Lactation: establishment, complications, suppression and drug safety

Day 4, and the woman in bed 6 is crying before you reach her. Her nipples are cracked, her breasts are rock hard, the baby has lost 9 per cent of its birth weight and somebody has already suggested formula. Every single one of those problems is fixable in the next twenty minutes if you know what you are looking at. Lactation is not a "midwifery issue" you can defer — it is examinable, it is where women are failed, and it turns up in the oral as a communication station.^[2][1]

Overview and definition

Milk-making happens in three named phases, and knowing them tells you which problem you are solving. ^[1][17]

• Lactogenesis I — secretory differentiation in the second half of pregnancy. The gland is built and colostrum is present before birth.^[1]
• Secretory activation (lactogenesis II) — the "milk coming in" at roughly 30 to 72 hours after birth, triggered by progesterone withdrawal once the placenta is delivered. Delayed secretory activation means it has not happened by 72 hours.^[1][17]
• Galactopoiesis — maintenance. From this point supply follows demand, governed locally rather than centrally.^[1]

References19ShowHide

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