How much water is in breast milk? Vitamins, minerals and trace elements. What does the immune defense of human milk consist of?

Breast milk is optimal product nutrition of the baby due to its composition, which meets all the needs of the child. What's included breast milk?

Breast milk contains: proteins, lipids, carbohydrates, minerals, biologically active components.

Some of the most important benefits of breast milk include:

• optimal and balanced content of nutrients;
• their high digestibility;
• the presence in breast milk of a wide range of biologically active substances and protective factors;
• beneficial effect on the development intestinal microflora child;
• low osmolarity;
• sterility;
• optimal temperature.

Composition of breast milk: proteins

The protein content in human milk is significantly lower than in cow's milk. Despite this, it fully meets the physiological needs of infants for plastic substances. At the same time, the lower protein content in breast milk leads to a decrease in the osmotic load on the intestines and the adverse effects of nitrogenous substances formed during the metabolic process on the glomeruli and tubules of the nephron of the kidneys and liver. In addition, this level of breast milk protein reduces the risk of developing metabolic syndrome in adolescence manifested by obesity and diabetes. This is due to the fact that excess protein from food simulates the production of insulin-like growth factor I. Its increased level Launches early maturation and increased cellular growth with an increase in adipose tissue and muscle mass, the development of “fat rebound”.

Human milk protein consists mainly of whey proteins (70-80%), containing all essential amino acids in the optimal ratio for the child, and casein (20%).

This feature leads to the formation of a looser clot when milk curdles in the stomach, its easy to digest and absorption, as well as faster evacuation. In addition, whey proteins are characterized by a favorable amino acid composition than casein. Cow's milk caseins contain more phosphorus than human milk caseins. This circumstance is one of the reasons for the poorer absorption of iron from cow's milk.

Among whey proteins in human milk, α-lactalbumin, lactoferrin and immunoglobulins predominate; β-lactalbumin is completely absent.

α-lactalbumin in human milk is active component galactosyltransferase, which catalyzes the synthesis of lactose from glucose in the mammary gland. Among the immunoglobulins in human milk, secretory immunoglobulin A predominates (95.2%), providing protection to infants from intestinal infections. The share of immunoglobulins G and M accounts for 2.9 and 1.9%, respectively.

Apolactoferrin in breast milk is an analogue of serum transferrin, which ensures the transport of iron through the intestinal mucosa into the bloodstream. This ability of apolactoferrin ensures a good supply of breast-fed children with iron, leads to antimicrobial activity, depriving intestinal microorganisms of growth factor in the form of iron, as well as an antioxidant effect due to the exclusion of iron from the processes of free radical oxidation of lipids. Cow's milk lactoferrin is highly saturated with iron, which interferes with its ability to transport iron and reduces its antimicrobial activity and antioxidant properties.

Breast milk proteins include hormones and milk enzymes.

There are 2 groups of enzymes:

1. With predominant activity in breast tissue: phosphoglucomutase, galactosyltransferase, lipoprotein lipase, synthetase fatty acids, thioesterase, γ-glugamyltransferase, xanthine oxidase;
2. Enzymes necessary for the child: proteases, antiproteases, α-lmylase, lipase, peroxidase, glutathione peroxidase, β-glucuronidase, alkaline phosphatase.

The presence of proteases in breast milk contributes to the appearance of free amino acids in it, which are actively absorbed in the intestines and are included in the synthesis of the child’s own protein, and non-protein nitrogenous substances (urea, creatine, creatinine, uric acid), which are absorbed after bacterial fermentation in the colon.

The range of hormones in breast milk is quite wide and is represented by the releasing factors of thyrotropin, gonadotropin, growth hormone, prolactin, oxytocin, thyroid hormones, corticosteroids, estrogen, progesterone and their metabolites, insulin, gastrointestinal regulatory peptides (bombesin, cholecystokinin, neurotensin, gastric inhibitory polypeptide).

Composition of breast milk: lipids

The lipid content in human milk ranges from 31-35 g/l to 41-52 g/l. This is due not only to the fact that the fat content in “foremilk” (released at the beginning of feeding) is lower than in “hind” milk (released at the end of feeding), but also due to the pronounced dynamics of fat levels in different periods of lactation. General content There is not much more fat in breast milk than in cow's milk.

The main part of lipids consists of triglycerides (98%), phospholipids, cholesterol and free fatty acids (total 2%).

Features of breast milk triglycerides are:

1. High content of mono- and polyunsaturated ω-6 fatty acids (linoleic), providing synthesis arachidonic acid and its derivatives, which are part of cytomembranes, prostaglandins;
2. The presence of long-chain polyunsaturated fatty acids of the ω-3 family (linoleic, eicosapentaenoic and docosohexenoic), necessary for the formation of the brain, neuroretina, prostaglandins, eicosanoids, thromboxane, leukotrienes. This feature is important because docosohexaenoic and eicosapentaenoic fatty acids cannot be formed in the baby’s body due to the lack of the corresponding enzymes - elongase and desaturase. The ω-6/ω-3 ratio is 10:1-7:1, which is considered the most optimal for their adequate metabolism;
3. The optimal positional structure of fatty acids that make up triglycerides and phospholipids, which ensures their most efficient digestion by lipases and a high degree of absorption. Thus, in human milk, palmitic acid is in the β-position in connection with glycerol (β-palmitate), in contrast to cow α-palmitate. Having split off from the α-position of glycerol, palmitic acid binds to calcium in the intestinal contents to form insoluble salts, leading to difficulty in calcium absorption and hardening of the stool.

The fatty acid composition of breast milk depends on the diet of the nursing mother.

To ensure optimal intracellular transport and oxidation of fatty acids, breast milk contains a vitamin-like compound - carnitine.

Fat absorption from breast milk, despite the low lipase activity in infants, is 85-95%.

Composition of breast milk: carbohydrates

The amount of carbohydrates in breast milk is significantly higher than in the milk of other mammalian species. Their average value is usually 7.4 g/100 ml.

