How is the continuation of lactation maintained

This stage requires prolactin and oxytocin. By the fifth or sixth month of pregnancy, the breasts are ready to produce milk. This is when the breasts make colostrum, a thick, sometimes yellowish fluid. At this stage, high levels of progesterone inhibit most milk production.

At birth, prolactin levels remain high, while the delivery of the placenta results in a sudden drop in progesterone, estrogen, and human placental lactogen levels. This abrupt withdrawal of progesterone in the presence of high prolactin levels stimulates the copious milk production of the lactogenesis II stage.

When the breast is stimulated, prolactin levels in the blood rise and peak in about 45 minutes, then return to the pre-breastfeeding state about three hours later. The release of prolactin triggers the cells in the alveoli to make milk. Colostrum is the first milk a breastfed baby receives. Secretory IgA also helps prevent food allergies. The All Our Babies pregnancy cohort: design, methods, and participant characteristics.

BMC Pregnancy Childbirth. Lancet London, England ; — Elective cesarean delivery: does it have a negative effect on breastfeeding? Hutton EK, Kornelsen J. Elective cesarean section and decision making: a critical review of the literature. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Predictors of delayed onset of lactation. Matern Child Nutr. The health implications of birth by Caesarean section. Biol Rev.

Radtke JV. The paradox of breastfeeding-associated morbidity among late preterm infants. J Obstetric Gynecologic Neonatal Nursing. Contact between mother, child and partner and attitudes towards breastfeeding in relation to mode of delivery.

Sex Reprod Healthc. A practical classification of newborn infants by weight and gestational age. J Pediatr. Download references. We are extremely grateful to the participants involved in the All Our Babies cohort, and to the All Our Babies staff and research team. We are extremely grateful to the investigators, co-ordinators, research assistants, graduate and undergraduate students, volunteers, clerical staff, and managers.

The University of Calgary has provided trainee salary support. Alberta Innovates Health Solutions provided funding towards this cohort and salary support for Suzanne Tough. You can also search for this author in PubMed Google Scholar. Correspondence to Amy J. SCT is responsible for the overall integrity, progress, questionnaire development and timely completion of the AOB study. AJH and MB performed the literature review.

SWM performed the statistical analysis. AJH drafted and revised the manuscript. All authors contributed to data interpretation, read and approved the final manuscript.

Reprints and Permissions. Hobbs, A. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth 16, 90 Download citation.

Received : 05 June Accepted : 19 April Published : 26 April Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Research article Open Access Published: 26 April The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum Amy J.

Hobbs 1 , Cynthia A. Mannion 2 , Sheila W. Abstract Background The caesarean section c-section rate in Canada is Results More women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding 7.

Conclusions We found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Background The rate of caesarean section c-section in Canada has increased from Table 1 Comparison of demographic and labour and delivery characteristics between vaginal deliveries, emergency c-sections and planned c-sections Full size table.

Table 2 Comparison of breastfeeding success and outcomes between vaginal deliveries, emergency c-sections and planned c-sections Full size table. Table 3 Unadjusted and adjusted logistic regression model of mode of delivery on breastfeeding duration to weeks postpartum Full size table. Discussion Our findings demonstrate that planned c-sections are associated with reduced breastfeeding success in the first 4 postpartum months, when compared to vaginal births.

Limitations Our study reflects the demographics of urban Calgary predominately caucasion, highly educated and of a higher SES ; however, generalizability to other populations should be interpreted with this in mind. Conclusion Our study suggests that c-sections are associated with more breastfeeding difficulties, greater use of resources, and shorter breastfeeding duration compared to vaginal deliveries. References 1. Google Scholar 2.

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Accessed 20 Sep Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: National Surveys in Taiwan. Reasons for earlier than desired cessation of breastfeeding. Whalen B, Cramton R. Overcoming barriers to breastfeeding continuation and exclusivity. Curr Opin Pediatr. PubMed Google Scholar. Determinants of exclusive breastfeeding in an urban population of primiparas in Lebanon: a cross-sectional study.

