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Lactation
12
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35 Montgomery tubercles
in the areola are adapted
sebaceous glands that have been
described as looking rather like
goose-bumps
...
Box 12
...
So breast size is not an
important factor in breastfeeding
...
The period of time
during which a mother feeds her baby is known as breastfeeding or nursing
...
8
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35)
...
36)
...
A system of mammary ducts convey milk to the nipple to be stored in
ampullae (k Fig
...
23)
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37 Anti-infective agents
in breast milk protect against
infection by bacteria, viruses and
other microorganisms
...
g
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Fig
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23 Section through a lactating breast
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8
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This is a concentrated mixture of proteins, vitamins, growth
factors and antibodies that helps the newborn baby adapt to life outside the uterus in
the first few days of life (k Box 12
...
Colostrum, although small in volume, helps the
newborn to pass meconium (the first faeces which are black and sticky) and provides
protection through the transition from a sterile, intrauterine environment to life in the
outside world
...
8
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It is uniquely suited to the baby both in terms of nutritional content
and growth factors and its composition changes as the baby grows
...
By 4–6 weeks postpartum, human milk is considered to be fully mature
although small changes occur in its composition during the remainder of the
lactation
...
g
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12
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4 Milk ejection reflex
The hormone oxytocin is secreted by the hypothalamus and stored in the
posterior pituitary
...
This
signals the release of oxytocin into the bloodstream, where it stimulates the
muscles surrounding the breast to squeeze out the milk
...
8
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After
the delivery, these hormones fall away allowing prolactin to signal to the
breasts to make milk
...
12
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The areolar region of the breast contains densely packed sensory endings
– mechanoreceptors – and suckling by the baby stimulates them to send
signals (nerve impulses) to the hypothalamus, which triggers the release of
oxytocin from the posterior pituitary gland
...
There may be a number of letdowns during a breastfeed although mothers are not always aware of them
...
The reflex often takes
1–2 weeks to settle down and, after a first baby, it becomes a conditioned
(learned) reflex
...
g
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38)
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The early milk during
each breastfeed (foremilk) is a lower fat mixture, but the milk gradually
changes as the breast becomes less full, with the later portion (hindmilk)
being higher in fat and energy
...
38 Dysphoric milk ejection
reflex (D-MER) is an abnormality
of the milk ejection reflex that
produces a state of unease just
prior to milk ejection that can
continue for several minutes and
may also produce a hollow or
churning feeling in the pit of the
stomach
...
e
...
12
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increased suckling
causes the release
of more oxytocin
and prolactin