The main representative (90%) of carbohydrates is β-lactose. Being a disaccharide that breaks down into small intestine under the influence of enterocyte brush border lactase (β-galactosidase), lactose is the main source of energy, galactose donor for the synthesis of glycolipids of cell membranes nerve cells, galactosyl-containing cellular receptors. In addition, the β-configuration of lactose leads to the fact that it is able to enter the large intestine undigested and undergo fermentation under the influence of enzymes of bifidobacteria and lactobacilli, thus acting as a stimulating factor - a prebiotic. The resulting short-chain fatty acids promote the absorption of calcium, magnesium and manganese in the intestine, reduce the pH in the lumen of the colon, thus creating unfavorable conditions for the existence of putrefactive flora.

The remaining 10% of carbohydrates in breast milk are galactoligosaccharides (GOS), consisting of 2-7 glucose and galactose residues in a linear chain. GOS are not broken down by enzymes human body, and their breakdown is ensured by bifidumbacteria. Thus, their prebiotic effect is ensured. In addition, GOS are capable of inhibiting the adhesion of pathogenic microbes on the intestinal mucosa, stimulating the immune system by affecting dendritic cells of lymphoid follicles, and intestinal motility.

Composition of breast milk: minerals

The total content of minerals in breast milk is on average 2 g/l, which is almost 4 times lower than in cow's milk. This is due to a significantly lower content of basic cations: calcium, sodium, potassium, zinc, iron, manganese and iodine. However, the provision of breastfed children with them in the first year of life is higher than that of artificially fed children. This is due high degree absorption of micro- and macroelements due to transport systems - peculiar carrier proteins found in breast milk.

Most of the calcium in human milk is bound to whey proteins. Its ratio with phosphorus is 2:1, which is optimal for absorption. The low calcium content in human milk is quite physiological state, since it ensures low osmolality of milk, does not interfere with the absorption of iron and limits the excretion of fatty acids from the body in the form of insoluble calcium soaps.

The amount of sodium, potassium and chlorides in breast milk is 4 times lower than in cow's milk. This again determines its low osmolality, but at the same time reduces the risk of developing hypernatremia as a result of the reduced ability of the nephron tubules to transport sodium and excrete it in the urine.

The iron content in breast milk is not fundamentally different from cow's milk, but is characterized by better absorption. This is due to the fact that about 30% of the iron in breast milk is associated with lactoferrin, and the remaining part with other protein and non-protein ligands - xanthine oxidase of breast milk fat globules, citrate. Despite this, the child’s iron needs are not adequately met, which requires proper organization of complementary feeding.

The level of zinc in breast milk is significantly lower than in cow's milk and decreases with increasing lactation period. It is mainly found in a state associated with albumin and citrate, as well as in the composition of alkaline phosphatase in fat globules. It is these zinc complexes that ensure its high absorption in the intestines and the absence of zinc deficiency in breastfed children. Cow's milk casein can inhibit the absorption of zinc in the intestine.

Similar to zinc, copper in breast milk is found in the form of complexes with citrate and serum albumin, and in cow milk - with casein, which provides it better absorption from breast milk.

A fairly low content of iron, zinc and copper is favorable, and their absorption is closely interrelated. This is due to the fact that excess iron and zinc lead to a reduced supply of copper. A lack of copper, in turn, will lead to impaired absorption of iron in the small intestine.

Composition of breast milk: biologically active components

Along with nutrients human milk contains a wide range of biologically active and protective factors, which distinguishes it from all other food products and allows it to be classified as “living structures”.

Dynamics of breast milk composition

The composition of human milk undergoes significant changes during lactation, especially in the first 2 weeks, when sequential secretion of colostrum occurs (the first 5 days), then transitional milk (6-14 days) and mature milk (from the 15th day of lactation).

As you can see, a woman’s breast milk contains all the nutrients a baby needs. AND cow's milk cannot be compared with human breast milk, so under no circumstances try to replace natural breastfeeding with cow's milk for a child under one year old.

Many of us know that breastfeeding is both nourishment, normal baby food, and a convenient way to love, nurture and care for a child. Do you know how the nursing breast works, how milk appears in it? The baby sucked all the milk, and the breasts became full again. Why do the breasts fill up again after emptying? What did our ancestors think about this? What do we know today? You will find answers to all these questions in this article. Once you learn how a breastfeeding mother's breasts work, you will appreciate even more. amazing process breastfeeding, nursing breasts and nursing mothers who nourish new life outside the womb.

From the history
For thousands of years, people have been interested in the anatomy and physiology of the breast. The earliest medical documentation of the female breast dates back to ancient Egypt. They describe how to determine whether a mother's milk is good or bad, and how to increase its quantity. The author recommends rubbing it on the mother's back fish fat, and she "sits cross-legged... rubbing her chest with a poppy plant" to increase milk flow (Fildes 1985). Marilyn Yalom, author of A History of the Breast, explains, “At a minimum, both methods helped the mother relax,” which in turn promoted milk let-down (the milk ejection reflex), but they likely did not affect milk production. The ancient physician Hippocrates (460-377 BC) believed that menstrual blood was somehow converted into milk. This point of view prevailed right up to the 17th century! During the Renaissance, Leonardo da Vinci (1452-1519) drew veins connecting the uterus and chest in his anatomical drawings.
Even the philosopher Aristotle (384-322 BC) wrote about breastfeeding. He believed that dark-skinned women had healthier milk than white-skinned women, and that children who drank warmer mother's milk cut teeth earlier. (He was wrong on both counts.) Aristotle also believed that children should not be given colostrum to drink. This misconception still persists in some cultures. Soranus, an ancient gynecologist (practicing in 100-140), recommended breast massage and forced vomiting as a means to increase milk supply. However, he did not advise drinking “drinks containing the ashes of burnt owls and bats” (Soranus 1991). By the 16th century, discoveries about breast anatomy began to move in the direction of today's understanding. Studies by pathologists have shown that the breast is composed of glandular tissue, which, as scientists of the time concluded, “converts the blood flowing to the breast through the veins into milk” (Vesalius 1969).
Many early documents on breastfeeding deal with the topic of wet nurses: women who were hired to breastfeed someone else's child. Nurses are mentioned in Hammurabi's code of laws (1700 BC), the Bible, the Koran and the works of Homer. There were clear instructions on what qualities the best nurses should have: from hair color, shape and appearance breast to floor of the wet nurse's children (Yalom 1997). Beginning in the 18th century, doctors finally began to understand that it was better for a mother's health to feed her baby herself rather than relying on a wet nurse, and that maternal colostrum was beneficial for the baby (Riordan 2005).

