Lactational Failure Definition Essay

1. American College of Obstetricians Gynecologists. Committee opinion No. 361: Breastfeeding: Maternal and infant aspects. Obstet Gynecol. 2007;109:479–480.[PubMed]

2. Bartick M. Reinhold A. The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics. 2010;125:e1048–1056.[PubMed]

3. American Psychiatric Assocation: Diagnostic, statistical manual of mental disorders. 4th. Washington, DC: American Psychiatric Assocation; 1994.

4. Flynn HA. Davis M. Marcus SM. Cunningham R. Blow FC. Rates of maternal depression in pediatric emergency department and relationship to child service utilization. Gen Hosp Psychiatry. 2004;26:316–322.[PubMed]

5. O'hara MW. Swain AM. Rates and risk of postpartum depression: A meta-analysis. Int Rev Psychiatry. 1996;8:37–54.

6. Dennis C-L. McQueen K. The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics. 2009;123:e736–751.[PubMed]

7. Infant Feeding Practices Study II Table 3.35. Percent of mothers who breastfed their babies as long as they wanted to, by breastfeeding duration and selected demographics1, among mothers who completely stopped breastfeeding and pumping milk for their baby during the study. 2009. [Mar 22;2010 ].

8. Li R. Fein SB. Chen J. Grummer-Strawn LM. Why mothers stop breastfeeding: Mothers' self-reported reasons for stopping during the first year. Pediatrics. 2008;122(Suppl 2):S69–76.[PubMed]

9. Insel TR. Young L. Wang Z. Molecular aspects of monogamy. Ann NY Acad Sci. 1997;807:302–316.[PubMed]

10. Lucas BK. Ormandy CJ. Binart N. Bridges RS. Kelly PA. Null mutation of the prolactin receptor gene produces a defect in maternal behavior. Endocrinology. 1998;139:4102–4107.[PubMed]

11. Torner L. Neumann ID. The brain prolactin system: Involvement in stress response adaptations in lactation. Stress. 2002;5:249–257.[PubMed]

12. Pang WW. Hartmann PE. Initiation of human lactation: Secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12:211–221.[PubMed]

13. Brunton PJ. McKay AJ. Ochedalski T, et al. Central opioid inhibition of neuroendocrine stress responses in pregnancy in the rat is induced by the neurosteroid allopregnanolone. J Neurosci. 2009;29:6449–6460.[PubMed]

14. Maguire J. Mody I. GABA(A)R plasticity during pregnancy: Relevance to postpartum depression. Neuron. 2008;59:207–213.[PMC free article][PubMed]

15. Nappi RE. Petraglia F. Luisi S. Polatti F. Farina C. Genazzani AR. Serum allopregnanolone in women with postpartum “blues.” Obstet Gynecol. 2001;97:77–80.[PubMed]

16. Klatzkin RR. Morrow AL. Light KC. Pedersen CA. Girdler SS. Associations of histories of depression and PMDD diagnosis with allopregnanolone concentrations following the oral administration of micronized progesterone. Psychoneuroendocrinology. 2006;31:1208–1219.[PubMed]

17. Klatzkin RR. Morrow AL. Light KC. Pedersen CA. Girdler SS. Histories of depression, allopregnanolone responses to stress, and premenstrual symptoms in women. Biol Psychol. 2006;71:2–11.[PubMed]

18. Andréen L. Nyberg S. Turkmen S. van Wingen G. Fernández G. Bäckström T. Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology. 2009;34:1121–1132.[PubMed]

19. Savage G. Observations on the insanity of pregnancy and childbirth. Guys Hosp Rep. 1875;20:83–117.

20. O'Hara MW. Schlechte JA. Lewis DA. Wright EJ. Prospective study of postpartum blues. Biologic and psychosocial factors. Arch Gen psychiatry. 1991;48:801–806.[PubMed]

