Somato mammotropin

all contribute for mammary gland growth during

pregnancy
 At birth

Drop in estrogen and progesterone level, oxytocin and

Prolactin associated with lactation
contd…
-Oxytocin
causes
Contraction of myoepithelial cells

“Milk-ejection” reflex or “Let-down” reflex

causes
Sensation of “Tingling” or “Sensual” feeling

 Fatigue, stress, fear or shame

inhibits
Milk ejection reflex
contd…
 Prolactin
* Described as “Great sensation hormone” (relax or
euphoric)
* Pro means “for”
* Lactin means “milk”
* Prolactin during pregnancy
Prolactin prior to birth and again few hrs after
birth or neonate suckling
* At term 150-200ng / ml
 ii) Stages of Mammary Function/Physiology of
Lactation
 Lactation – starts following delivery,
 But preparation for effective lactation starts during
pregnancy.
 The physiological basis of lactation is divided into 4
phases. They are;
a. Mammogenesis – Preparation of breasts
b. Lactogenesis – synthesis and secretion of milk
from alveoli
c. Galactokinesis – Ejection of milk.
d. Galactopoiesis - Maintenance of lactation
a) Mammogenesis
 Pregnancy – remarkable growth of both
ductal and lobuloalveolar systems.
 An intact nerve supply is not essential for

the growth of mammary glands during

pregnancy.
 Begins just prior to puberty and continues

through puberty, MC and Pregnancy

 It is not fully developed until it has

produced milk
b) Lactogenesis
- Gradual process of making milk
 Occur in 3 stages

Lactogenesis I Lactogenesis II Lactogenesis III

During these stages human milk varies in components,
appearance and volume
Lactogenesis I:

 Begins around 14-16 wks of gestation

 Ductular and lobular proliferation by the

influence of hormones

 Colostrums like substance is produced but

not secreted

 This stage continues until second trimester

Lactogenesis II:
- Begins around 28 weeks gestation
- If breast manipulated leaking can occur
- Colostrum the first “milk”, is a thick
substance that appears yellow (carotene
content)
- Colostrum present in ducts in 2nd trimester and
secreted at first few days of postpartum
- The hormonal changes involve primarily
HPL, progesterone, Estrogen and Prolactin
contd…
 After placenta delivered

Estrogen and progesterone

Remains
Prolactin in high level
 Colostrum is important, rich in immunoglobulins,

has laxative effect on gut aids in passage of

Meconium
 It is higher in protein, Lower in fat, and CHO

 Lower in energy ie 67Kcal/100ml 20Calories/Ounce

Mature milk has about 75Kcal/100ml,

22.5 Calories/Ounce
contd…
 Lactogenesis II continues only when breast is
adequately stimulated
By Adequate stimulation

Lactogenesis II continued
First secretes
Colostrum
Gradually replaced by
Transitional milk (3-10days)
-Dramatic hormonal changes
-do the tears
contd…
 by 10th day
Transitional milk replaced by Mature milk
Lactogenesis III:
-Called Galatopoiesis
-Begins 10 days after birth
-Mature milk contains about 22.5 calories /Ounce
Fore milk i) Produced and stored
-Mature milk between feeding
Hind milk ii) Released at the
beginning of next
i) Produced during feeding feeding
ii) Released at the end of iii) Appearance similar
feeding to skimmed milk
iii) Much richer iv) Characteristics blue
3) Lactation

 Continued production of milk

 Regulated by oxytocin and Prolactin

4) Involution
 Lactation continued as long as breast is suckled

 During weaning

Infant suckles less frequently

Prolactin level

contd…
Hormonal contribution to lactation

Hormone Function

Prolactin (A.P.) - Stimulates alveolar cells to

produce milk
- Primarily initiating lactation
- Secondary Important
maintaining lactation
- Cause lactation infertility
by
contd…
 * release of FSH and LH form
pituitary
or
* Causing ovaries to be un
responsive to gonadotropins
Prolactin inhibiting
hormone
(Hypothalamus) -Suppresses release of Prolactin
from anterior Pituitary
Oxytocin (P.P.) -Causes myoepithelial cells to
contract
contd…
 -Release is inhibited by fear,
anxiety, embarrassment distraction
-Causes uterine contraction and
postpartum involution
Estrogen (ovary
and Placenta) At parturition
Blood level drops
aids in
initiating lactation
-Not important for lactation
there after
contd…
Progesterone (Ovary
and Placenta) At parturition