Over the past 50 years medical science Much more has been learned about human milk, especially in the field of immunology. Today it is known that colostrum contains a huge concentration of antibodies that protect the newborn from disease; that the composition and proportions nutrients in milk are the standard of nutrition for infants and children. If a woman gives birth prematurely, her milk is different in composition from the milk of a woman who gave birth at term. The milk of the mother of a premature baby is adapted to the needs of such a vulnerable baby. In the book “The Women's Art of Breastfeeding” it is written: “No two mothers have the same milk... The composition of human milk changes from day to day and differs even depending on the time of day... The colostrum that the baby sucks on the first day of life is different from the colostrum on the second or the third day."
Human milk is a complex living substance that lays the foundation for the health and optimal development of young children.

Breast development
Breasts begin to develop in the womb of both male and female fetuses. Between 4 and 7 weeks of embryonic life, external skin begin to thicken along the line from armpit before groin area. This is how milk folds or milk lines are formed. Later, most of these “milk lines” disappear, but a small part in the breast area remains, and here from 16 to 24 mammary buds are formed, which develop and turn into milk ducts and alveoli - the sacs in which milk is produced and stored.
The milk ducts initially lead to a small depression under the skin, but soon after birth a nipple forms at this site (Sadler 2000). The nipple is surrounded by an areola. After this, the development of the mammary gland stops until puberty.
The next stage of breast development occurs when girls begin puberty, at approximately 10 to 12 years of age. Breasts begin to grow a year or two before the start of menstruation. Breast tissue grows a little during each ovulatory cycle. Most breast growth occurs during puberty but continues until approximately 35 years of age (Riordan 2005). Breasts are not considered fully mature until a woman has given birth and begins producing milk (Love & Lindsey 1995).
In the book “Breastfeeding. Questions and answers." (THE BREASTFEEDING ANSWER BOOK) it is written that the mature breast consists of glandular tissue for the production and movement of milk; supportive connective tissue; blood, which supplies nutrients needed for milk production; lymph - a fluid that removes waste products through lymphatic system body; nerves that send signals to the brain; and adipose tissue, which protects against damage (Mohrbacher & Stock 2003). Glandular tissue consists of alveoli, which produce and store milk until the surrounding muscle cells push the milk into the small (alveolar) ducts. The small ducts then merge into larger ducts, which open into 5-10 milk pores at the tip of the nipple. Until recently, it was believed that in addition to the alveoli, milk was also stored in the lactiferous sinuses, extensions of the ducts in front of the nipple. However, recent ultrasound examinations showed that the lacteal sinuses are not permanent structures of the breast (Kent 2002). The milk ducts under the nipple widen under the influence of the milk ejection reflex, but narrow again after feeding, when the remaining milk returns back to the alveoli.
The structure of the breast can be compared to a tree. Alveoli are leaves, ducts are branches. Many small branches merge to form several large branches, which in turn form the trunk. Like the branches of a tree, the chest consists of lobules, each of which is formed from one large duct with many small ducts and alveoli connected to them. Most experts believe that women have 15 to 20 of these lobes in each breast, but one recent study suggests that there are more likely 7 to 10 of them in each breast (Kent 2002).
The areola or areola, the dark area around the nipple, gets its coloration from the pigments eumelanin and pheomelanin. Located on the areola sebaceous glands(which secrete oil that softens and protects the skin), sweat glands, and Montgomery glands, which secrete a substance that lubricates the nipple and protects it from bacteria.

Pregnancy and lactation
During pregnancy, the breasts change greatly under the influence of pregnancy hormones, which include estrogen, progesterone, and prolactin. Each hormone plays a specific role in preparing the body for breastfeeding. The most noticeable change is breast enlargement. During the first trimester of pregnancy with high speed Ducts and alveoli grow and branch. Many women note that their breasts have become more sensitive.
Lactogenesis is the term to describe the onset of lactation. There are three stages of lactogenesis. The first stage begins approximately 12 weeks before birth, when the mammary glands begin to produce colostrum. The breasts enlarge even more as the alveoli fill with colostrum, but due to high level Due to progesterone in the mother's blood, milk is not produced in full until the baby is born.
The second stage of lactogenesis begins after the birth or separation of the placenta. Progesterone levels drop while prolactin levels remain high. Prolactin is the main hormone of lactation. It is produced under the influence of pituitary hormones, thyroid gland, adrenal glands, ovaries and pancreas. There's a rush to my chest more blood rich in oxygen. 2-3 days after birth, milk “comes in.” The amount of milk increases rapidly, the composition of the milk changes: colostrum is gradually replaced by “mature” milk. The amount of sodium, chlorine and protein in milk decreases, and the amount of lactose and other nutrients increases. The color changes from golden yellow, the typical color of colostrum, to a bluish white. Since at this stage of lactogenesis, milk production is under the influence of hormones, milk is produced in the breast regardless of whether the mother is breastfeeding or not. It is very important to feed frequently during this time (and/or pump if baby is not latching or is not latching well), as frequent feedings in the first week after birth are thought to increase the number of prolactin receptors in the breasts. Receptors recognize a specific hormone and respond to it. The more prolactin receptors there are, the more sensitive the mammary glands are to prolactin, which, according to researchers, affects the amount of milk produced by the mother at the next stage of lactogenesis.
The third stage of lactogenesis is also known as milk formation. At this stage, the production of mature milk is established. Now milk is produced not under the influence of hormones (endocrine control), but under autocrine control. This means that continued milk production depends more on how empty the breasts are, rather than on the level of hormones in the blood. Milk is produced according to the principle “demand creates supply”, namely the more the mother breastfeeds, i.e. The more the baby sucks, the more milk will be produced. And accordingly, the less you feed, the less milk there will be.

