Insufficient milk supply / lactation failure

What it is

Two different failures sit under this title. The first is failure of lactation as a presenting feature of Sheehan's syndrome, which occurs after delivery due to severe bleeding; there the failure is of prolactin. The second is a feed that is never properly established. Its name in the material is insufficient breastfeeding, and it is what causes breastfeeding jaundice, a type of neonatal jaundice.

The normal physiology it fails against

Among the needs to be met in pregnancy is growth of the breasts for lactation. The pituitary gland enlarges due to proliferation of prolactin-secreting cells, and prolactin levels are increased, ten times higher at term, to prepare the breasts for lactation.

Progesterone, a placental hormone, does two things here that pull against each other: it stimulates the glandular comp. of breast, and it suppresses lactation till parturition. So the feed does not begin before the placenta is delivered.

Preparation for lactation is itself a named item of health education before delivery. At the fourth visit, 28-30 weeks, the health education covers danger signs, preparation for lactation and fetal movement; at the sixth visit, 36-38 weeks, it covers caring of the newborn baby, breast feeding and birth spacing methods. The first visit at booking already includes a breast examination.