BREAST MILK

Breast milk production, commonly referred to as lactation, involves a series of physiological changes in the breasts. Here's an explanation of the symptoms or signs that milk is coming in during the postpartum period:

• Growth in breast volume: One of the early signs that milk is coming in is an increase in breast size and volume. The breasts may become fuller and feel heavier as they prepare to produce milk.

• Local heat: Some women may experience a sensation of warmth or localised  heat in their breasts as milk production begins. This is often due to increased blood flow to the breast tissue.

• Tingling sensation in the nipple and areola: As milk production ramps up, some women report a tingling or pins-and-needles sensation in their nipples and areolas. This sensation is often referred to as the "let-down reflex" and can occur when the baby begins to nurse or when a breast pump is used.

• Breast fullness and firmness: The breasts may become notably full and firm as milk production increases. This fullness can sometimes be uncomfortable or even painful, but it typically subsides as the baby feeds and milk is expressed.

• Leakage: Many women experience leakage of milk from their breasts during the postpartum period. This leakage can occur spontaneously or in response to various stimuli, such as hearing a baby cry or having a full breast. Nursing pads or breast pads can help manage this leakage.

Several types of milk are produced in the mammary gland, which are: 

• Pre-colostrum: Pre-colostrum milk, also known as early milk, is produced in the final stages of pregnancy, preparing the breasts for milk production. 

• Colostrum: Colostrum is the first type of breast milk produced in the initial days after childbirth. It is often referred to as "liquid gold" due to its high concentration of nutrients and protective properties. Colostrum is rich in antibodies, proteins, vitamins, and minerals, which help provide essential nutrition and support the baby's immune system. It also has a laxative effect that helps the baby pass meconium, the first stool.

• Transitional Milk: As colostrum transitions into mature milk, it becomes known as transitional milk. This type of milk is produced in the days following childbirth and contains a mix of colostrum and mature milk components. It is higher in volume and continues to provide important nutrients and immune support.

• Mature Milk: Around two weeks after childbirth, mature milk is established. Mature milk is further divided into two main types:

Foremilk: This is the milk that is available at the beginning of a breastfeeding session. It is relatively thinner and quenches the baby's thirst due to its higher water content.

Hindmilk: As the breastfeeding session progresses, hindmilk becomes available. It is richer in fat and calories, providing the baby with essential energy and helping with weight gain.

When a baby suckles milk,  the hormones oxytocin and prolactin are released. Milk originates from the alveoli that is triggered by the hormones and releases milk.

Medical treatment to stimulate or enhance breast milk production may be considered in certain situations when breastfeeding difficulties arise. Here's an explanation of the medications:

• Sulpiride: Sulpiride is a medication that belongs to the class of drugs known as antipsychotics. It has a dopamine-blocking effect and can sometimes be prescribed off-label to increase milk production in breastfeeding women. It works by increasing prolactin levels, a hormone responsible for milk production. Sulpiride should only be used under the guidance and supervision of a healthcare provider, and its use for breastfeeding purposes should be carefully considered based on individual circumstances.

• Metoclopramide: Metoclopramide is a medication that primarily affects the gastrointestinal system but also has the side effect of increasing prolactin levels. It is sometimes prescribed to stimulate milk production in breastfeeding mothers who are experiencing low milk supply. However, its use can be associated with side effects, and its benefit should be weighed against potential risks. It should be used under the guidance of a healthcare provider.

• Domperidone: Domperidone is another medication that can stimulate milk production by increasing prolactin levels. It is often used off-label for this purpose when other methods have not been successful or when there are concerns about low milk supply. Domperidone may have fewer central nervous system side effects compared to metoclopramide and is sometimes preferred for this reason. Like other medications, it should be used under medical supervision.

Natural methods and strategies to promote breast milk production and breastfeeding success can be beneficial for many women. Here's an explanation of the natural treatment options:

• Gently massage breasts: Gentle breast massage can help stimulate milk flow and relieve breast engorgement. It can be done before or during breastfeeding or pumping to encourage milk ejection.

• Use a breast pump: Breast pumping can be an effective way to express milk and maintain or increase milk supply. Pumping can be especially helpful for mothers who need to establish or boost milk production.

• Breastfeed frequently: Frequent breastfeeding sessions, often referred to as "cluster feeding," can help stimulate milk production. Nursing on demand allows your baby to signal when they are hungry and helps establish a strong milk supply.

• Reduce stress levels: High stress levels can interfere with milk production. Practising relaxation techniques such as deep breathing, meditation, and mindfulness can help reduce stress and promote a more relaxed breastfeeding experience.

• Nurse on both sides: Offering both breasts during each feeding can help ensure that your baby receives both foremilk (lower-fat milk at the beginning of a feed) and hindmilk (higher-fat milk toward the end of a feed). This can provide optimal nutrition and help maintain milk supply.

• Apply warm compresses to breasts before feeding: Warm compresses can help relieve breast discomfort and encourage milk flow. Using a warm, damp cloth or a heating pad on your breasts before nursing or pumping can be soothing.

• Herbs like fenugreek, blessed thistle, and nettle: Some herbs are believed to have galactagogue properties, meaning they may help increase milk supply. Fenugreek, blessed thistle, and nettle are examples of herbs that some breastfeeding mothers have found beneficial. It's important to consult with a healthcare provider or lactation consultant before using herbs to ensure they are safe and appropriate for your situation.

• Relaxation: Creating a calm and peaceful environment for breastfeeding can enhance the breastfeeding experience. Find a comfortable and quiet place to nurse and try to focus on the bond between you and your baby.

• Stay well hydrated: Adequate hydration is essential for milk production. Drinking plenty of water throughout the day can help ensure that you are well-hydrated and can produce an adequate milk supply.

• Skin-to-skin contact with the baby: Skin-to-skin contact, also known as kangaroo care, can promote bonding between you and your baby and help stimulate milk production. Holding your baby skin-to-skin can also help regulate their body temperature and encourage breastfeeding.