Physiology and milk quantity
Understanding the process of milk production can help a mother organize breast-feeding so that the baby always has enough milk. For example, sometimes a woman feels that the baby has completely emptied the breast and there is absolutely nothing left in it, although the baby has not yet had enough. If a mother knows that milk is constantly being produced in the alveoli, she will confidently give her baby the breast, even if it seems “empty.” One study found that on average, babies suck only 76% of the milk currently in the breast per day.
Milk production depends on how empty the breasts are. When a baby suckles, a signal is sent to the mother's brain that triggers the release of the hormone oxytocin. The release of oxytocin into the blood causes the muscle cells around the alveoli to contract, causing milk to be pushed out through the ducts to the nipple. This is the milk ejection reflex. At this moment, a woman may feel a tingling sensation in her breasts or feel the milk flowing in, so this reflex is called a tide. During high tide, the alveoli are emptied, and milk flows to the nipple, from where the baby sucks it out. When the alveoli are empty, they produce more milk. Recent research has revealed that human milk contains an organic compound called a feedback inhibitor of lactation, which regulates milk production. When there is a lot of milk in the breast, this protein signals the alveoli to stop producing milk. Once the baby has emptied the breast, and therefore there is no longer the “lactation inhibitor” that stops milk production, the alveoli begin to produce milk again. That's why for optimal quantity It is so important to put your baby to the breast frequently and let him empty the breast as much as possible.
Another factor that affects the amount of milk is the storage capacity of the breast. Sometimes women with small breasts worry that they will not have enough milk. These worries are in vain: the amount of milk does not depend on the size of the breast. It is possible that a small breast may not store as much milk between feedings as a large breast, but if you put your baby to the breast frequently, there will be just as much milk as your baby needs. Women with bigger breasts and a larger storage capacity, breasts can afford to feed less frequently and this may not affect milk supply. On the other hand, some women with small breasts need to breastfeed more often because their breasts fill faster and their milk production slows down as their sacs fill. Frequent feedings not only have a positive effect on your milk supply, it also good prevention congestion and breast infections. (Author's note: Studies show that "external breast size was not a reliable indicator of milk supply and breast capacity, and that all women produced enough milk per day" [regardless of breast size]).
Does a mother need to know how much milk is in her breasts at one feeding to determine how often she should feed her baby? Definitely not. Healthy babies suck out exactly as much milk as they need and when they need it, and mothers don’t even have to rack their brains about what’s happening in the breast. An idea of ​​how nursing breasts work can only be useful in cases where a woman needs to figure out why she doesn’t have enough milk. In addition, this knowledge will help a woman analyze myths and misconceptions about breastfeeding. For example, she will know that she does not have to wait between feedings for her breasts to “fill up”—there is always milk in the breasts. The theory will also be a good help in cases where the child seems hungry or has a growth spurt: the woman will confidently feed one more time, because... knows that more frequent feedings will almost immediately speed up milk production.

How different substances pass into breast milk?
Understanding the mechanism of milk production helps the mother understand how various substances (proteins, as well as harmful substances or drugs) enter the milk. This will help a woman decide how to eat, receive treatment, and what lifestyle to lead when she is breastfeeding.
How do different substances get into milk? When a woman takes medicine or eats food, they are broken down in the gastrointestinal tract (GIT), and then the molecules of these substances are absorbed into the blood. Together with the blood, the molecules enter the capillaries breast tissue, where they enter the milk through the cells lining the alveoli. This process is called diffusion.
This is how various components of milk, as well as medications and other substances, enter the milk. However, whether this or that substance gets into milk, and in what quantity, depends on many factors. In the first days after birth, there are gaps between lactocytes, the cells that line the alveoli and block or allow various substances to pass through. Therefore, in the first days after birth, substances can penetrate into milk more freely. After a few days, the lactocyte gaps close. From this point on, it is more difficult for various substances to penetrate the barrier between blood and milk (blood-milk barrier).

Thanks to the process of diffusion, various useful components, such as antibodies, enter colostrum and mature milk. Antibodies are protein molecules that are part of the blood and help the body fight infection. In human milk the most high concentration antibodies occur at the beginning and end of lactation. Very important antibodies - secretory immunoglobulin A (SIgA) - are synthesized and stored in the breast. In addition to SIgA, milk contains about 50 antibacterial factors, many of which come from maternal blood. And this does not include those factors that have not yet been discovered! Antibodies and antibacterial factors are one of the most important benefits of breastfeeding. All women pass on antibodies to their babies during pregnancy and childbirth, but breastfeeding helps the mother protect her baby from disease even longer.
As a result of diffusion, substances that may bother the baby also enter breast milk. Many people believe that if mom eats gas-forming foods, such as cabbage ( different types), the baby will also swell. Is it true? No. The gases themselves do not penetrate into the blood from the gastrointestinal tract, and therefore do not enter the milk. However, during the digestion of food, some proteins from the food enter the blood and then into the milk. Some babies react to certain types squirrel: their tummy is swollen, they are worried. If the mother notices that after eating a certain food the baby has such a reaction, you can try to temporarily exclude this specific product from the diet. It is especially important to note here that in most children the cause of anxiety and gas formation lies in something else. Allergic reactions to certain substances in breast milk manifest themselves in the form of skin irritations, respiratory problems and gastrointestinal problems. If someone in the family is allergic to certain foods, the mother should abstain from them during the period of breastfeeding.
What does all this mean for a nursing mother? A nursing mother can eat whatever she wants and can be sure that most children will not react in any way to what they eat from their mother.