21. Yonkers KA. Vigod S. Ross LE. Diagnosis, pathophysiology, and management of mood disorders in pregnant and postpartum women. Obstet Gynecol. 2011;117:961–977.[PubMed]

22. Gaynes BN. Gavin N. Meltzer-Brody S, et al. Perinatal depression: Prevalence, screening accuracy, and screening outcomes summary. Evid Rep Technol Assess. 2005;119:1–8.[PMC free article][PubMed]

23. Bloch M. Schmidt PJ. Danaceau M. Murphy J. Nieman L. Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157:924–930.[PubMed]

24. Moses-Kolko EL. Berga SL. Kalro B. Sit DK. Wisner KL. Transdermal estradiol for postpartum depression: A promising treatment option. Clin Obstet Gynecol. 2009;52:516–529.[PMC free article][PubMed]

25. Ahokas A. Kaukoranta J. Wahlbeck K. Aito M. Estrogen deficiency in severe postpartum depression: Successful treatment with sublingual physiologic 17beta-estradiol: A preliminary study. J Clin Psychiatry. 2001;62:332–336.[PubMed]

26. Carter S. Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology. 1998;23:779–818.[PubMed]

27. Insel TR. Is social attachment an addictive disorder? Physiol Behav. 2003;79:351–357.[PubMed]

28. Champagne F. Meaney MJ. Like mother, like daughter: Evidence for non-genomic transmission of parental behavior and stress responsivity. Prog Brain Res. 2001;133:287–302.[PubMed]

29. Ragnauth AK. Devidze N. Moy V, et al. Female oxytocin gene-knockout mice, in a semi-natural environment, display exaggerated aggressive behavior. Genes Brain Behav. 2005;4:229–239.[PubMed]

30. Fahrbach S. Morrell J. Pfaff D. Role of oxytocin in the onset of estrogen-facilitated maternal behavior. In: Amico J, editor; Robinson A, editor. Oxytocin: Clinical laboratory studies. Amsterdam: Elsevier; 1985. pp. 372–388.

31. Kendrick K. Keverne E. Control of synthesis and release of oxytocin in the sheep brain. Ann NY Acad Sci. 1992;652:102–121.[PubMed]

32. Kendrick K. Keverne E. Hinton M. Goode J. Oxytocin, amino acid and monoamine release in the region of the medial preoptic area and bed nucleus of the stria terminalis of the sheep during parturition and suckling. Brain Res. 1992;569:199–209.[PubMed]

33. Levy F. Kendrick KM. Keverne EB. Piketty V. Poindron P. Intracerebral oxytocin is important for the onset of maternal behavior in inexperienced ewes delivered under peridural anesthesia. Behav Neurosci. 1992;106:427–432.[PubMed]

34. Skrundz M. Bolten M. Nast I. Hellhammer DH. Meinlschmidt G. Plasma oxytocin concentration during pregnancy is associated with development of postpartum depression. Neuropsychopharmacology. 2011;36:1886–1893.[PMC free article][PubMed]

35. Newton M. Newton NR. The let-down reflex in human lactation. J Pediatr. 1948;33:698–704.[PubMed]

36. Nissen E. Uvnas-Moberg K. Svensson K. Stock S. Widstrom AM. Winberg J. Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by caesarean section or by the vaginal route. Early Hum Dev. 1996;45:103–118.[PubMed]

37. Nissen E. Gustavsson P. Widstrom AM. Uvnas-Moberg K. Oxytocin, prolactin, milk production and their relationship with personality traits in women after vaginal delivery or cesarean section. J Psychosom Obstet Gynaecol. 1998;19:49–58.[PubMed]

38. Leake RD. Waters CB. Rubin RT. Buster JE. Fisher DA. Oxytocin and prolactin responses in long-term breast-feeding. Obstet Gynecol. 1983;62:565–568.[PubMed]

39. Larsen CM. Grattan DR. Prolactin, neurogenesis, and maternal behaviors. Brain Behav Immun. 2011 [Epub ahead of print]. [PubMed]

