Milk Production and Breastfeeding

Each breast has approximately twenty lobes, which consist of lobules divided into alveoli and ducts.  The alveoli contain milk-producing acini cells surrounded by myoepithelial cells which contract and propel milk from the breast.  Smaller lactiferous ducts carry milk from the alveoli and empty into one large duct that widens to create a lactiferous sinus or ampulla near the nipple.  Lactiferous tubules emerge at the surface of the nipple and release milk from the breast.  The nipple is comprised of erectile tissue which contracts during nursing to control the flow of milk.  Oxytocin stimulates the letdown of milk but prolactin is responsible for milk production. 

There are numerous keys to successful breastfeeding.  First is to obtain an asymmetric latch, in which a greater portion of the areola is taken in at the lower jaw than at the top of the mouth. This positions the nipple deeply into the baby’s mouth so the sucking reflex can be most effective.  This latch also frees the baby’s nose for easy breathing.  The second is for the mother to be relaxed during breastfeeding and allow for frequent, long and peaceful nursing sessions.  This enables a greater release of oxytocin and prolactin and in turn, increased milk production. Lastly, the mother should let go of inhibitions and trust her body.  Breastfeeding is an intimate act that requires privacy and is a physically demanding activity.  Needs for rest, good nutrition, privacy and support are paramount. 

Engorgement is visually evident and results from more milk than the baby immediately needs.  It may occur when the milk first comes in or when the baby skips a feeding.  Although uncomfortable, it will resolve spontaneously as supply adjusts to demand.  To help with engorgement, ensure you are nursing on demand and with proper positioning for asymmetric latch.  Soaking breasts in warm water can stimulate the release of any backed-up milk.  Twenty-minute compresses repeated throughout the day with steamed, fresh comfrey leaves or strong tea can stimulate the flow of milk.  Whole, raw cabbage leaves may also be used and left on until they soften.  For lingering engorgement, try hot ginger compresses under the arms or in the upper outer quadrants of the breasts.  To further assist, try hand expressing milk by oiling the breasts and use long strokes from the collar bone towards the nipple, both above and below the breast.  Grasp the edges of the areola, press inward, squeeze together and pull toward the nipple.  If the breasts are full, tender and hot to the touch, getting the baby to nurse or expressing milk is crucial.  Homeopathic remedies of bryonia 30C and phytolacca 30C can be taken, alternating every twenty minutes until engorgement symptoms resolve.  Echinacea tincture (a half drop per pound of body weight) can be taken several times a day to prevent mastitis.

Mastitis occurs when milk is left pooled in the sacs, particularly a residual amount remaining time after time.  This may cause a breeding ground for bacteria entering through the nipple.  Personal cleanliness is important in preventing mastitis along with proper positioning, proper latch and relaxed and thorough on-demand nursing.  A healthy immune system maintained by adequate rest, adequate fluids and calories is critical.  Mastitis is characterized by reddening of the breast, in lumpy areas or in streaks, and a fever of 103 or 104.  Engorgement or lumpy soreness accompanied by a rising fever can be resolved with Homeopathic remedy belladonna 30C taken every twenty to thirty minutes until fever reduces to normal.  Nursing or expressing congested milk is key.  Coating the breasts in aloe vera helps reduce the risk of secondary infection.  Echinacea tincture also helps to heal mastitis.  It is key to stay well hydrated, well-nourished and get adequate rest.  Heat treatments, herbal or homeopathic remedies and rest may resolve borderline cases but with a high fever, antibiotics are necessary.  Timely treatment is critical to prevent an abscess.