Medicines taken by a nursing mother can also penetrate the lactocyte barrier from the blood into the alveoli. Author of the book "Drugs and Mother's Milk" Thomas Hale writes that there are several factors that influence the entry medicines into milk. The concentration of the drug in the mother's blood affects the amount of the drug that passes into the milk. If there is a high concentration of a drug in the blood, more of the drug will get into the milk, where the concentration is lower, through the process of diffusion. During the process of diffusion, the concentration of substances is maintained at the same level on both sides of the barrier. Therefore, as the concentration of a certain substance decreases in the mother's blood, particles of the same substance that entered the milk will return to the blood, and its concentration in the milk will also decrease. (Author’s note: How do you know when milk contains the most of a substance? This can be determined if you know the time of maximum concentration (Tmax) of the drug in the blood. Usually this information is in any pharmacological reference book. In practice, this means that feeding can be plan to avoid feeding at times when drug concentrations in the blood are highest.)
Why is it important to understand the diffusion process? Some mothers mistakenly think that after they drink a glass of wine, the alcohol will be in the milk until they express it. As a result, she doubts whether to feed the baby or express and discard the milk. In fact, the level of alcohol in milk will decrease at the same time as in the blood. For a woman weighing 54 kilograms, the amount of alcohol contained in one glass of wine or beer will disappear from the blood within 2-3 hours. After the same time, there will be no alcohol left in the milk. (Author's note: You can determine when the concentration of a substance in milk decreases by looking in the pharmacological reference book. The half-life (T 1/2) indicates the period of time during which the concentration of the drug in the body decreases by 50%).
The extent to which a drug passes into mother's milk is also influenced by the molecular weight (actually the size of the molecule) of the substance that makes up the drug, protein binding, and fat solubility. Substances with low molecular weight penetrate into milk more easily. (Author's note: Substances with a molecular weight of less than 200 easily penetrate into milk. If most of the drug is bound to proteins, the drug cannot penetrate into the milk, because the drug is “glued” to the protein, and there are no free drug molecules in the plasma, which could easily pass into milk if they were not bound to proteins. Milk contains more fat than plasma, so fat-soluble drugs can concentrate in milk fats. In the book "Drugs and Mother's Milk" T. Hale writes, that many medications are compatible with breastfeeding. If a particular medication is incompatible with breastfeeding, a suitable substitute can almost always be found. If a woman needs to take medication, she should consult a doctor. Modern medicine has more knowledge about the physiological process of lactation than at any other time in history. We have data about the structure of the breast, information about how the components of the breast work to produce milk. Compared to the past, we have a good understanding of how different substances get into mother's milk. Armed with knowledge, we can successfully manage breastfeeding, avoid unnecessary weaning, and resolve any problems that may arise during breastfeeding. This makes us appreciate the opportunity to breastfeed more when everything goes well!

Mother's milk is indispensable for the baby as the main nutrition from the first days of life. The natural mechanism inherent in a woman by nature is of incomparable value for the existence of humanity. However, more and more young women refuse it, preferring to feed their children artificially. What exactly is lactation, how is it formed, what benefits does it provide to mother and child?

Breastfeeding is an unforgettable experience in a woman’s life, as well as establishing a close emotional connection with her newborn.

When and how does lactation occur?

Lactation is a difficult, but natural moment for a woman, the formation of breast milk, which accumulates in the breast and is then removed from it by the baby’s sucking of the nipple. The basis of what is happening is hormonal changes, which does not depend on the size of the bust. Preparing the mammary gland to produce milk is called lactogenesis. Lactopoiesis is the medical name for maintaining lactation.

The development of lactation changes begins during pregnancy, and at the time of childbirth, the woman’s correctly adjusted hormonal background causes the arrival of milk. Where does breast milk come from?

The required amount of milk is produced due to the presence of three hormones in the mother’s body: prolactin, placental lactogen and oxytocin. Entering the blood, these hormones stimulate the onset of the lactation process in a woman who has given birth.

Let's see what they are responsible for, and how the physiology of the female body contributes to this.

Hormones and their features

We have already found out that the natural physiology of lactation is determined by three important hormones. Each of these three hormones performs its own role, predetermined by nature. Placental lactogen is secreted by placental cells in late pregnancy, when the mechanism of preparing the breast for successful milk production is activated. The concentration of the hormone gradually decreases after childbirth, and after a few days it completely disappears from the blood of the fetus and mother.

Placental lactogen is produced during pregnancy

Prolactin initiates and maintains normal milk production during lactation. If the amount of prolactin in the blood does not correspond normal indicator, a crash occurs. The hormone is a peptide and is produced in the pituitary gland. An increase in the amount of prolactin begins during pregnancy, and by the time the baby is born, the cells that secrete it make up 70-80% of all pituitary cells. It is not without reason that prolactin is called the hormone of motherhood, since only thanks to it the entire mechanism of milk formation is launched during breastfeeding.

Oxytocin organizes the movement of fluid through the milk ducts and supports the reflex process of milk release. You can feel how it works by feeling a slight tingling sensation in your breasts and when a small amount of milk comes out between feedings. Nutrient fluid accumulates in the alveoli, then passes through the tubules and ducts, overcomes the sinuses and passes through the nipple to the baby.

Duration of lactation

Duration refers to individual indicators and can vary from several months to several years. The recognized norm is indicated by specialists within a period of 5-24 months. In the first weeks after the birth of the baby, the volume of nutrient fluid in the mother may vary. Its stable amount is established after 6-12 days, and as much milk is produced as is necessary for the full development of the child. From this moment, lactation lasts at least 3-6 months.

After the two-year mark, lactation will stop naturally

The synthesis of hormones that support milk formation is completed if a woman stops breastfeeding, which takes about 1-2 weeks. An important component of everything that happens is regular emptying of the mammary gland. If the regularity of emptying the breast is not observed, the secretion stagnates in the alveoli and ducts, the arrival of milk slows down and may stop altogether. In just one day, the mother produces 600-1300 ml of milk.

How many stages is lactogenesis divided into?

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Let's take a closer look at lactogenesis. Doctors break it down into several important stages:

• Stage 1 begins 12 weeks before the baby is born, when colostrum is produced in the breast cells. The level of prolactin, estrogen and progesterone increases, against this background the female breast changes and its sensitivity increases. Prolactin controls the development of alveoli and lobules located in the mammary gland.
• Stage 2 starts at the time of birth. Doctors tend to determine its onset from the first time the baby is put to the breast. The baby makes his first attempts to suckle at the breast and receives the most valuable maternal colostrum.
• Stage 3 is a transitional stage, marked by the gradual transformation of colostrum into full-fledged milk. The duration of the third stage takes 3-7 days. It takes place in three stages: the first 3 days, colostrum is produced, then early transitional milk is formed, replaced by late transitional milk, and finally, the production of mature milk begins.

