Rea­sons for in­suf­fi­cient lac­ta­tion

Daily Mirror (Sri Lanka) - - HEALTH CAPSULE - BY A.L.S.SEWWANDI

Breast milk is a na­ture’s gift to a new­born and it is the first spe­cific and per­fect nour­ish­ment which con­tains all the well-ad­justed nu­tri­tious el­e­ments for the baby. This is be­cause it pro­duces op­ti­mum growth and de­vel­op­ment, and pro­vides sub­stan­tial pro­tec­tion from ill­ness.

More­over, lac­ta­tion is ben­e­fi­cial to a mother’s health and bi­o­log­i­cally sup­ports a spe­cial mother and baby re­la­tion­ship. In an­cient time, our moth­ers had in­ten­sively fed their ba­bies with breast milk up to one to two years since most of them were housewives and had suf­fi­cient lac­ta­tion. But with the pass­ing of time the lac­ta­tion pe­riod is short­en­ing and as a re­sult a child’s health be­comes poor. Re­search stud­ies have in­di­cated that child health in South Asia is a ma­jor con­cern with a great num­ber of mal­nour­ished chil­dren and ap­prox­i­mately 43.6% of <5 years chil­dren are un­der­weight in South Asia due to prom­i­nent rea­son of shorter and lack of breast feed­ing prac­tices. In ad­di­tion to that, some stud­ies done in a ru­ral area of Sri Lanka found that 32% of the ba­bies who are less than 03 months of age were fed on for­mula milk in­stead of breast milk. The World Health or­ga­ni­za­tion (WHO) rec­om­mends ex­clu­sive breast­feed­ing up to six months of age, with con­tin­ued breast­feed­ing along with ap­pro­pri­ate com­ple­men­tary foods up to two years of age or be­yond. Re­cently most of lac­tat­ing women suf­fer from in­suf­fi­cient breast milk pro­duc­tion and some­times this mod­ern life and food in­take pat­tern may be highly af­fected be­cause of this prob­lem. There­fore, I de­cided to fo­cus on this topic which let us to dis­cuss the pos­si­ble rea­sons for shorter lac­tat­ing pe­riod.

Mech­a­nism of breast milk pro­duc­tion and se­cre­tion

The non-preg­nant and non-lac­tat­ing fe­male breast is ar­ranged pri­mar­ily from adi­pose and col­lage­nous tis­sue. Breast milk pro­duc­tion be­gins be­tween 10 and 22 weeks of ges­ta­tion. Within 48 hours of de­liv­ery, the mother pro­duces a small amount of milk, mainly colostrum and milk pro­duc­tion is con­trolled by a com­plex in­ter­play of hor­mones and neu­ro­trans­mit­ters. Pro­lactin is se­creted by the an­te­rior pi­tu­itary in re­sponse to nip­ple stim­u­la­tion. Near the 5th week of preg­nancy, the level of cir­cu­lat­ing pro­lactin starts to in­crease and dur­ing preg­nancy, pro­lactin and other hor­mones such as In­sulin, cor­ti­sol and thy­roid hor­mones stim­u­late the breasts anatom­i­cally for the milk se­cre­tion. How­ever, es­tro­gen, pro­ges­terone, and other pla­cen­tal hor­mones in­hibit pro­lactin- me­di­ated milk syn­the­sis dur­ing preg­nancy. Af­ter de­liv­ery of the new­born, pro­lactin level drops sharply, but it is re­stored for a 1-hour spike dur­ing each feed­ing to stim­u­late the pro­duc­tion of milk for the next feed­ing. With each pro­lactin spike, es­tro­gen and pro­ges­terone also in­crease slightly.

The mam­mary gland com­prises milk-trans­port­ing lac­t­if­er­ous ducts, which ex­pand and branch ex­ten­sively dur­ing preg­nancy in re­sponse to oe­stro­gen, growth hor­mone, cor­ti­sol, and pro­lactin. More­over, in re­sponse to pro­ges­terone, clus­ters of breast alve­oli bud from the ducts and ex­pand out­ward to­wards the chest wall. Breast alve­oli are bal­loon-like struc­tures lined with milk-se­cret­ing lac­to­cytes, that are sur­rounded by a net of con­trac­tile my­oep­ithe­lial cells. Milk is se­creted from the lac­to­cytes, fills the alve­oli, and is squeezed into the ducts.

When the in­fant suck­les, sen­sory nerve fi­bres in the are­ola start a neu­roen­docrine re­flex that re­sults in milk se­cre­tion from lac­to­cytes into the alve­oli. The pos­te­rior pi­tu­itary re­leases oxy­tocin, which stim­u­lates my­oep­ithe­lial cells to squeeze milk from the alve­oli so it can drain into the lac­t­if­er­ous ducts, col­lect in the lac­t­if­er­ous si­nuses, and dis­charge through the nip­ple pores. It takes less than 1 minute from the time when an in­fant be­gins suck­ling un­til milk is se­creted.

