Written by : Dr.M.D.Mazumdar, MD
The breasts increase greatly in size during pregnancy as they prepare for the important function of feeding the baby after childbirth.
The ducts and glands proliferate in size, the blood supply increases and more fat gets deposited around the glandular tissue. The breast acini, which are small threadlike cells, develop into larger cells, fully capable of producing milk from the mother's blood. So, the breasts are also called the Accessory Organs of Reproduction.
The World Health Organisation WHO recommends early initiation of breastfeeding (i.e. within one hour of giving birth) .
The breasts begin to secrete a thin yellowish fluid called the colostrum in the later weeks of pregnancy. Colostrum is also secreted during the first 3-4 days after delivery. It is ideal as the baby's first food since it contains all the various food ingredients in the right proportion for easy digestion.
It is necessary to feed the baby often during this stage as the amount of colostrum secreted is less in amount.
Actual milk formation and secretion starts from the 3rd-4th day of the postpartum period. The breasts may become engorged, tense and tender when the milk first comes in, but once regular suckling is established, the breast engorgement passes off.
The Let down reflex occurs when a baby is put to the breast. The baby's suckling stimulates minute nerve endings in the nipples. These send a reflex to the pituitary gland which responds by secreting two important hormones - oxytocin and prolactin.
Prolactin causes milk to form in the alveolar cells in the breast from the circulating blood. Oxytocin contracts the cells to push out the milk through the nipples
Somce women feel pain in the breast when the let down reflex starts. others may feel a tingly sensation. Most have no symptoms at all.
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The baby can be fed in more than one position to distribute the suckling pressure - the different positions are shown in the images below. The mother should choose whichever position she finds most comfortable.
Women who are breastfeeding should not take birth control pills containing estrogen. Estrogen can affect the quality and quantity of the milk. The risks for blood clots are also high in the first 4 weeks after birth of the baby. If at all a birth control pill is needed, then progestin only pills like the Minipill should be taken.
The standard treatment is to apply an anti-yeast medicines to the breast. Anti-yeast suspension should also be painted inside the baby's mouth to prevent recurrence of the infection.
It may also be necessary to avoid breastfeeding at this time from the affected breast. The excess milk should be pumped out. Breastfeeding can be resumed once the soreness decreases.
Production of milk continues as long as suckling continues. It starts to decrease when breastfeeding stops and may stop completely in 4 - 6 months after stopping breastfeeding. But the breast will start producing milk again if suckling occurs again at any time of the woman's life.
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