Lactation | Medical Science Optional Notes for UPSC PDF Download

Steps in lactation 

Lactogenesis is a intricate process that encompasses numerous hormones and reflexes, with the pivotal roles played by two primary hormones: prolactin and oxytocin.

Reflexes in New Born

Upon touching the baby's palate with the nipple, the infant initiates sucking movements, and this reflex is particularly robust right after birth. The sucking reflex involves several actions, including drawing in the nipple and areola to create an elongated teat within the mouth, pressing the stretched nipple and areola against the palate with the jaw and tongue, and extracting milk from the lactiferous sinuses through a wavelike peristaltic movement of the tongue beneath the areola and nipple, compressing them against the palate above.

Other reflexes in baby

• The rooting reflex: When the cheek or side of the mouth is touched, the baby instinctively opens their mouth and seeks the nipple. This reflex, known as the rooting reflex, aids the baby in locating the nipple and achieving proper attachment to the breast.
• The swallowing reflex: As the mouth fills with milk, the baby automatically swallows the milk. It takes a few suckles before the baby obtains enough milk to initiate the swallowing reflex. This process involves coordination with breathing, and the suckle-swallow-breathe cycle typically lasts for approximately one second.

Lactational Amenorrhea

Exclusive breastfeeding for the first 6 months following childbirth leads to amenorrhea. This is believed to be attributed to the reduction in pulsatile secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) caused by infant suckling, subsequently suppressing ovarian activity. The precise mechanism through which the suckling stimulus influences the pulsatile secretion of GnRH remains unclear.

Advantages of Breast feeding

Breast milk stands out as the optimal nourishment for newborns, representing the most valuable gift a mother can provide to her infant.

• It encompasses all the essential nutrients necessary for the healthy growth and development of a baby from birth up to the initial six months of life.
• The practice of exclusive breastfeeding for the initial six months holds the potential to diminish the under-5 mortality rate by 13%, making it the most impactful intervention known for reducing mortality in newborns and young children.

Advantages for the mother include:

• Early breastfeeding aids uterine involution, lowering the risk of postpartum hemorrhage.
• It offers contraceptive protection through lactational amenorrhea. If the mother exclusively breastfeeds and has not yet resumed menstruation, additional contraception is unnecessary for the first 6 months post-delivery.
• Breastfeeding diminishes the likelihood of breast and ovarian cancer.
• It proves to be the most efficient method for the mother to shed the extra weight gained during pregnancy.

The Baby-friendly Hospital Initiative (BFHI), initiated by WHO and UNICEF, aims to encourage maternity and newborn service facilities globally to adopt the Ten Steps to Successful Breastfeeding.

These Ten Steps comprise a set of policies and procedures that maternity and newborn service facilities are encouraged to implement in order to promote breastfeeding.

WHO has urged all such facilities worldwide to adhere to the Ten Steps for the support of breastfeeding.

Ten Steps to Successful Breastfeeding

Critical management procedures
1. (a) Ensure full compliance with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
(b) Implement a written infant feeding policy that is regularly communicated to both staff and parents. (c) Establish continuous monitoring and data-management systems.
2. Guarantee that staff possesses adequate knowledge, competence, and skills to actively support breastfeeding.

Key clinical practices
3. Engage in discussions about the importance and management of breastfeeding with pregnant women and their families.
4. Facilitate immediate and uninterrupted skin-to-skin contact, supporting mothers to initiate breastfeeding as soon as possible after birth.
5. Support mothers in initiating and sustaining breastfeeding while addressing common difficulties.
6. Refrain from providing breastfed newborns any food or fluids other than breast milk unless medically indicated.
7. Enable mothers and their infants to remain together, practicing rooming-in 24 hours a day.
8. Support mothers in recognizing and responding to their infants' cues for feeding.
9. Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers.
10. Coordinate discharge to ensure that parents and their infants have timely access to ongoing support and care.

Feed Back Regulation of Ovarian Function

• In the early phase of the follicular phase, inhibin B is low, and FSH is moderately elevated, promoting follicular growth. The negative feedback effect of the rising plasma estrogen level restrains LH secretion.
• Approximately 36-48 hours before ovulation, the estrogen feedback effect becomes positive, triggering the surge in LH secretion (LH surge) that leads to ovulation.
• Ovulation takes place about 9 hours after the peak of LH. FSH secretion also peaks, despite a slight rise in inhibin, possibly due to robust stimulation of gonadotropes by GnRH.
• Throughout the luteal phase, LH and FSH secretion is subdued due to elevated levels of estrogen, progesterone, and inhibin.
• It's important to note that a moderate, constant level of circulating estrogen negatively influences LH secretion. However, during the menstrual cycle, an elevated estrogen level has a positive feedback effect, stimulating LH secretion.

Reproductive physiology-Repeats

Lactation -Repeats

• Illustrate the sucking reflex using a diagram and delineate the positive and negative feedback mechanisms of estrogen. (2017)
• Enumerate the benefits of breastfeeding and explore the reasons behind amenorrhea during lactation. (2014)
• Provide a concise discussion on the involvement of various hormones in lactation. Explain the significance of amenorrhea during lactation. (2012)
• Outline the steps involved in lactation and elaborate on the advantages of breastfeeding. (2010)