PHYSIOLOGY OF LACTATION

Although lactation starts following delivery the preparation for effective lactation starts during pregnancy. The physiological basis of lactation is divided into 4 phases 1. 2. 3. 4. Preparation of breast (Mammogenesis) Synthesis and secretion from breast alveoli (Lactogenesis) Ejection of milk (Galactogenesis) Maintainence of lactation (Galactopoiesis)

Lactation (secretion of milk) is the end result of many interacting factors , including the development of the breast tissue and the duct system , primarily under the influence of hormones estrogen, progesterone and human placental lactogen (HPL) The endocrine control in relation to different phases of lactation Mammogenesis: Pregnancy is associated with a remarkable growth of both the ducteal and lobular alveolar systems. An intact nerve supply is not essential for the growth of the mammary gland during pregnancy Lactogenesis: Though some secretory activity is evident (colostrums) during pregnancy and accelerated following delivery, milk secretion starts on 3rd or 4th of post partition day. Around this time ,the breast engorged ,tense, tender and feel warm in spite of high prolactin level during pregnancy ,milk secretion is kept in abeyance. Probably, the steroids the estrogen and progesterone circulating during pregnancy make the breast tissues irresponsive to prolactin. When the estrogen and progesterone are withdrawn following delivery, prolactin begins its milk secretory activity is enhanced directly or indirectly by growth hormone ,thyroxin , glucocorticoids and insulin. For milk secretion to occur nursing effort is essential.

LACTATION REFLEXION ARC AND THE ROLE OF PROLACTIN AND OXYTOCIN

CEREBRAL CORTEX

HYPOTHALAMUS

PITUITARY GLAND

PROLACTIN TO AFFERENT ALVEOLAR CELLS

OXYTOCIN

OF MAMMARY GLAND

SUCKLING MILK

SPINAL CORD T4, 5,6

PUERPERAL UTERUS INVOLUTION

GI HORMONES GI MOTILITY

Galactokinesis: Discharge of milk from mammary glands depends not only on the suctions exerted by the baby during sucking but also on the contractile mechanism which express the milk from the alveoli into the ducts During sucking, a conditional reflex is set up : The ascending tackle impulses from the nipple and areola pass via thoracic sensory (4,5,and6) afferent neural are to the Para ventricular and supra optic nuclei of the hypothalamus to synthesize and transport oxytocin to the posterior pituitary . Oxytocin (efferent are via blood) which is liberated from the posterior pituitary, produces contraction of the myoepithileal cells of the alveoli and the ducts containing the milk. This is the milk ejectionor milk let down reflex where by the milk is formed down into the ampula of the lactiferous duct ,where from it can be expressed by the mother or sucked out by the baby .Presence of the infant or infants cry can induce the let down without sucking .A sensation of rise of pressure in the breast by milk experienced by the mother at the beginning of sucking called drought .This can also be produced by the injection of oxytocin . The milk ejection reflex is inhibited by factors such as pain, breast enlargement or adverse psychic conditions .The ejection reflex may be deficient for several days following initiation of milk secretion and results in breast enlargement Galactopoiesis: Prolactin appears to be the single most important galactopoietic hormone. For maintenance of effective and continuous lactation,sucking is essential . It is not only essential for the removal of milk from the glands but it also causes the release of prolactin. Secretion is a continuous process unless suppressed by congestion or emotional disturbances .Milk pressure reduces the rate of production and hence periodic breast feeding is necessary to relieve the pressure which in turn maintains the secretion.