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Reasons for insufficient lactation

31 May 2019 - {{hitsCtrl.values.hits}}      

Breast milk is a nature’s gift to a newborn and it is the first specific and perfect nourishment which contains all the well-adjusted nutritious elements for the baby. This is because it produces optimum growth and development, and provides substantial protection from illness. 
Moreover, lactation is beneficial to a mother’s health and biologically supports a special mother and baby relationship. In ancient time, our mothers had intensively fed their babies with breast milk up to one to two years since most of them were housewives and had sufficient lactation. But with the passing of time the lactation period is shortening and as a result a child’s health becomes poor. Research studies have indicated that child health in South Asia is a major concern with a great number of malnourished children and approximately 43.6% of <5 years children are underweight in South Asia due to prominent reason of shorter and lack of breast feeding practices. In addition to that, some studies done in a rural area of  Sri Lanka found that 32% of the babies who are less than 03 months of age were fed on formula milk instead of breast milk. The World Health organization (WHO) recommends exclusive breastfeeding up to six months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Recently most of lactating women suffer from insufficient breast milk production and sometimes this modern life and food intake pattern may be highly affected because of this problem. Therefore, I decided to focus on this topic which let us to discuss the possible reasons for shorter lactating period.
Mechanism of breast milk production and secretion
The non-pregnant and non-lactating female breast is arranged primarily from adipose and collagenous tissue. Breast milk production begins between 10 and 22 weeks of gestation. Within 48 hours of delivery, the mother produces a small amount of milk, mainly colostrum and milk production is controlled by a complex interplay of hormones and neurotransmitters. Prolactin is secreted by the anterior pituitary in response to nipple stimulation. Near the 5th week of pregnancy, the level of circulating prolactin starts to increase and during pregnancy, prolactin and other hormones such as Insulin, cortisol and thyroid hormones stimulate the breasts anatomically for the milk secretion. However, estrogen, progesterone, and other placental hormones inhibit prolactin- mediated milk synthesis during pregnancy.  After delivery of the newborn, prolactin level drops sharply, but it is restored for a 1-hour spike during each feeding to stimulate the production of milk for the next feeding. With each prolactin spike, estrogen and progesterone also increase slightly.
The mammary gland comprises milk-transporting lactiferous ducts, which expand and branch extensively during pregnancy in response to oestrogen, growth hormone, cortisol, and prolactin. Moreover, in response to progesterone, clusters of breast alveoli bud from the ducts and expand outward towards the chest wall. Breast alveoli are balloon-like structures lined with milk-secreting lactocytes, that are surrounded by a net of contractile myoepithelial cells. Milk is secreted from the lactocytes, fills the alveoli, and is squeezed into the ducts.
When the infant suckles, sensory nerve fibres in the areola start a neuroendocrine reflex that results in milk secretion from lactocytes into the alveoli. The posterior pituitary releases oxytocin, which stimulates myoepithelial cells to squeeze milk from the alveoli so it can drain into the lactiferous ducts, collect in the lactiferous sinuses, and discharge through the nipple pores. It takes less than 1 minute from the time when an infant begins suckling until milk is secreted.
Composition of breast milk and importance
Breast milk contains both nutritional composition and non-nutritive bioactive factors.  The nutritional components of human milk derive from three sources; by synthesis in the lactocyte, dietary nutrient, and from maternal stores while there are two types of nutritional components namely macro (protein, fat, lactose and energy) and micro (vitamins, minerals and other bioactive factors) nutrients. There are several non-nutritive bioactive factors, which include cells, anti- infectious and anti-inflammatory agents, growth factors, and prebiotics that promote survival and healthy development, protect against infection and inflammation and contribute to immune maturation, microbial colonization of new born.
Insufficient breast milk production
Insufficient milk supply is one of the main reasons for breastfeeding discontinuation in these days while it was rare in the past. According to the past research studies, there are several causes which may be reason for insufficient breast milk production among lactating women.
1.  Hormonal causes
If mother’s placenta is failure to withdrawal of progesterone or reduced the level of prolactin release or other placental abnormalities such as increta (condition that occurs where the placenta deeply attaches into the wall of uterus). Moreover, gestational ovarian theca lutein cysts (type of ovarian cyst) that elevate testosterone levels and as a result of that suppress the milk production.
2.  Glandular causes
Insufficient glandular tissue is a very uncommon condition which known as Mammary hypoplasia,  that  can  cause  for  low  or  no  milk  production.  Women  with  mammary hypoplasia simply has not developed proper mammary tissue during adolescence, but their breasts may be small or large. Breast reduction or enhancement surgeries and nipple piercings also negatively effect on reduced breast milk production by damaging milk ducts in the nipple.
3.  Post glandular
Ineffective or infrequent milk removal and ineffective breastfeeding due to baby’s oral anatomy such as tongue tie. And also  birth injuries, breathing challenges, health or neurological issues, Caesarean birth, hypertension, anaemia and excessive blood loss.
4.  Use of hormonal birth control
Any form of hormonal birth control (the pill, patch or injections) can cause a significant drop in their milk for certain lactating women.
5.  Certain medications or herbs
6.  Others
Preterm birth, insulin dependent diabetes mellitus and gestational diabetes, metabolic status or health, obesity, older maternal age, stress, Thyroid imbalance or disease, Polycystic Ovary Disease, Luteal phase defect, smoking, food restriction and pregnancy.
Lactogenic food
Lactogenic food support lactation. Eating sufficient calories and getting more nutrients is helpful in itself for lactation, but these foods also contain substances that interact with and support the composition of lactation. These substances such as phytoestrogen, natural plant sedatives, plant sterols and saponins, and tryptophan, among others. Moreover, a rich supply of minerals and a good balance of fats ensure that the mother’s cells and nerves are functioning at an optimal level.
1. Carrot, Beet
2. Dark Green Leafy Vegetables
3. Grains and Legumes
4. Almonds, cashews
5. Oils and fats
6. Natural herbal root beverages and Barley water
7. Garlic
8. Oats
In conclusion, insufficient lactation is a major problem among lactating mothers in the newer generations. It can happen due to this modern living style, feeding habits etc. Hence, pregnant mothers have to pay attention to these factors during and after pregnancy since breast milk is the perfect food for newborn and it cannot be substituted by the other formulated food.
(The writer is a medical laboratory technologist at a private hospital and holds an MSc. Degree in Industrial and Environmental Chemistry from the University of Kelaniya and BSc. Food Production and Technology Management degree from the Wayamba University of Sri Lanka)