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Lactation
1.
2. Changes during pregnancy
Increased breast tissue
Maturation of structure
Hormonal controls
Prolactin: stimulates milk
production
Oxytocin: stimulates milk release
“let-down” reflex
3. Suckling stimulates nipple
--->pituitary gland secretes
oxytocin--->let down reflex
results in milk ejecting cells
contract forcing milk from
milk cells into milk ducts.
Milk pools in lactiferous
sinuses under the areola.
Suckling stimulates milk to
come from the nipple.
Hypothalamus
Prolactin
Lacteal
Uterus
Oxytocin
Myoepithelial
Cell
Pituitary Gland
7. Mammogenesis
› Mammary (breast) growth occurs. The
size and weight of the breast increases.
› Preparation for milk production
› Starts at puberty and continues until
third trimester of pregnancy
› Ductal proliferation –estrogen
› Lobuloalveolar development -
progesterone
8.
9. Stage 1 (late pregnancy):
Alveolar cells are differentiated from secretory cells.
Stage 2 (day 2 or 3 to day 8 after birth):
By day 4-5 days postpartum, estrogen and progesterone
levels have dropped and thus;
Acinar cells develop into secretory cells
The tight junction in the alveolar cell closes.
Milk secretion begins.
Breasts are full and warm.
Endocrine control switches to autocrine (supply-demand)
control
10. Causes alveolar cells to initiate milk
secretion
Stimulate glandular production of colostrum
(which is initial milk produced characterized
by a yellow color and thick texture)
Acts synergistically with cortisol to stimulate
milk production
Prolactin “surges” occur within 15 minutes of
nipple stimulation
11. Ejection of Milk-(Oxytocin)
Primary function is milk ejection
Contracts myoepithelial cells located around the
alveolar cells and the glandular ducts.
Milk expelled from alveoli into ducts and
subareolar sinuses that lead to the nipple pore.
Oxytocin is produced in response to suckling
effect.
12. Cont.
Suckling infant stimulates touch receptors densely
located around the nipple and areola.
Sensations create impulses that activate dorsal root
ganglia via the intercostals nerves.
Impulses ascend the spinal cord, creating an afferent
neuronal pathway to both the paraventricular nuclei of
the hypothalamus where oxytocin is synthesized and
secreted by the pituitary gland.
Stimulation of nuclei causes release of oxytocin down
the pituitary stalk and into the posterior pituitary gland,
where oxytocin is stored.
13.
14. Maintenance of Lactation
› later than day 9 after birth to beginning of
involution
› Established secretion is maintained
› Autocrine system control continues
› Stimulated by milk removal
Regular synthesis and release of prolactin and
oxytocin
Stored milk causes increased intramammary
pressure which limits nutrient and hormonal
supply to the mammary gland
15. Moves milk from lobules to sinuses, so baby
can eat
Inhibited by stress, pain, anxiety
Triggered by sound, smell, sight of infant
Let Down:
Ejection, not suction, moves milk
to the areola
16. Infant grasps
most of the areola
in his mouth
Tongue “milks”
milk to the back
of the mouth prior
to swallowing.
Latch: The baby’s tongue moves milk from
areola to nipple.
17. Milk in lobules contains
whey protein called
Feedback Inhibitor of
Lactation (FIL)
If milk is not removed,
and lumen is full,
production will
decrease
Goal: 10-12 feeds in 24
hours, until baby is
done.
Moving Milk: Demand drives supply.
Negative
feed back
20. While breastfeeding results in amenorrhea
and delays the return of fertility, the length
of the delay cannot be reliably predicted or
detected
Most lactating women will resume menses
within 6–9 months
Prolactin has a negative effect on secretion of
GnRH and the gonadotropins
21. Don’t drink alcohol
Don’t take medications unless OK by Medical
Provider
Don’t take illegal drugs
Don’t smoke
Don’t get into environmental contaminants
Don’t have caffeine
21
22. Anxiety
o Increased catecholamine production will lead to
Vasoconstriction and reduction of oxytocin delivery to
the myoepithelial cells
Combination birth control pills
Mainly estrogen
Smoking
Nicotine – inhibits prolactin synthesis and secretion
Inadequate dietary intake
Editor's Notes
Breast tissue differentiates during gestation
At delivery, loss of placental hormones allows milk production to begin
Infant suckling at the breast causes contraction of myoepithelial cells and release of milk
Milk produced in mammary epithelium within lobules
With nursing, oxytocin triggers contraction of myoepithelial cells and transfer to sinuses
A shallow latch, or sucking on the nipple, stimulates let down but doesn’t empty the breast. It also leads to sore, cracked nipples, engorged breasts, and hungry, frustrated babies.
Don’t distribute formula company materials in your office or hospital
Ensure pediatric follow-up in the first 3-5 days
Skin-to-skin at birth, nurse in the first hour
Room in
Feed on demand
No pacifiers or formula, unless medically necessary