Author: Gauri Kshirsagar

What is Lactogenesis or Lactation?

Lactogenesis is the onset of milk secretion and includes all of the changes in the mammary epithelium (breast glands) necessary to go from the undifferentiated (not developed) mammary gland in early pregnancy to full lactation sometime after delivery.

How does milk production i.e. Lactation occur in humans?

Lactation occurs in three stages:

Hormonally Driven	STAGE 1: Lactogenesis I	Occurs during pregnancy
		The Mammary (Breast) glands becomes sufficiently differentiated (develop) to secrete small quantities of specific milk components. In other words the glands are now ready to secrete milk.
		But  milk secretion is held back by high circulating plasma concentrations of progesterone
	STAGE 2: Lactogenesis II	Occurs after 30-40 hours after delivery
		Progesterone level decreases approximately 10-fold during the first 4 days after birth,  which leads to transfer to the infant of 500 to 750 mL/d of milk by day 5 postpartum.
Autocrine (Local) Control	STAGE 3: Established Lactation	Milk synthesis is controlled at the breast — milk removal is the primary control mechanism for supply. Milk removal is driven by baby’s appetite. Under normal circumstances, the breasts will continue to make milk indefinitely as long as milk removal continues.
		Although hormonal problems can still interfere with milk supply, hormonal levels play a much lesser role in established lactation.

Stage 1 and 2: occur whether or not a mother is breastfeeding her baby.

Stage 3: Milk secretion is directly related to duration and frequency of breastfeeding.

How does feeding the baby control milk production?

There are two mechanisms which will maintain the milk production in the breast:

1. Milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL) – the role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present).
2. The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites – thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through – thus rate of milk synthesis increases.

Both of the above factors support research findings that tell us:

How does milk supply vary throughout the day?

Earlier researchers observed that milk volume is typically greater in the morning hours (a good time to pump if you need to store milk), and falls gradually as the day progresses.

How can a mother make sure there is increased supply of milk to her baby?

To speed milk synthesis and increase daily milk production, the key is to remove more milk from the breast and to do this quickly and frequently, so that less milk accumulates in the breast between feedings. In practice, this means that a mother who wishes to increase milk supply should aim to keep the breasts as empty as possible throughout the day.To accomplish this goal and increase milk production:

1. Empty the breasts more frequently (by nursing more often and/or adding pumping sessions between nursing sessions)
2. Empty the breasts as thoroughly as possible at each nursing/pumping session.
3. To better empty the breasts:
4. Make sure baby is nursing efficiently.
5. Use breast massage and compression.
6. Offer both sides at each nursing; wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.
7. Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible)

What measures to be taken in case of oversupply?

Mothers who are working to remedy oversupply usually need to decrease supply without decreasing overall nursing frequency or weaning baby. One way to accomplish this is by “block nursing” – mom nurses baby as frequently as usual but restricts baby to one breast for a set period of time (often 3-4 hours but sometimes longer) before switching sides. In this way, more milk accumulates in the breast before mom switches sides (thus slowing milk production) but baby’s nursing frequency is not limited.

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