BMC Public Health. The motivational determinants of breast-feeding: predictors for the continuation of breast-feeding. Prev Med. Individual net-benefit maximization: a model for understanding breastfeeding cessation among low-income women. Matern Child Health J. Perceived infant feeding preferences of significant family members and mothers' intentions to exclusively breastfeed. J Hum Lact. Global Targets Accessed 24 May Health Promotion Administration. Maternal health booklet. Cultural factors and social support related to breastfeeding among immigrant mothers in Taipei City, Taiwan.

Why mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first year. Why Chinese mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first six months.

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Breastfeed Med. Knowledge, attitudes, and breast feeding practices of postnatal mothers: a cross sectional survey. Int J Health Sci Qassim. For these reasons, trimester-specific values for hemoglobin and hematocrit are proposed for screening for anemia in pregnant women 6. Estrogens are responsible for these changes in plasma proteins, which can be reproduced by administration of estradiol to nonpregnant women. The average weight gained by healthy primigravidae eating without restriction is This weight gain represents two major components: 1 the products of conception: fetus, amniotic fluid and the placenta and 2 maternal accretion of tissues: expansion of blood and extracellular fluid, enlargement of uterus and mammary glands and maternal stores adipose tissue.

Low weight gain is associated with increased risk of intrauterine growth retardation and perinatal mortality. High weight gain is associated with high birth weight and secondarily with increased risk of complications related to fetopelvic disproportion.

A large body of epidemiologic evidence now shows convincingly that maternal prepregnancy weight-for-height is a determinant of fetal growth above and beyond gestational weight gain. At the same gestational weight gain, thin women give birth to infants smaller than those born to heavier women.

Because higher birth weights present lower risk for infants, current recommendations for weight gain during pregnancy are higher for thin women than for women of normal weight and lower for short overweight and obese women 7.

These recommendations are summarized below Table 1. Data from Institute of Medicine 7. BMI, body mass index. Recommendations for weight gain during pregnancy were formulated in recognition of the need to balance the benefits of increased fetal growth against the risks of labor and delivery complications and of postpartum maternal weight retention. The target range for desirable weight gain in each prepregnancy weight-for-height category is that associated with delivery of a full-term infant weighing between 3 and 4 kg.

Determination of nutrient needs during pregnancy is complicated because nutrient levels in tissues and fluids available for evaluation and interpretation are normally altered by hormone-induced changes in metabolism, shifts in plasma volume and changes in renal function and patterns of urinary excretion. Nutrient concentrations in blood and plasma are often decreased because of expanding plasma volume, although total circulating quantities can be greatly increased.

Individual profiles vary widely, but in general, water-soluble nutrients and metabolites are present in lower concentrations in pregnant than in nonpregnant women whereas fat-soluble nutrients and metabolites are present in similar or higher concentrations. Homeostatic control mechanisms are not well understood and abnormal alterations are ill-defined.

Dietary Reference Intakes for pregnant and lactating women in comparison with those of adult, nonreproducing women are presented in Table 2. Also presented in Table 2 are comparative cumulative energy and nutrient expenditures of adult, pregnant and lactating women.

The recommended intakes for pregnant adolescents generally would be increased by an amount proportional to the incomplete maternal growth at conception.

The percentage increase in estimated energy requirement is small relative to the estimated increased need for most other nutrients. Accordingly, pregnant women must select foods with enhanced nutrient density or risk nutritional inadequacy. Comparison of recommended daily energy and nutrient intakes and cumulative expenditures of adult, pregnant and lactating women.

Values are from the Institute of Medicine 9 — Calculations are based on recommended intakes per day, assuming 9 months is equivalent to Because total energy expenditure does not change greatly and weight gain is minimal in the first trimester, additional energy intake is recommended only in the second and third trimesters.