40. Bridges RS. Numan M. Ronsheim PM. Mann PE. Lupini CE. Central prolactin infusions stimulate maternal behavior in steroid-treated, nulliparous female rats. Proc Natl Acad Sci USA. 1990;87:8003–8007.[PMC free article][PubMed]

41. Larsen CM. Grattan DR. Prolactin-induced mitogenesis in the subventricular zone of the maternal brain during early pregnancy is essential for normal postpartum behavioral responses in the mother. Endocrinology. 2010;151:3805–3814.[PubMed]

42. Soltis J. Wegner FH. Newman JD. Urinary prolactin is correlated with mothering and allo-mothering in squirrel monkeys. Physiol Behav. 2005;84:295–301.[PubMed]

43. Kordon C. Blake CA. Terkel J. Sawyer CH. Participation of serotonin-containing neurons in the suckling-induced rise in plasma prolactin levels in lactating rats. Neuroendocrinology. 1973;13:213–223.[PubMed]

44. Arbogast LA. Voogt JL. Endogenous opioid peptides contribute to suckling-induced prolactin release by suppressing tyrosine hydroxylase activity and messenger ribonucleic acid levels in tuberoinfundibular dopaminergic neurons. Endocrinology. 1998;139:2857–2862.[PubMed]

45. Kiem DT. Kanyicska B. Stark E. Fekete MI. Prolactin release induced by opiate agonists, effect of glucocorticoid pretreatment in intact and adrenalectomized rats. Neuroendocrinology. 1988;48:174–179.[PubMed]

46. Rasmussen KM. Kjolhede CL. Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics. 2004;113:e465–471.[PubMed]

47. Mennella JA. Pepino MY. Breastfeeding and prolactin levels in lactating women with a family history of alcoholism. Pediatrics. 2010;125:e1162–1170.[PMC free article][PubMed]

48. Chatterton RT., Jr Hill PD. Aldag JC. Hodges KR. Belknap SM. Zinaman MJ. Relation of plasma oxytocin and prolactin concentrations to milk production in mothers of preterm infants: Influence of stress. J Clin Endocrinol Metabol. 2000;85:3661–3668.[PubMed]

49. Berga SL. Mortola JF. Girton L, et al. Neuroendocrine aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab. 1989;68:301–308.[PubMed]

50. Amico JA. Johnston JM. Vagnucci AH. Suckling-induced attenuation of plasma cortisol concentrations in postpartum lactating women. Endocr Res. 1994;20:79–87.[PubMed]

51. Altemus M. Deuster PA. Galliven E. Carter CS. Gold PW. Suppression of hypothalmic-pituitary-adrenal axis responses to stress in lactating women. J Clin Endocrinol Metab. 1995;80:2954–2959.[PubMed]

52. Brunton PJ. Russell JA. Douglas AJ. Adaptive responses of the maternal hypothalamic-pituitary-adrenal axis during pregnancy and lactation. J Neuroendocrinol. 2008;20:764–776.[PubMed]

53. Slattery DA. Neumann ID. No stress please! Mechanisms of stress hyporesponsiveness of the maternal brain. J Physiol. 2008;586:377–385.[PMC free article][PubMed]

54. Neumann ID. Brain mechanisms underlying emotional alterations in the peripartum period in rats. Depress Anxiety. 2003;17:111–121.[PubMed]

55. Grattan DR. Pi XJ. Andrews ZB, et al. Prolactin receptors in the brain during pregnancy and lactation: Implications for behavior. Horm Behav. 2001;40:115–124.[PubMed]

56. Nolten WE. Lindheimer MD. Rueckert PA. Oparil S. Ehrlich EN. Diurnal patterns and regulation of cortisol secretion in pregnancy. J Clin Endocrinol Metab. 1980;51:466–472.[PubMed]