The complete formula for lactogenesis looks like this: colostrum -> early transitional milk -> late transitional milk -> mature milk. If the transition from colostrum to the first two forms takes approximately 3-7 days, then it takes from 3 weeks to 3 months to reach milk maturity. Since hormones are involved in all stages of lactation, its course does not depend on whether the woman is feeding the child or not. For proper breast milk production, it is important to follow simple rules:

• Feed your baby frequently so that the number of prolactin receptors in the breast increases. This promotes the rapid interaction of breast components with prolactin, which ensures milk production. The connection that occurs prepares the basis for the next stage of lactogenesis.
• Avoid hourly regulation of feedings. The baby should be given breastfeeding on demand, at least every 2 hours, including at night. It is better not to express your breasts or soothe your baby with a pacifier or pacifier.

Why do breasts hurt during lactation?

Where does chest pain come from? Painful sensations appear in the chest at the second stage of lactation, when the hormone oxytocin comes into effect. The “oxytocin reflex,” as doctors call it, is characterized by the following symptoms:

• before feeding and during it, there is a tingling and burning sensation in the chest;
• felt pain syndrome and a feeling of excessive breast fullness;
• the breast begins to leak a few minutes before feeding;
• When the baby stops feeding, milk continues to be released.

At the second stage of lactation, the breasts may feel noticeably sore

The release of oxytocin from cells starts at the moment the baby sucks the breast. The baby stimulates the nerve endings of the nipple, as a result of which the production of a hormone begins in the posterior lobe of the pituitary gland, which passes into the breast cavity through the blood. Accumulating during sucking, oxytocin provokes the release of milk during feeding. This is how the “oxytocin reflex” goes. The hormone does not stimulate milk production if:

• Feeling pain, the mother does not breastfeed the baby;
• the parent is upset or very offended;
• feels anxious and restless;
• doubts his abilities.

Young women in labor need to remember that adequate breast filling is directly related to their emotional state, since it is controlled and with the participation of hormones. It is obvious that the processes are closely interconnected. If you are worried, stressed because of some difficult family situation, or feel fear, then your milk will not come in normally.

If in the last trimester of pregnancy the expectant mother was worried and worried a lot, problems with lactation may arise

How does milk formation occur?

Milk formation occurs when the milk reaches a mature “age”. If you are giving birth for the first time, then the transition from early and late to mature milk lasts from 1 to 3 months; for experienced women giving birth, this process takes 3 weeks to 1.5 months. Signs of milk maturity are:

• breasts are soft to the touch;
• there is no feeling of breast fullness before feeding;
• painful hot flashes stop;
• Milk production begins immediately at the time of feeding.

The difference between preparation for the start and milk production itself is that milk does not come from an increase in the number of hormones oxytocin and prolactin, but as a reaction to the baby's sucking. The volume of nutrient fluid depends on the degree of breast emptying. The “empty vessel” principle comes into play: feeding, empty breasts, milk production. The main thing is to adhere to the rules of frequent feeding both day and night.

After mature lactation is established, milk begins to arrive immediately before feeding

Why do lactation crises occur?

A lactation crisis is several short-term (2-7 days) periods in a child’s life when he, being unreasonably worried and irritated, requires constant breastfeeding. The timing of their onset is individual and occurs at the ages of 3 weeks, six weeks, 3 and 6 months. The causes of lactation crises are:

• Activation of growth. The child begins to grow, as they say, by leaps and bounds, he does not have enough nutrition, so he grabs the breast to meet his needs and adjust the filling of the mammary glands to his growing appetite.
• The reaction of the mother's body to the full moon. The period when milk production decreases in some mothers, while in others it increases.

How to correctly assess the situation?

Test wet diapers. If you gain more than 12 pieces (for girls more than 10), the baby gains about 113 grams of weight (the minimum standard according to WHO) per week, which means you have enough milk. However, you may get the impression that all you do is feed your child all the time. The baby, barely having time to empty one breast, grabs the other. Please note that such behavior of a baby is considered normal and does not indicate a lactation crisis. An increased desire to eat may be caused by improper care or a stressful situation for the baby.

The wet diaper test (or the number of times a diaper is urinated) can tell if your baby is getting enough milk

During a lactation crisis, the baby’s anxiety increases due to the lack of the required volume of milk, which can meet all his nutritional needs. Blaming the lactation crisis alone for this would be a mistake. The baby may also be capricious due to bad weather or sudden changes. atmospheric pressure. Both the full moon and too noisy influences the child’s psycho-emotional background water procedures, and long walks, and the presence of strangers.

How to behave during this period?

It is possible that you will not encounter a crisis or that it will pass unnoticed by you. Initially, you should not tune in to such a problem, and it is even more wrong to expect its occurrence. Remember the main principle of milk formation - demand creates supply. This means that the more volume the baby sucks, the faster it is replenished. The child instinctively “hangs” on the chest in order to provide himself with the required amount in advance. Mom should not rush to feed her treasure with formula. It is also wrong not to give the baby the breast upon his request. Try not to worry, wait a little, and you will see that within 3-7 days milk will begin to be produced as much as a little gourmet needs.

Don’t worry about a lack of milk during a lactation crisis - the more often you put your baby to the breast, the more milk will appear

What is lactation involution?

Involution of lactation is its complete completion (see also:). Its first signs appear at 2-3 years. Natural involution should not be confused with forced weaning of the child. The correct course of lactation involution occurs at a natural level, when the parent’s body physiologically stops milk production. Artificial termination of the lactation period does not belong to the concept of involution. What is lactation involution and how does it happen?

How does it affect the mammary glands?

Dramatic changes begin with the regression of processes that occurred during the entire feeding period. The natural closure of the excretory ducts on the nipples begins, glandular tissues are replaced by fatty ones, the breasts take over the same form and the state in which she was before pregnancy. The breast becomes completely incapable of feeding on the 40th day, counting from the last feeding. It is worth noting that the time duration of lactation involution is the same for all women and does not depend on how long your lactation period lasted.

In preparation for and during lactation, the breasts undergo changes.

Signs of involution

Discomfort when breastfeeding, strong desire stopping it does not mean that the time has come for the natural involution of lactation. To accurately determine the onset of breastfeeding involution, there are certain signs. It is useful for nursing parents to know them, so we will dwell on them in more detail. Carefully read each sign so as not to be frightened and not to flatter yourself with vain hopes.

