Breast feeding is instinctive and most mothers take to it naturally. However, a lot of mothers switch over to formulae at the slightest problem.
One of the most common causes cited for resorting to top feeds is inadequate milk production.
Primary lactation failure is an extremely rare event. Usually it is due to secondary causes.
In order to understand the factors associated with low milk production, let us first take a look at where and how milk is produced and how it reaches the baby and the factors that could affect the milk production at each stage.
Production and release of mother’s milk
Milk is produced in the glands present in the breast. This glandular tissue is embedded in fat, giving the breast the round contour and size. The amount of glandular tissue is similar in most women. Thus, the amount of milk production does not depend on the size of the breast.
When the baby suckles, his action stimulates nerve endings surroundings the nipple which carry the message to the pituitary gland in the brain. The gland then secretes the prolactin hormone, which passes through the mother’s bloodstream to the breast epithelial cells to produce milk. Thus, more frequent and vigorous suckling ensures more secretion of prolactin and more production of milk. Milk production is thus regulated by the baby’s demand.
Milk production depends on:
- Emptying of the breasts
- Expression of milk
- Night feeds
Factors that suppress prolactin production leading to low milk formation are as follows:
- Delayed feeding.
- Prelacteal feeds.
- Bottle feeding.
- Incorrect positioning of mother and baby.
- Painful breast conditions.
- Administration of certain drugs like L-Dopa, ergot preparation and large amounts of pyridoxine.
The ejection of milk from the breast or the milk ejection reflex works under the influence of a hormone oxytocin, which is secreted by the pituitary gland in response to the suckling stimulus. It reaches the mother’s breast through the blood stream. Oxytocin causes contraction of the smooth muscle cells in the breast, which ejects the milk through the nipple.
Some amount of oxytocin hormone can also be secreted by the stimulation of other sensory pathways. Thus, milk ejection or let down reflex may occur on seeing, touching, hearing, smelling or even thinking about the infant. On the other hand, if the mother lacks confidence in her ability to breast feed, worry, anxiety and embarrassment are some factors that may interfere with this reflex. Thus, the most common cause for failure of the ejection reflex is psychological inhibition.