Com­po­si­tion of breast milk and im­por­tance

Breast milk con­tains both nu­tri­tional com­po­si­tion and non­nu­tri­tive bioac­tive fac­tors. The nu­tri­tional com­po­nents of hu­man milk de­rive from three sources; by syn­the­sis in the lac­to­cyte, di­etary nu­tri­ent, and from ma­ter­nal stores while there are two types of nu­tri­tional com­po­nents namely macro (pro­tein, fat, lac­tose and en­ergy) and mi­cro (vi­ta­mins, min­er­als and other bioac­tive fac­tors) nu­tri­ents. There are sev­eral non-nu­tri­tive bioac­tive fac­tors, which in­clude cells, an­ti­in­fec­tious and anti-in­flam­ma­tory agents, growth fac­tors, and pre­bi­otics that pro­mote sur­vival and healthy de­vel­op­ment, pro­tect against in­fec­tion and in­flam­ma­tion and con­trib­ute to im­mune mat­u­ra­tion, mi­cro­bial col­o­niza­tion of new born.

In­suf­fi­cient breast milk pro­duc­tion

In­suf­fi­cient milk sup­ply is one of the main rea­sons for breast­feed­ing dis­con­tin­u­a­tion in these days while it was rare in the past. Ac­cord­ing to the past re­search stud­ies, there are sev­eral causes which may be rea­son for in­suf­fi­cient breast milk pro­duc­tion among lac­tat­ing women. 1. Hor­monal causes

If mother’s pla­centa is fail­ure to with­drawal of pro­ges­terone or re­duced the level of pro­lactin re­lease or other pla­cen­tal ab­nor­mal­i­ties such as inc­reta (con­di­tion that oc­curs where the pla­centa deeply at­taches into the wall of uterus). More­over, ges­ta­tional ovar­ian theca lutein cysts (type of ovar­ian cyst) that el­e­vate testostero­ne lev­els and as a re­sult of that sup­press the milk pro­duc­tion.

2. Glan­du­lar causes In­suf­fi­cient glan­du­lar tis­sue is a very un­com­mon con­di­tion which known as Mam­mary hy­popla­sia, that can cause for low or no milk pro­duc­tion. Women with mam­mary hy­popla­sia sim­ply has not de­vel­oped proper mam­mary tis­sue dur­ing ado­les­cence, but their breasts may be small or large. Breast re­duc­tion or en­hance­ment surg­eries and nip­ple pierc­ings also neg­a­tively ef­fect on re­duced breast milk pro­duc­tion by dam­ag­ing milk ducts in the nip­ple.

3. Post glan­du­lar In­ef­fec­tive or in­fre­quent milk re­moval and in­ef­fec­tive breast­feed­ing due to baby’s oral anatomy such as tongue tie. And also birth in­juries, breath­ing chal­lenges, health or neu­ro­log­i­cal is­sues, Cae­sarean birth, hy­per­ten­sion, anaemia and ex­ces­sive blood loss.

4. Use of hor­monal birth con­trol Any form of hor­monal birth con­trol (the pill, patch or in­jec­tions) can cause a sig­nif­i­cant drop in their milk for cer­tain lac­tat­ing women.

5. Cer­tain med­i­ca­tions or herbs

6. Oth­ers

Preterm birth, in­sulin de­pen­dent di­a­betes mel­li­tus and ges­ta­tional di­a­betes, meta­bolic sta­tus or health, obe­sity, older ma­ter­nal age, stress, Thy­roid im­bal­ance or dis­ease, Poly­cys­tic Ovary Dis­ease, Luteal phase de­fect, smok­ing, food re­stric­tion and preg­nancy.

Lac­to­genic food

Lac­to­genic food sup­port lac­ta­tion. Eat­ing suf­fi­cient calo­ries and get­ting more nu­tri­ents is help­ful in it­self for lac­ta­tion, but these foods also con­tain sub­stances that in­ter­act with and sup­port the com­po­si­tion of lac­ta­tion. These sub­stances such as phy­toe­stro­gen, nat­u­ral plant sedatives, plant sterols and saponins, and tryp­to­phan, among oth­ers. More­over, a rich sup­ply of min­er­als and a good bal­ance of fats en­sure that the mother’s cells and nerves are func­tion­ing at an op­ti­mal level.

1. Car­rot, Beet

2. Dark Green Leafy Veg­eta­bles

3. Grains and Legumes

4. Al­monds, cashews

5. Oils and fats

6. Nat­u­ral herbal root bev­er­ages and Bar­ley wa­ter

7. Gar­lic

8. Oats

In con­clu­sion, in­suf­fi­cient lac­ta­tion is a ma­jor prob­lem among lac­tat­ing moth­ers in the newer gen­er­a­tions. It can hap­pen due to this mod­ern liv­ing style, feed­ing habits etc. Hence, preg­nant moth­ers have to pay at­ten­tion to these fac­tors dur­ing and af­ter preg­nancy since breast milk is the per­fect food for new­born and it can­not be sub­sti­tuted by the other for­mu­lated food. (The writer is a med­i­cal lab­o­ra­tory tech­nol­o­gist at a pri­vate hos­pi­tal and holds an MSC. De­gree in In­dus­trial and En­vi­ron­men­tal Chem­istry from the Univer­sity of Ke­laniya and BSC. Food Pro­duc­tion and Tech­nol­ogy Man­age­ment de­gree from the Wayamba Univer­sity of Sri Lanka)

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