HOLY CROSS COLLEGE OF NURSING, KOTTIYAM

OBSTETRICS AND GYNEACOLOGICAL NURSING

CLINICAL TAECHING

ON

PHYSIOLOGY OF LACTATION

SUBMITTED BY SUBMITTED TO

MS DEVUCHANDANA R MS VIDYA CS

I YEAR MSc NURSING LECTURER

HOLY CROSS COLLEGE HOLY CROSS COLLEGE

OF NURSING OF NURSING

SUBMITTED ON :16/03/2020
LACTATION

Lactation is under the control of endocrine glands ,particularly the pituitary hormones
prolactin and oxytocin.It is influenced by the suckling process and by maternal
emotions.The establishment of lactation in the human are determined by the least three
factors

*The anatomic structure of the mammary gland and the development of alveoli,ducts,and
nipples

*The initiation and maintenance of milk secretion

*Milk ejection or propulsion of milk from the alveoli to the nipple

Breast milk is the most nutritious food for babies. It also protects from infection, allergies,
some chronic diseases and childhood cancers, and sudden infant death syndrome
(SIDS). Breastfeeding allows eye-to-eye contact and physical closeness, strengthening the
bond between the child and mother after solids are introduced at around six months of age,
continued breastfeeding is recommended. The AAP recommends that babies be breastfed at
least until 12 months or longer if both the mother and child wish. WHO's guidelines
recommend "continued frequent, on-demand breastfeeding until two years of age or beyond."

Breast milk has been recognized by the world health organization as offering ‘superior
nutrition for optimal health’

Anatomy and physiology of breast

The breast is one of two prominences located on the upper ventral region of
the torso of primates. In females, it serves as the mammary gland, which produces and
secretes milk to feed infants.[2] Both females and males develop breasts from the
same embryological tissues. At puberty, estrogens, in conjunction with growth hormone,
cause breast development in female humans and to a much lesser extent in other primates.
Breast development in other primate females generally only occurs with pregnancy.

Subcutaneous fat covers and envelops a network of ducts that converge on the nipple, and
these tissues give the breast its size and shape. At the ends of the ducts are lobules, or clusters
of alveoli, where milk is produced and stored in response to hormonal signals.[3] During
pregnancy, the breast responds to a complex interaction of hormones,
including estrogens, progesterone, and prolactin, that mediate the completion of its
development, namely lobuloalveolar maturation, in preparation
of lactation and breastfeeding.

Along with their major function in providing nutrition for infants, female breasts have social
and sexual characteristics. Breasts have been featured in notable ancient and modern
sculpture, art, and photography. They can figure prominently in the perception of a woman's
body and sexual attractiveness. A number of cultures associate breasts with sexuality and
tend to regard bare breasts in public as immodest or indecent. Breasts, especially the nipples,
are an erogenous zone.

1. Chest wall
2. Pectoralis muscles
3. Lobules
4. Nipple
5. Areola
6. Milk duct
7. Fatty tissue
8. Skin

Physiological changes in breast during pregnancy

1. Breast Growth

Breast enlargement is the most noticeable change during pregnancy, but the pattern of growth
may differ from woman to woman. While some women experience a slow and steady growth,
others see growth-spurts. If it is first pregnancy, may find that bra-size has increased by as
much as one cup, and breasts feel fuller and heavier. A sudden increase in size stretches skin
and may cause itchiness. It is not uncommon for stretch marks to appear, but these are mostly
temporary, and need not be too concerned about them.

2. Breast Tenderness

Soreness or breast tenderness is most noticeable during the first trimester and usually eases as
the second-trimester approaches. Caused by a surge in hormones, soreness can make the most
regular daily tasks uncomfortable.

3. Visible Veins

The increased blood flow in the body during pregnancy may lead to the occurrence of visible
veins in the delicate skin of breasts. This condition is temporary, and the veins usually return
to their normal size after give birth or after stop breastfeeding.

4. Lumps and Bumps

Some women may notice the development of lumps in the breasts. While most of these are
benign, it helps to have them checked if notice changes or new lumps. Most lumps are caused
by galactoceles (milk-filled cysts), fibroadenomas (fibrous tissue) or cysts.

5. Nipple Changes While Pregnant

Pregnancy causes an increase in pigmentation in nipples, also called areola. The changes in
the third trimester include a growth in the size of the nipples and the appearance of
Montgomery’s Tubercule
6. Montgomery’s Tubercules

Appearing as small pimples around the areola, these bumps are named after an Irish
Obstetrician who was the first to observe them. The number of bumps is different for each
woman. These tubercles are believed to perform a protective function, as they secrete oil
which keeps the areola moisturised and relieves sore nipples during pregnancy. Resist the
urge to pop them, or may end up with an infection.

