This is a wonderful chapter to study after Chapters 14 and 15 because it answers the next question:
“How does the mother nourish and protect her baby after birth?”
For a midwife, this is one of the most practical chapters in the book. You’ll use this knowledge during every postpartum visit.
Chapter 16 – Lactation and Infant Nutrition
- Read Coad, Anatomy & Physiology for Midwives, 4th edition, chapter 16.
- Write out your answers to Coad, Chapter Case Study, page 471.
- Create a Coad “Chapter 16 Study Sheet.” Include the following:
Learning Goals
□ Describe the anatomy of the breast.
□ Explain hormonal control of lactation.
□ Describe milk production and milk ejection.
□ Apply physiology to solving breastfeeding problems.
□ Explain maternal adaptations during lactation.
□ Describe why breast milk is the ideal infant food.
□ Explain the nutritional and immunologic advantages of human milk.
Essential Vocabulary
Breast Anatomy
- Lobes
- Lobules
- Alveoli
- Lactocytes
- Myoepithelial cells
- Lactiferous ducts
- Nipple
- Areola
- Montgomery glands
Hormones
- Prolactin
- Oxytocin
- Estrogen
- Progesterone
- Human placental lactogen (hPL)
- Feedback inhibitor of lactation (FIL)
Milk Production
- Lactogenesis I
- Lactogenesis II
- Lactogenesis III (galactopoiesis)
- Milk synthesis
- Milk ejection reflex
- Let-down reflex
- Supply and demand
Breast Milk
- Colostrum
- Transitional milk
- Mature milk
- Foremilk
- Hindmilk
Infant Feeding
- Rooting reflex
- Suck reflex
- Swallow reflex
- Latch
- Milk transfer
Immunity
- Secretory IgA
- Lactoferrin
- Lysozyme
- Oligosaccharides
- Beneficial microbiome
Draw
1. Hormonal Control of Lactation
Baby suckles
↓
Nipple stimulation
↓
Hypothalamus
↓
Pituitary
↓
Prolactin → Milk production
Oxytocin → Milk ejection
2. Supply and Demand
Frequent feeding
↓
Milk removed
↓
More milk produced
↓
Healthy supply
3. Milk Development
Pregnancy
↓
Colostrum
↓
Transitional milk
↓
Mature milk
Concepts I Must Know
| Concept | Importance |
|---|---|
| Prolactin | Makes milk |
| Oxytocin | Releases milk |
| Supply and demand | Primary regulator after birth |
| Colostrum | First milk |
| Secretory IgA | Passive immunity |
| Proper latch | Efficient milk transfer |
Processes I Must Understand
- Breast development during pregnancy
- Lactogenesis
- Milk production
- Let-down reflex
- Milk removal
- Hormonal regulation
- Infant feeding physiology
Midwifery Connections
| Concept | Why it Matters |
|---|---|
| Skin-to-skin | Promotes breastfeeding success |
| Early breastfeeding | Stimulates milk production |
| Deep latch | Prevents nipple trauma |
| Frequent feeding | Builds milk supply |
| Milk removal | Prevents engorgement |
| Oxytocin release | Contracts uterus and reduces postpartum bleeding |
| Colostrum | Provides concentrated nutrition and immune protection |
Clinical Connections
Be able to explain:
- Why babies should feed within the first hour.
- Why frequent feeding increases milk production.
- Why supplementation may reduce milk supply if it replaces breastfeeding without additional milk removal.
- Why a deep latch matters more than feeding duration.
- Why breast fullness is not always an indicator of milk production.
- Why breastfeeding reduces postpartum hemorrhage risk.
- Why nighttime feeds are important for establishing supply.
- Why human milk changes throughout a feeding and over time.
Things Worth Memorizing
Hormones
Prolactin
- Milk production
Oxytocin
- Milk ejection
- Uterine contraction
- Bonding
Colostrum
Remember:
- Small volume
- High protein
- High antibodies (especially secretory IgA)
- Easy to digest
- Natural laxative (helps pass meconium and reduce jaundice)
Mature Milk
Contains:
- Fat
- Lactose
- Protein
- Water
- Vitamins
- Immune factors
- Living cells
- Enzymes
- Growth factors
Questions I Should Answer Without Looking
- Which hormone produces milk?
- Which hormone causes let-down?
- Why is early breastfeeding encouraged?
- Why does frequent nursing increase milk supply?
- What is colostrum?
- Why is skin-to-skin important?
- Why is breast milk easier to digest than formula?
- What immune protection does breast milk provide?
- Why is a deep latch important?
- What are common causes of low milk supply?
Compendium Entry
This chapter deserves five pages.
Page 1 – Breast Anatomy
Draw:
- Lobes
- Lobules
- Alveoli
- Ducts
- Nipple
- Areola
Explain the function of each structure.
Page 2 – Hormonal Control
Create a chart:
| Hormone | Function |
|---|---|
| Prolactin | Milk production |
| Oxytocin | Milk ejection |
| Estrogen | Breast growth during pregnancy |
| Progesterone | Breast development; inhibits copious milk secretion until after birth |
| hPL | Mammary development during pregnancy |
Page 3 – Lactation Timeline
Include:
- Pregnancy breast changes
- Colostrum
- Lactogenesis II (“milk coming in”)
- Mature milk
- Supply and demand regulation
Page 4 – Breastfeeding Benefits
Two-column table:
| Mother | Baby |
|---|---|
| Reduced postpartum bleeding | Ideal nutrition |
| Faster uterine involution | Passive immunity |
| Lower risk of breast and ovarian cancer | Reduced infections |
| Convenient and inexpensive | Healthy gut microbiome |
| Supports bonding | Lower risk of NEC in preterm infants |
Page 5 – Breastfeeding Problems
Include causes and solutions for:
- Poor latch
- Engorgement
- Plugged ducts
- Mastitis
- Nipple trauma
- Perceived low milk supply
- Oversupply
- Slow weight gain
Quick Reference Cards
This chapter could generate excellent quick-reference cards on:
- Breast Anatomy
- Hormones of Lactation
- Prolactin vs. Oxytocin
- Stages of Human Milk
- Colostrum
- Breastfeeding Benefits
- Deep Latch Checklist
- Signs of Effective Milk Transfer
- Causes of Low Milk Supply
- Engorgement
- Mastitis
- Plugged Ducts
- Milk Ejection Reflex
- Supply and Demand
- Breastfeeding Red Flags
One additional study suggestion
“Normal Breastfeeding vs. Common Problems”
| Normal | Needs Assessment |
|---|---|
| Baby feeds 8–12+ times in 24 hours | Infrequent or ineffective feeds |
| Audible swallowing after milk comes in | No swallowing heard |
| Comfortable latch after initial seconds | Persistent nipple pain or damage |
| Adequate wet and dirty diapers | Poor output |
| Steady weight gain after initial physiologic loss | Continued weight loss or poor gain |
| Breasts soften after feeds | Persistent engorgement or signs of mastitis |
This kind of practical summary bridges the physiology with postpartum care. It also reinforces an important principle: many breastfeeding challenges stem from ineffective milk transfer rather than an inability to produce milk. Understanding the underlying physiology helps you identify the cause and support the mother more effectively.
Leave a Reply