Approximately an additional and kcal are recommended during the second and third trimesters, respectively. The assessment of vitamin and mineral status during pregnancy is difficult because there is a general lack of pregnancy-specific laboratory indexes for nutritional evaluation. Plasma concentrations of many vitamins and minerals show a slow, steady decrease with the advance of gestation, which may be due to hemodilution; however, other vitamins and minerals can be unaffected or increased because of pregnancy-induced changes in levels of carrier molecules When these patterns are unaltered by elevated maternal intakes, it is easy to conclude that they represent a normal physiological adjustment to pregnancy rather than increased needs or deficient intakes.

Even when enhanced maternal intake does induce a change in an observed pattern, interpretation of such a change is difficult unless it can be related to some functional consequence For these reasons, much of our knowledge is based on observational studies and intervention trials in which low or high maternal intakes are associated with adverse or favorable pregnancy outcomes. Available data on vitamin and mineral metabolism and requirements during pregnancy are fragmentary at best, and it is exceedingly difficult to determine consequences of seemingly deficient or excessive intakes in human populations.

However, animal data show convincingly that maternal vitamin and mineral deficiencies can cause fetal growth retardation and congenital anomalies. Similar associations in humans are rare. Selected vitamins and minerals that are likely to be limiting or excessive in the diets of pregnant women and their association with pregnancy outcome are briefly discussed.

Low maternal vitamin A status is inconsistently associated with intrauterine growth retardation in communities at risk for vitamin A deficiency. Overt vitamin A deficiency is not apparent in the United States; instead, the concern during pregnancy is about excess The main circulating form of vitamin D in plasma, hydroxycholecalciferol, is responsive to increased maternal intake and falls with maternal deficiency.

The biologically active form of the vitamin, 1,dihydroxycholecalciferol, circulates in bound and free forms and both are elevated in pregnancy All forms of vitamin D are transported across the placenta to the fetus.

Vitamin D deficiency during pregnancy is associated with several disorders of calcium metabolism in both the mother and her infant, including neonatal hypocalcemia and tetany, infant hypoplasia of tooth enamel and maternal osteomalacia The prevalence of vitamin D deficiency is high in pregnant Asian women in England and in pregnant women in other European countries at northern latitudes, where the amount of ultraviolet light reaching the earth's surface is not sufficient for synthesis of vitamin D in the skin during winter months.

Food sources of vitamin D are few and no increase in vitamin D intake during pregnancy is recommended 9. Research is needed to assess vitamin D requirements of women of reproductive age, the extent to which the diet or light exposure can furnish needed amounts and the possible benefit of supplemental quantities before and during pregnancy. Compromised maternal folate intake or status is associated with several negative pregnancy outcomes including low birth weight, abruptio placentae, risk for spontaneous abortions and neural tube defects Folic acid supplementation prevents both the occurrence and recurrence of neural tube defects 24 and significantly reduces the incidence of low birth weight Previously, folic acid supplementation was started relatively late in pregnancy but now in the United States, the Food and Drug Administration requires folic acid fortification of most grain products, and intakes have dramatically increased.

It will be important to evaluate the extent to which folic acid fortification increases intake of reproducing women, decreases neural tube defects and affects growth and development of the fetus.

The total iron cost of pregnancy is estimated at mg, of which mg are retained by the woman when blood volume decreases after delivery and mg are permanently lost.

Hemoglobin concentration declines during pregnancy along with serum iron, percentage saturation of transferrin and serum ferritin.

Maternal anemia is associated with perinatal maternal and infant mortality and premature delivery. This level cannot normally be obtained from foods, and supplementation is required to achieve recommended intakes. The routine use of iron supplements during pregnancy, however, is not universally endorsed. Another paper in this publication provides recent evidence supporting iron supplementation during pregnancy Maternal iodine deficiency leading to fetal hypothyroidism results in cretinism, characterized by severe mental retardation 3.

Thyroid hormones are critical for normal brain development and maturation. Manifestation of other features of cretinism deafmutism, short stature and spasticity depends on the stage of pregnancy when hypothyroidism develops.

When it develops late in pregnancy, the neurological damage is not as severe as when it exists early in pregnancy. Cretinism is prevented by correcting maternal iodine deficiency before or during the first 3 mo of pregnancy.