10.14: Pregnancy and Lactation
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A mother's milk is ideal because it meets the baby's specific needs. Lactation is a neuroendocrine response in milk production. Sucking stimulates the sensory nerve endings in the nipples and sends stimulus to the hypothalamus. The hypothalamus stimulates the anterior pituitary and prolactin is released. In milk let-down, the sucking stimulates sensory nerves in the nipples. This stimulates the hypothalamus which then stimulates the posterior pituitary and releases oxytocin. Sucking also stimulates contraction of the cells around the alveoli in the mammary cells. Milk then flows into the milk ducts causing milk let-down.
Breast milk provides all the nutrients required for the first 4-6 months. It contains carbohydrates (such as lactose), fats (such as linoleic acid), and easily digestible proteins (such as alpha-lactalbumin). Breast milk also contains an adequate supply of vitamins and minerals, digestive enzymes, hormones and immunological factors.
The first milk produced after birth is called colostrum. This is synthesized during the end of pregnancy and 3-5 days of postpartum. It is very high in protein and low in fat and carbohydrates, and contains immunoglobulins. This helps the baby have a first bowel movement and prevent jaundice. This bowel movement from the colostrum is a different color and consistency of bowel movements once the mother's milk comes in.
The composition varies in breast milk during feeding, and over time with development of the baby. When breastfeeding, there are three names for the composition of the milk: the fore milk, present during the beginning of breastfeeding; mid is the middle of feeding; and hind which is toward the end of the feeding and contains a composition high in fat.
When breastfeeding the mother should consider the types of food that will be consumed. If the mother is on a low fat diet, or if foods like garlic, broccoli, and onions are eaten, it may affect the baby's preference for breastfeeding. Also, the mother should consider not breastfeeding after the consumption of alcohol, caffeine, smoking, and certain medications.
Some barriers to breastfeeding have been identified as lack of professional and social support, misinformation, embarrassment, early discharge from the hospital without instruction, and returning to work or school without adequate lactation rooms.
When breastfeeding, initiate as soon after delivery as possible, position the baby correctly, feed on demand from both breasts at each feeding and at least 10 minutes on each breast. Additionally, there should be a good educator in the case the infant is not latching on.
A common problem that may happen when breastfeeding is mastitis, which is an inflammation of one or both breasts, and is usually associated with the infection of a blocked milk duct during lactation. The symptoms include flu-like symptoms, red streaks on the breast, and hot skin. Antibiotics may be necessary to clear the infection. Thrush, a fungal yeast infection, may also happen, and could be passed between mom and baby. A symptom of thrush includes white flecks on the tongue; in this situation the baby and mother should be treated by a doctor.
Breast milk is recommended through the first 12 months. Supplementation of cow's milk is not recommended, due to the high amount of protein that would cause liver damage to the baby.
Why breastfeed?
- It is easily digested
- Composition changes with infant needs
- Changes during a feeding, high in fat at the end of feeding
- Antibodies in milk
- Breastfeeding moms miss less work because babies are sick less
- Fewer allergies
- Less spit-up
- Less constipation and diarrhea
- Better jaw development
- Decreased risk of SIDS (Sudden Infant Death Syndrome)
- Higher IQ
- Decreased risk of diabetes, Crohn's Disease, Celiac Sprue
- Bonding
- Convenient, always at the correct temperature and ready to go
- Less expensive
- Helps the uterus return to normal size more quickly
- Less incidence of postpartum “blues”
- Lower risk of breast cancer
- Lower risk of osteoporosis
- It is free
Before I had my son, I would have described myself as a woman who was very in touch with her sexuality. It was an integral part of my identity that I took pride in. Then, I became a mother. Overnight, my body was no longer my own. For 10 months, I had another life growing inside of me. After he was born, my breasts became my son’s primary source of food and comfort, and my body was unrecognizable in the mirror. Every thought in my mind related to my son, who was physically on my body all day and much of the night for the first year of his life. I had zero sex drive. In addition to the transition I was undergoing internally, the way the world treated me felt different. The rules for how I was supposed to conduct myself publicly seemed to have shifted. I remember my first summer as a mother, getting my then 9 month old ready to go to the park. I tried on my favorite pre-baby denim short-shorts, but ultimately couldn’t stomach the thought of wearing them in public while with my son. I remember feeling uncomfortable at the idea of baring myself in a way that might be perceived as sexual, when my body currently belonged to a being so pure and innocent. Now more than two and a half years into my motherhood journey, I am beginning to reconcile the woman I used to be with my identity as somebody’s mother. I have exited the period of extreme enmeshment that comes with having a newborn and breastfeeding. I have also come to realize that I fundamentally reject the idea that a woman cannot be both a good mother and a sexual being. After all, I wouldn’t be a mother if not for my sexuality. And as a mother to a young boy, I feel it is important to teach him that mothers are whole human beings (who can wear whatever they want!).
Juliana Garcia