Child's age

Having breastfed the baby for up to a year, the mother begins to think about switching him completely to regular food. Desire appears by various reasons: a course of treatment awaits, going back to work, advice from relatives and friends. The excuses found encourage the false idea that completion occurs naturally. By passing off wishful thinking as reality, you forget about the precisely established deadlines for involution - the child’s age is 2-4 years.

Early completion of the formation of nutrient fluid in the breast is carried out against the background new pregnancy or with hormonal imbalances (primary hypogalactia). With primary hypolactia, milk production is significantly reduced, creating the appearance that lactation involution has occurred. If this happens at the age of 1-1.5 years, to claim that you have involution means deceiving yourself.

Most often, from the age of two, a child switches to “adult” food by decision of the parents.

Increased sucking activity

When the lactation period approaches its end, the amount of milk decreases and the baby does not get enough. The baby increasingly asks for the breast, sucks it diligently, moves to another, and does not let go for a long time. The baby can suck even on an empty breast, waiting for milk to be released. The period of such activity lasts for several months and depends on how long the entire lactation period lasts and how often the baby is put to the breast.

Mom's fatigue

Psycho-emotional and physiological fatigue comes from the fact that breastfeeding can last up to 2-4 years. A stressful lifestyle and the body’s continuous work to produce milk provoke dizziness and weakness, which are felt after feeding. The approach of the final stage causes pain in the mammary gland, nipples also hurt, and general discomfort is felt. Feeding time begins to irritate, and there is a desire to stop it. General state during this period can be compared with the initial stages of pregnancy, when fatigue, irritability, and drowsiness set in. Violations are also possible menstrual cycle.

At some point, the mother stops enjoying the feeding process and wants to stop it completely

Psychological fatigue of both participants in the process

No matter how long it takes breastfeeding, the time comes when both its participants, mother and child, are tired and psychologically ready to give up on it. We must not forget that breastfeeding itself plays a role important role in the development of the baby not only as nutrition, but also gives great psychological assistance. Pleasant moments of close contact have a beneficial effect on the psycho-emotional state of the parent and her little treasure. If it is difficult for a baby to abruptly stop breastfeeding, he sleeps poorly, is capricious without sucking milk, it is obvious that the moment for refusal has not yet come. It turns out that both decisions - for and against breastfeeding - are difficult.

The problem of a lack of breast milk is familiar to many mothers during the breastfeeding period. Some people have little breast milk from the very beginning of feeding their baby. For some, its amount decreases periodically during periods of lactation crises. And for some, it almost disappears at some point due to stress or irregularities. It happens that the problem is completely imaginary, and the mother just thinks

While feeding a baby, you can often hear mothers complaining about blue milk that is thin like water. Mothers worry whether the baby is getting enough to eat, whether he has enough calories and microelements. So why is breast milk runny? How to make it fatter and is it necessary to do it? We will answer these questions in this article.

When a newborn is born, the wish for “sweet milk” is very often heard. Yes, in normal conditions human milk is sweet. But its taste may change. In this article we will look at the situation when milk becomes salty - this can happen for various reasons, from the mother’s diet to lactostasis or mastitis. Why is human breast milk sweet?

Staphylococcus is often found in breast milk. Mothers usually panic during such tests. What to do if you find staphylococcus? Do I need to get treatment myself? Will a baby get infected if breastfed? Without the correct information, mom can make mistakes. For example, stop breastfeeding when it is absolutely unnecessary. Or, conversely, not pay attention to severe symptoms

As soon as the baby is born, he shows with all his appearance that he wants to eat, opening his mouth slightly and trying to find the nipple. Already at this moment, the nursing mother is thinking about how much milk she has. What does it contain? Is that all essential microelements for the baby? Mom wants to know if it can affect the composition of breast milk.

How is milk produced in a woman's breast? How long must pass after the previous feeding of the baby for milk to appear in the woman’s body again? What does its quantity depend on? Why does a baby ask for breastfeeding so often at the beginning of life? In this article you will find answers to all these

Many doctors argue that from birth it is necessary to establish a certain feeding regime for the child, explaining their opinion by the fact that breast milk is digested no earlier than after 3 hours. To dispel this myth, an experiment was conducted in which it was determined how much adapted milk formula is digested and at what speed breast milk is absorbed. The study involved 20

Breast milk is produced in the alveoli mammary glands from the blood and lymph of a woman. What mommy eats and drinks is broken down into molecules in the gastrointestinal tract and absorbed into the blood. From tissue capillaries mammary gland molecules pass through the cells lining the alveoli into the milk. Since food is not digested instantly, and molecules are not removed from the blood immediately, this process takes some time.

Myth No. 1. You need to eat a lot

“The quantity of breast milk and its quality depend on many factors, the main one being the nutrition of the nursing mother.”

The amount of production from the mother’s “dairy” has nothing to do with malnutrition, since the milk is not obtained from products consumed by the woman. Fats and proteins are secreted by the breast cells themselves. A- and p-casein, lactoalbumin and P-lactoglobulin are formed from proteins in the mammary gland. Only immune globulins and serum albumin enter milk in preformed form from the blood. But the energy costs that the nursing body undergoes must be compensated good nutrition. Therefore, the quantity and even quality of milk, even with a meager diet, may be sufficient for the child’s needs, but female body may not be able to withstand the load, because the breasts will “take” the resources needed to produce milk from all the reserves and reserves of the body.

Myth No. 2. About the impact of products on a child and “allergy to hepatitis B”

“A nursing mother should monitor her diet very carefully; at first, everything potentially allergenic products. New foods should be introduced one per week and the child’s reaction should be closely monitored.”

There is a myth that some foods can cause a reaction in a child: from gas formation to allergic reactions.

Firstly, two concepts are often confused: allergies and food intolerances; these are two different things. In one case this is systemic disease With hereditary factor, in another - this is a consequence of inadequate feeding: too frequent shifting from one breast to another, supplementing and feeding. The cause of food intolerance in the form of bloating, changes in stool character, dysbiosis and dermatitis must be sought, first of all, in the method of breastfeeding, and not in the foods consumed by the mother. In the third case, the allergy - a consequence of infection of the mother's milk - is no longer a food allergy, but a bacterial allergy; it cannot be treated by adjusting the diet.

