Obstetrics and Gynaecology · MU Sofia

14. Lactation. Breast care in pregnancy and lactation

Explains how lactation is physiologically controlled across pregnancy and after delivery, covering the roles of oestrogen, progesterone, prolactin and oxytocin, and the sequence of colostrum, transitional and mature milk. Includes a table of benefits for the baby and the mother, a table of common breast problems with their management, and a list of situations where breastfeeding is not advised, with a note on suppressing lactation.

Inside: 4 sections · 2 tables · 16 flashcards · 2 min

Topic 14 of 61 in the MU Sofia syllabus for Obstetrics and Gynaecology (Dental Medicine, Year 4). The free AceMed note covers it in 4 sections, about 217 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Physiology of lactation
  3. Benefits
  4. Breast care

Introduction

Breast milk is the ideal food for the newborn. WHO recommends exclusive breastfeeding for 6 months and continued breastfeeding with other foods to 2 years or beyond.

Physiology of lactation

  • In pregnancy: oestrogen grows the ducts, progesterone the alveoli; prolactin and hPL prepare secretion, but high progesterone blocks milk production.
  • After delivery of the placenta progesterone falls, and prolactin starts milk secretion (lactogenesis II, "milk coming in" on days 2–4).
  • Suckling keeps prolactin high (milk production) and releases oxytocin (milk ejection, "let-down"); oxytocin also contracts the uterus, so breastfeeding helps involution.
  • Production follows demand: frequent, effective emptying is what keeps the supply.

Milk

  • Colostrum (first days): rich in protein and IgA, yellow, small volume.
  • Transitional milk, then mature milk from about 2 weeks.

Breast care

  • Pregnancy: no special preparation needed; check for flat or inverted nipples.
  • Early skin-to-skin contact and first feed within the first hour; feed on demand, 8–12 times a day.
  • Correct latch (mouth wide, lower lip turned out, more areola below than above) prevents sore and cracked nipples.

Problems

When not to breastfeed

Maternal HIV where safe formula is available (otherwise breastfeeding with antiretroviral therapy), active untreated TB, chemotherapy, some drugs (e.g. lithium, amiodarone), illicit drugs, galactosaemia in the baby. Lactation can be suppressed with cabergoline.

Prolactin makes the milk and oxytocin lets it down: frequent suckling drives both.

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