57. Magiakou MA. Mastorakos G. Rabin D. Dubbert B. Gold PW. Chrousos GP. Hypothalamic corticotropin-releasing hormone suppression during the postpartum period: Implications for the increase in psychiatric manifestations at this time. J Clin Endocrinol Metab. 1996;81:1912–1917.[PubMed]

58. Raison CL. Miller AH. When not enough is too much: The role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003;160:1554–1565.[PubMed]

59. Lonstein JS. Stern JM. Site and behavioral specificity of periaqueductal gray lesions on postpartum sexual, maternal, and aggressive behaviors in rats. Brain Res. 1998;804:21–35.[PubMed]

60. Light KC. Smith TE. Johns JM. Brownley KA. Hofheimer JA. Amico JA. Oxytocin responsivity in mothers of infants: A preliminary study of relationships with blood pressure during laboratory stress and normal ambulatory activity. Health Psychol. 2000;19:560–567.[PubMed]

61. Mezzacappa ES. Kelsey RM. Katkin ES. Breast feeding, bottle feeding, and maternal autonomic responses to stress. J Psychosom Res. 2005;58:351–365.[PubMed]

62. Altemus M. Redwine LS. Leong Y-M. Frye CA. Porges SW. Carter CS. Responses to laboratory psychosocial stress in postpartum women. Psychosom Med. 2001;63:814–821.[PubMed]

63. Nierop A. Bratsikas A. Klinkenberg A. Nater UM. Zimmermann R. Ehlert U. Prolonged salivary cortisol recovery in second-trimester pregnant women and attenuated salivary alpha-amylase responses to psychosocial stress in human pregnancy. J Clin Endocrinol Metab. 2006;91:1329–1335.[PubMed]

64. Entringer S. Buss C. Shirtcliff EA, et al. Attenuation of maternal psychophysiological stress responses and the maternal cortisol awakening response over the course of human pregnancy. Stress (Amsterdam, Netherlands) 2010;13:258–268.[PMC free article][PubMed]

65. Shea AK. Kamath MV. Fleming A. Streiner DL. Redmond K. Steiner M. The effect of depression on heart rate variability during pregnancy. A naturalistic study. Clin Autonom Res. 2008;18:203–212.[PubMed]

66. Watkins LL. Grossman P. Krishnan R. Sherwood A. Anxiety and vagal control of heart rate. Psychosom Med. 1998;60:498–502.[PubMed]

67. Kemp AH. Quintana DS. Gray MA. Felmingham KL. Brown K. Gatt JM. Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biol Psychiatry. 2010;67:1067–1074.[PubMed]

68. Ahluwalia IB. Morrow B. Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics. 2005;116:1408–1412.[PubMed]

69. Watkins S. Meltzer-Brody S. Zolnoun D. Stuebe A. Early breastfeeding experiences and postpartum depression. Obstet Gynecol. 2011 [Epub ahead of print] [PubMed]

70. Grewen KM. Light KC. Mechlin B. Girdler SS. Ethnicity is associated with alterations in oxytocin relationships to pain sensitivity in women. Ethn Health. 2008;13:219–241.[PMC free article][PubMed]

71. Flink IK. Mroczek MZ. Sullivan MJ. Linton SJ. Pain in childbirth and postpartum recovery: The role of catastrophizing. Eur J Pain. 2009;13:312–316.[PubMed]

72. Gracely RH. Geisser ME. Giesecke T, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004;127:835–843.[PubMed]

73. Hapon M. Simoncini M. Via G. Jahn G. Effect of hypothyroidism on hormone profiles in virgin, pregnant and lactating rats, and on lactation. Reproduction. 2003;126:371–382.[PubMed]

74. Hapon MB. Varas SM. Gimenez MS. Jahn GA. Reduction of mammary and liver lipogenesis and alteration of milk composition during lactation in rats by hypothyroidism. Thyroid. 2007;17:11–18.[PubMed]

75. Miyake A. Tahara M. Koike K. Tanizawa O. Decrease in neonatal suckled milk volume in diabetic women. Eur J Obstet Gynecol Reprod Biol. 1989;33:49–53.