Blood level drops

aids in
initiating lactation
-Not important for lactation
there after
Growth Hormone
(A.P.) -Act with Prolactin in initiation
- Important in maintaining
established lactation
contd…
ACTH (A.P.) -Necessary for maintenance
of Lactation
Thyroxine (Thyroid) -Important in maintaining
lactation
-Either by direct effect on
mammary glands
or
By control of metabolism
Thyrotropin releasing - Stimulates release of
Hormone Prolactin
(Hypothalamus) - To maintain established
lactation
 Customs and Beliefs in relation to
Lactation
Customs / cultural Behaviours
Native American -Value the Traditional methods
Asian -Earlier generations breast fed
second generations Not breastfed delay in
Breast feeding or “Bottle and breast”
African -Bottle feeding-Status symbol
Hispanic -Belief that breast feeding is
good
Americans -Artificial feeding is equalent to
human milk
contd…
Mexican American -Colostrum is dirty or bad
don’t begin breast feeding at birth
Beliefs
 Breast feeding is a learned art, woman must be motivated to

learn it
 6 factors influence motivation to learn - Attitude

Felt need
Stimulation
Emotion
Competence
Reinforcement
contd…
-Some Erroneous beliefs about breastfeeding
experience
i) Breast feeding hurts
ii) Breast feeding will make the breast to sag
iii) I can’t breast feed because I didn’t prepare my
nipples
iv) I don’t want to breast feed because I don’t like to
drink milk
 Responsibility of a Nurse / Midwife
 Influence the attitude
 Who come with positive attitude requires positive
reinforcement
 Those who cane with negative attitude in need of
motivation
i) Confront wrong beliefs and assumptions attitude
ii) Or remove components of failure or fear
 Birth injuries
Trauma during birth includes
i) Trauma to skin and superficial tissues
ii) Muscle Trauma
iii) Nerve Trauma
iv) Fractures
i) Trauma to skin and superficial tissues
a) Skin Trauma

 Cause is iatrogenic ie forceps blades, vacuum

extractor cups, scalp electrodes and scalpels

Cause Effect
1) Forceps blades Abrasion, bruising,
superficial fat necrosis
2) Vacuum extractor cups Abrasion
3) Scalp electrodes Puncture wounds
4) Caesarean section Laceration of the
baby’s skin
contd…
Nursing management
 Keep clean and dry wound

 If any s/s of infection medical advice is important

 Antibiotics

 Deeper lacerations needs closure with dutterfly

strips or sutures
b) Superficial tissues
- It involves edematous swellings or drwising or both
 During labour

Part of fetus overlying the cervical cas

Subjected to
contd…
Pressure-”girdle of contact”
lead to
Obstruction of venous return
Results in
Congestion and edema
Consists
Serum and blood (Serosanguineous
fluid)
 Caput succedaneum:- Occurs in cephalic
presentation the edematous swelling under the scalp
and above the periosteum
i) Doesn’t enlarge in size
ii) Can ‘pit’ on pressure
iii) Can cross a suture line
iv) resolves by 36hrs
-Baby may experince little discomfort
-Gentle handling is appropriation
 Other injury
-In face presentation - Congested and bruised eyes
- Edematous lips
-In breech presentation - Bruised and edematous
genitalia and buttocks
-Baby may have discomfort and pain
-Proper handling while changing nappies or dressing
baby
-Hygiene in nappy area
-Apply ointment
-If skin excoriated infection can occur
-edema / bruising reslove with in few days of life
contd…
ii) Muscle trauma
-injuries to muscle result from tearing or when the
blood supply is disrupted
 Torticollis
-Commonly damaged muscle is stern mastoid
Compression of Blood vessels
Gradually
Alveoli collapse

Resting state
-During weaning milk changes is terms of
a) Its volume
b) Nutritional components
c) Immunologic properties
contd…
 Suckling
Stimulates

Anterior pituitary Posterior Pituitary

To secrete To Secrete
Prolactin Oxytocin
Stimulates Stimulates
Breast alveoli Breast alveoli
To To
Secrete milk Eject milk into duct

Infant can drink it