7. Breast Leakage- Pregnancy Squirts

Leaky breasts are a common occurrence, even as early as 16 weeks into pregnancy. As the
milk ducts prepare for their task post-delivery, they leak colostrum, a straw-coloured liquid.
The colostrum is what your baby should drink right after birth, as it is rich in antibodies that
protect newborn.
PHYSIOLOGY OF LACTATION

The physiological basis of lactation is divided into four phases

 Preparation of breasts(mammogenesis)
 Synthesis and secretion from the breast alveoli(lactogenesis)
 Ejection of milk(galactokinesis)
 Maintenance of lactation(galactopoiesis)
Mammogenesis:- Pregnancy is associated with a remarkable growth of both ductal and
lobuloalveolar systems. An intact nerve supply is not essential for the growth of the
mammary glands during pregnancy.

Lactogenesis:-Milk secretion actually starts on 3 rd or 4th postpartum day.Colostrum is

secreted as a result of stimulation of the mammary alveolar cells by placental lactogen ,a
prolactin like substance. Inspite of a high prolactin level during pregnancy ,milk secretion
is kept in abeyance. Probably the steroids ,oestrogen and progesterone circulating during
pregnancy make the breast tissues unresponsive to prolactin.When the oesterogen and
progesterone are withdrawn following delivery,prolactin begins its milk secretory activity
in previously fully developed mammary glands. The secretory activity is enhanced directly
or indirectly by growth hormone ,thyroxine ,Glucocorticoids and insulin.

Galactokinesis:-Discharge of milk from the mammary glands depends not only on the
suction exerted by the baby during suckling but also on the contractile mechanism which
express the milk from the alveoli into the duct.
DURING SUCKLING ,A CONDITIONED REFLEX IS SET UP

The ascending tackle impulses from the nipple and areola pass via thoracic cavity
afferent neural arc to the para ventricular and supra optic nuclei of the hypothalamus to
synthesis and transport oxytocin to the posterior pituitary .Oxytocin which is liberated
from the posterior pituitary ,produces contraction of the myoepithelial cells of the alveoli
and the ducts containing the milk .This is the “milk ejection” or “milk let down” reflex
where by milk is forced down into the ampulla of the lactiferous ducts,wherefrom it can be
expressed by the mother or sucked out by the baby. Presence of the infant and infant’s cry
can induce let down with out suckling. A sensation of rise of pressure in the breasts by
milk experienced by the mother at the beginning of sucking is called “draught” This can
also be produced by the injection of oxytocin.

The milk ejection reflex is inhibited by factors such as pain, breast engorgement or
adverse psychic condition .The ejection reflex may be deficient for several days following
of milk secretion and results in breast engorgement.

Galactopoiesis:- Prolactin appears to be the single most important galactopoietic hormone.

For effective and continuous lactation ,suckling is essential .It is not only essential for the
removal of milk from the gland ,but it also causes the release of prolactin.Scretion is
continuous process unless suppressed by congestion or emotional disturbances.

MILK PRODUCTION

A healthy mother will produce about 500-800ml of milk a day to feed her infant with
about 500kcal/day.this requires about 600Kcal/day for the mother which must be made up
from the mother’s diet or from her body store. For this purpose a store of about 5kg of fat
during pregnancy is essential to make up any nutritional deficit during lactation.

STIMULATION OF LACTATION

Mother is motivated as regard the benefits of breast feeding since the early
pregnancy. No prelacteal feeds are given to the infant .Following delivery important steps
are

 To put the baby to the breast at 2-3 interval from the first day
  Plenty of fluids to drink
 To avoid breast engorgement .Early (1/2-1hour) and exclusive breast feeding in correct
position are encouraged
CONCLUSION
Lactation is under the control of endocrine glands ,particularly the pituitary hormones
prolactin and oxytocin.It is influenced by the suckling process and by maternal
emotions.The establishment of lactation in the human are determined by the least three
factors

BIBLIOGRAPHY

 https://academic.oup.com/ajcn/article/70/4/525/4729098
 Bhaskar nima .midwifery and obstetrical nursing. 1 st edition . Emmes medical
publication(2012), 289
 D c dutta. Text book of obstetrics . 6th edition . central publication,(2004),