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Expanding Clinicians' Roles in Breastfeeding Support: Continuing Medical Education (CME) Online Tutorial

  • Section 1
  • Section 2
  • Section 3
  • Section 4
  • Section 5
  • Section 6
  • Section 7
  • References
  • Post Test

Section 2: Breastfeeding Background

Mammary Gland Anatomy and Physiology

Physiology:15

Initiation of lactation is mediated by hormone release. Progesterone, prolactin, oxytocin and cortisol each play a role in milk production and lactation.

Progesterone:

  • High levels of progesterone maintain pregnancy and suppress milk production by inhibiting prolactin.
  • When the baby is born and the placenta is delivered, progesterone levels decrease.

Prolactin: (“Milk Production”)

  • Prolactin is produced in the anterior pituitary gland.
  • Prolactin is inhibited during pregnancy by progesterone.
  • Prolactin is stimulated by suckling and milk removal.
  • Prolactin secretion results in milk production.
  • Prolactin levels vary depending on time of day; they are highest after onset of sleep and early morning, and lowest at mid-morning.
  • Prolactin secretion is a drug target for medications to increase milk supply.
  • Prolactin Inhibitory Factor (PIF) is released from the hypothalamus and it inhibits prolactin release from the pituitary gland.

Oxytocin: (“Let-down”)

  • Oxytocin is produced in the posterior pituitary gland.
  • Infant suckling and nipple stimulation stimulate oxytocin secretion.
  • Oxytocin serves to cause milk ejection or “let-down” (the mother may sense this as a warm sensation or tingling in the breast).
  • Oxytocin also causes uterine contractions early in the postpartum period, shrinking the uterus to its pre-pregnancy state; mothers may experience uterine cramps when let-down occurs.

Cortisol:

  • Cortisol is produced in adrenal glands.
  • Cortisol is released in response to stress.
  • High levels of cortisol can delay lactogenesis while low levels and decreased stress improve breastfeeding.

After milk supply is well established, the amount of breast milk produced primarily a result of the supply and demand process. Nursing often in the first few days, and milk removal serves to up-regulate receptors and position the mother for a better supply longer term. Feedback inhibitor of lactation (FIL) is a protein in breast milk that is important in the supply and demand process of milk production; if the breasts are emptied regularly, there is less FIL present in the breast and more milk will be produced.

  • Previous
  • Milk Production
  • Breastfeeding Background
  • Milk Production
  • Composition of Milk
  • Risks of Not Breastfeeding for Infants
  • Risks of Not Breastfeeding for Mothers
  • When To Not Breastfeed
  • Benefits of Breastfeeding for the Population

Anatomy

breast anatomyThe Montgomery tubercles are not illustrated nor are the associated Morgagni glands that provide lubrication for the nipple and areola.12

  1. Chest wall
  2. Pectoralis muscle
  3. Lobules: Divisions in the breast (N=15-20 lobes) separated by connective tissue.
  4. Papilla Mammae (nipple): Elevated skin in the center of the areola containing multiple openings for milk ejection.
  5. Areola Mammae: Circular pigmented area that surrounds the nipple.
  6. Milk Ducts: Transportation system for milk release and ejection.
  7. Fat
  8. Skin

Health Resources in Action logo

Roger A. Edwards, ScD
Consultant
Massachusetts Department of Public Health
508-472-0406
rogeredwards2002@hotmail.com

Rachel Colchamiro, MPH, RD, LDN, CLC
Director of Nutrition Services
Nutrition Division
Massachusetts Department of Public Health
617-624-6153
rachel.colchamiro@state.ma.us

massachusetts department of health logo

Rachel Colchamiro, MPH, RD, LDN, CLC
Director of Nutrition Services
Nutrition Division
Massachusetts Department of Public Health
617-624-6153
rachel.colchamiro@state.ma.us

Ellen Tolan, RD, LDN, IBCLC
State Breastfeeding Coordinator
Nutrition Division
Massachusetts Department of Public Health
617-624-6128
ellen.tolan@state.ma.us

Julie Forgit, LDN, CLC
State WIC Breastfeeding Peer Counselor Program Coordinator
Nutrition Division
Massachusetts Department of Public Health
617-624-6139
julie.forgit@state.ma.us

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Susan Browne, MD
Breastfeeding Coordinator
MA Chapter
American Academy of Pediatrics
978-685-0977
brnfaap@mac.com

Mary Foley, RN, BSN, IBCLC
Lactation Program Coordinator
Melrose-Wakefield Hospital
Hallmark Health System
791-507-1980
mfoley@hallmarkhealth.org

Lucia Jenkins, RN, IBCLC, RLC
Melrose-Wakefield Hospital
Hallmark Health System
791-507-1980
luciansla@aol.com

Hallmark Health System logo

Lauren E. Hanley, MD, FACOG, IBCLC
Assistant Professor of Obstectrics, Gynecology
and Reproductive Biology
Harvard University School of Medicine
Massachusetts General Hospital
617-724-2229
lehanley@partners.org

Mary Ellen Boisvert, MSN, CLC, CCE
Six Sigma Black Belt
University of Massachusetts Dartmouth
Assistant Clinical Professor, College of Nursing
maryellen.boisvert@umassd.edu

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