As a newly-minted doctor and breastfeeding activist, I used to believe that all mothers could breastfeed. Now, after almost a decade of clinical experience, I know better. Sometimes, breastfeeding physiology just doesn’t work. And frankly, as medical professionals, we handle these situation poorly.

Lactation happens through a choreographed interplay of hormones that build up milk-making machinery during pregnancy and then manufacture milk and deliver it to the baby during feeding. So-called “primary lactation failure,” when a mother’s milk never comes in, may happen because the machinery doesn’t develop , or because the signals to make and move the milk are not in sync or absent altogether.

When a mother’s milk isn’t flowing, physicians should check for any medications that may be interfering with milk production, as well as assess function of the thyroid and pituitary gland, which can be damaged during childbirth after heavy bleeding. Absent milk production can also occur if part of the placenta is left behind at birth. If these tests are all normal, a few drugs can boost the level of prolactin, the milk-making hormone. ABM covers these drugs in our Protocol on Galactogogues.

Often, however, we don’t find an answer. With little knowledge and few treatment options, the physician is typically left telling a mother that she has “lactation failure.” Too often, that diagnosis is followed by some patronizing comment like, “It’s ok — I was formula fed, and I turned out fine.”

Now, I have a question: Why do we accept that malfunction of a major part of reproductive physiology is untreatable, and that the acceptable solution is a synthetic substitute and a pat on the head?

Consider that we spend more than $1 billion a year on Viagra to treat another type of reproductive malfunction. I suspect men with erectile dysfunction would not respond well to being told “We’re sorry, we don’t have a treatment for this important aspect of your reproductive and social well-being. But here’s an artificial substitute.”

This disparity in knowledge and treatment is no accident. If you search the database of federally funded medical research for “lactation failure,” there are only 9 studies listed, compared with 84 for erectile dysfunction. It seems that, as a nation, we simply don’t consider inability to breastfeed to be an important problem.

Mothers and babies deserve better. First, given the limits of current medical knowledge, we should admit that we should have better answers. And would should honor, not trivialize, her efforts to initiate and sustain breastfeeding. When we tell her, “It’s ok, I was formula fed, and I turned out fine,” we are basically saying that she’s a little crazy to have worked so hard to breastfeed, because it’s really not important, and she shouldn’t worry her pretty little head about it.

Instead, I praise the mother for all the ways she tried to make feeding work. I have even written letters to the baby, documenting for mom how hard she worked to breastfeed. Then, we talk about how breastfeeding is not simply a matter of feeding breast milk. Mom and baby can enjoy much of the bonding and intimacy of breastfeeding with skin-to-skin contact, holding and snuggling her baby, and putting the baby to breast for comfort after feeding.

We also talk about how to respond to strangers who make snide comments to bottle-feeding mothers. I’ve been assailed for nursing in a restaurant, and I was deeply humiliated when a woman stalked up and said, “For future reference, the bathroom is back there!” I can only imagine what a mother who cannot breastfeed — or decides not to — endures when strangers pass judgement on how she is nourishing her baby.

And then there are the policy issues. Physicians and nurses need training to identify moms at risk for lactation failure, provide early help and support, and prevent horror stories of dehydrated infants and devastated mothers. We need more and bigger milk banks to distribute donor human milk. And we need to encourage mothers who couldn’t make milk to transform their feelings of guilt and loss into action by writing letters to demand research funding for this all-too-common problem.

Not all mothers can make milk, but modern medicine has solved more complex problems. What we need is the willpower and resources to determine the causes of lactation failure and develop appropriate treatments so that all mother can reach their breastfeeding goals.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine.

Like this:



0 Replies to “Lactational Failure Definition Essay”

Lascia un Commento

L'indirizzo email non verrà pubblicato. I campi obbligatori sono contrassegnati *