Food products themselves cannot become aggressive for a child in a mother who knows for sure that she tolerates them well; the product simply does not have any ways through which it will become an aggressor in mother’s milk. But the mother’s negative reaction to the product will immediately affect itself in the form food intolerance The child has.

Factors contributing to the development of food sensitization (allergization) in children:

Hereditary predisposition;
. gastrointestinal pathology in the mother, leading to permeability of the intestinal barrier, as a result of which food allergens, circulating in the mother’s blood, pass through the placenta to the child during its intrauterine development
. late breastfeeding after childbirth
. supplementary feeding with formulas in the first days of life
. supplementary feeding with formulas at 2-3 months of age if hypolactia (lack of milk) is suspected
. consumption of highly allergenic foods by mothers prone to allergies large quantities(non-compliance with a hyposensitizing diet)
. It is of no small importance that the father of the unborn child follows diets if the father has allergies or is prone to allergies
. maternal consumption large quantity preservatives and dyes that strongly irritate the mucous membrane gastrointestinal tract and increasing the absorption of allergenic substances into the blood
. Various foods can change the color and consistency of a baby's stool if they contain substances that can pass through the blood into breast milk.

K potentially dangerous products still include alcohol and caffeine in excessive doses. For alcohol - over 1 ppm per day (this is 1 glass of wine or 1 bottle of beer). For caffeine - over 200 mg per day (that's about 2 cups of coffee).

Myth No. 3. You need to drink a lot

“It should also be taken into account that during lactation a woman needs significantly more water. It is no coincidence that mothers are recommended to drink a glass of tea with milk before each feeding of the baby.”

Does milk tea actually increase breast milk production? This is one of the “favorite” myths among nursing mothers. But let's figure out what affects the amount of milk. In the body of a nursing woman, milk is formed not from drunk milk, but from blood and lymph under the influence of the hormone prolactin. That is, the amount of milk is regulated not by the amount of fluid in the stomach, but by hormones in the pituitary gland. The amount of the latter mainly depends on how often and correctly the baby sucks and on the presence of a sufficient number of day and night feedings. Therefore, tea with milk is not involved here. And yet, the “magic drink” really helped many mothers. How is this possible? The fact is that the baby cannot get enough milk from the breast simply by sucking. The hormone oxytocin helps him in this, which contracts the muscle cells around the mammary gland and ducts. This results in increased secretion (rather than production) of milk from the nipples. At the same time, mothers note distension, tingling, warming in the chest and sometimes leakage of milk through the nipple.

There is one trick: when the tongue receptors are irritated by a pleasantly hot drink, the release of oxytocin increases. This is what is observed when drinking tea with milk. But the same effect can be obtained by drinking any other liquid of the same temperature.
There is also a myth that the amount of liquid consumed affects the amount of milk produced. Increasing the amount of fluid consumed does not affect the increase in milk supply. But drinking too much liquid puts a strain on the kidneys, which is a stress factor for the body, and any stress blocks the release of hormones necessary for lactation. It turns out the other way around - overuse liquid can lead to a decrease in milk production, just as thirst also creates discomfort and interferes with relaxation and blocks the release of hormones. Therefore, it is rational to consume the amount of liquid that the body requires and drink as much as you want, and not through force, and without limiting yourself in taking liquid.

For nursing mothers to better absorb any liquid, it is better not to drink mixed drinks, such as tea and coffee with milk. Since it is believed that breastfeeding women need to maintain the required level of calcium in the body, alongside this myth coexists the myth that the foods richest in calcium are dairy products. This is not entirely true, firstly, calcium from milk is the most difficult to digest, and secondly, milk is an allergen and should be consumed with caution. If you suspect allergic reactions or intolerances. And to increase the calcium content in the body, it is better to use other foods high in calcium instead of milk: sesame seeds, almonds, sardines, hazelnuts, watercress, hard cheeses, broccoli, white cabbage, black bread, leeks, bananas. Teas, as a rule, are recommended not for black teas, but for herbal and fruit and fruit and berry drinks. A high calcium content, for example, is observed in a drink made from rose hips and nettles.

Myths No. 4. About harmful products

“Citrus fruits, berries, chocolate are especially dangerous in this regard...”

Breast milk contains the maximum amount of antibodies to all types of aggressive elements that a person can receive in a lifetime. Substances passed through breast milk form stable food tolerance - the ability to digest any food. Excluding certain foods from the diet means depriving the child of the opportunity to form his own defense against harmful factors environment, including allergens. An exclusive “Anti-allergenic diet” without indications from the mother is a direct way to make a child potentially susceptible allergic reactions in future. Allergy prevention can be ensured by exclusive breastfeeding for up to 6 months, as well as the introduction of complementary feeding according to the principle of pedagogical complementary feeding, when the mother's food products and those used for complementary feeding are identical, the body will be able to recognize the allergen itself and give the necessary antibodies to it. A nursing mother should better listen to the work of her own body, the so-called atopic dermatitis may begin in children whose mothers themselves do not digest certain foods well, but continue to eat them.

Myths No. 5. Products “specially for lactation”

“There are specialized products for nursing mothers. These include: drinks and juices for pregnant women and nursing mothers, teas for pregnant and nursing mothers; porridge instant cooking for pregnant and lactating women; dry protein-vitamin-mineral complexes for nursing mothers; vitamins for pregnant and lactating women.”

The vast majority of all these products “for nursing” are nothing more than a commercial move and the products offered are the most ordinary products, they are simply offered under the guise of “special”. It is cheaper and more reliable to eat and drink home-prepared herbal teas, the herbs for which you will buy at a pharmacy or in departments of " traditional medicine" You can also choose cereals in any department in the supermarket, and if you want a twist, or you don’t trust ordinary manufacturers, again, use the departments of environmental and dietary products. It is not recommended to take artificial vitamin supplements without the specific recommendation of your doctor.
author Alexandra Kudimova