Breastfeeding: Description, Hormones, and Stages of Lactogenesis (Nursing)

00:02 Are you ready to talk about newborn nutrition? Well, I'm ready.

00:05 And you're here.

00:06 So let's do it.

00:08 So there are several options for feeding the baby.

00:11 We can do breastfeeding.

00:13 Naturally, I want to take a minute and just talk about the word breastfeeding.

00:16 So breastfeeding is sort of our historical term, how we talk about feeding the baby with our breast.

00:21 But I want you to recognize that not everyone uses the word breastfeeding, because they don't call these breasts, they might say nursing, or they may say chest feeding.

00:30 So make sure that you talk to your client about what term they would prefer to use.

00:35 The other option, of course, is bottle feeding.

00:37 And I'm going to say this a several times during this lecture, recognize a bottle feeding is an option.

00:42 I'm going to tell you all about the benefits of breastfeeding.

00:45 But recognize there is a choice and parents have the right to do whichever they choose to do.

00:52 So let's first start off by talking about breastfeeding.

00:55 So I'm using breastfeeding globally.

00:57 Remember, nursing, chest feeding also works here.

01:01 So recommendations for breastfeeding from the American Academy of Pediatrics.

01:05 This is the organization that provides recommendations for pediatric care is that there's exclusive breastfeeding for the first 6 months of life.

01:13 And then after that, that we will use complementary feeding along with breastfeeding for the rest of that year.

01:21 Okay, first 6 months, breastfeeding only, 6 months to a year, complimentary feedings, so they get to eat table foods and baby foods and things like that.

01:31 But we'll continue breastfeeding.

01:34 Now let's look at the recommendations from the World Health Organization.

01:38 They give recommendations for the entire world.

01:41 They also recommend exclusive breastfeeding for the first 6 months of life.

01:46 However, after that, they recommend continue breastfeeding along with complementary foods for the first two years, that's much longer than one year, which is what we recommend here in the United States.

02:00 Why do you think that is? Well, because we know it's good for the baby.

02:03 And in some countries, there's a lack of really quality foods and things like that.

02:08 So getting breast milk actually helps to sustain the baby much longer than past that first year.

02:16 Let's break down the physiology of how we make milk.

02:20 So the pituitary gland actually releases prolactin.

02:24 Prolactin is a hormone.

02:26 Guess what it does? The word gives it away.

02:29 Prolactin.

02:32 Pro like I make it, I encourage it.

02:35 Lactin like lactose, like milk.

02:39 Prolactin.

02:40 So the pituitary gland is responsible for that.

02:43 We also have alveoli that are actually responding to the prolactin by increasing milk production.

02:49 So the pituitary gland releases prolactin, and the alveoli respond to that by increasing milk production.

02:57 So how do we get the release of prolactin in the first place? Well, the suckling of the baby.

03:02 So every time the baby goes to eat at the breast, that suckling stimulates prolactin.

03:08 Now here's the really interesting fact is that the suckling actually stimulates the milk for the next feeding.

03:14 So it's not an instant process.

03:16 And that's why we get into sort of a supply and demand process, we've got a suckle at the breast to get ready for the next feeding.

03:24 The other hormone we need to talk about is oxytocin.

03:28 Oxytocin is responsible for the let-down of the milk.

03:32 So remember, prolactin makes milk.

03:36 Oxytocin in this case is responsible for the let-down reflex.

03:40 Now, maybe you remember oxytocin from our lecture on labor because oxytocin stimulates uterine contractions, but it also stimulates the let-down of the milk.

03:52 So what does the oxytocin do? It actually causes the muscles around the areola to compress.

03:58 And that compression actually allows the milk ducts to evacuate the milk.

04:03 So one more time, prolactin responsible for making the milk and oxytocin is responsible for getting it out.

04:12 You got it.

04:14 I don't know if you remember.

04:16 But way back in our lecture on physiologic changes of pregnancy, I talked about the stages of lactogenesis, and I promised you that it would come up again.

04:25 Well, here it is today.

04:26 We're going to break down stage ll, lll and lV of lactogenesis right now.

04:31 So I have a graph here and I want to make sure it's clear to you.

04:35 So you see on the left side on the vertical axis, we're going to look at the stages of lactogenesis, and then on the horizontal axis, we'll look at when it occurs in pregnancies.

04:44 So we'll put those together and talk about what happens at each stage.

04:48 So stage l happens early in pregnancy around 16 weeks, and at this point, we have the beginning of the production of colostrum.

04:57 So remember, colostrum is that liquid gold.

04:59 We're going to talk more about that in just a minute.

05:02 Then when we get to stage ll, we get to secretory activation.

05:07 So this is when the mature milk comes in.

05:10 So this is around day 4 and it goes all the way up to day 10.

05:15 Then at day 10, we have Galactopoiesis.

05:18 And at this point, the milk is well established, the baby is suckling, and we're getting a good feedback between supply and demand.

05:26 So everything is just moving along really smooth.

05:29 And then we get to the end of our lactation, when we get to the time where the birthing person says, "You know what, it's time that we not breastfeed anymore." We are in stage lV.

05:40 So this is Involution.

05:42 So our milk supply is going to go down because we no longer have supply, no longer have demand.

05:49 Everything slows. That is stage lV.

05:52 So one more time, stage l of lactogenesis we are producing colostrum.

05:58 Stage ll is when we get into mature milk, it starts to be produced.

06:03 Stage lll is when we're enjoying a good feedback between supply and demand.

06:07 And stage lV is when we get a decrease supply because we're going to end the breastfeeding or nursing or chest feeding.

06:15 Remember, lose terminology there.