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Lactation describes the secretion of milk from the and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all animals (including humans) is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.
In most species, lactation is a sign that the female has been pregnant at some point in her life, although it can happen without pregnancy. Nearly every species of mammal has nipples; except for monotremes, egg-laying mammals, which instead release milk through ducts in the abdomen. In only one species of mammal, the Dayak fruit bat from Southeast Asia, is milk production a normal Male lactation.
Galactopoiesis is the maintenance of milk production. This stage requires prolactin. Oxytocin is critical for the milk let-down reflex in response to suckling. Galactorrhea is milk production unrelated to nursing. It can occur in males and females of many mammal species as result of hormonal imbalances such as hyperprolactinaemia.
It is also possible to induce lactation without pregnancy through combinations of birth control pills, galactagogue, and milk expression using a breast pump.
When the breast is stimulated, prolactin levels in the blood rise, peak in about 45 minutes, and return to the pre-breastfeeding state about three hours later. The release of prolactin triggers the cells in the alveoli to make milk. Prolactin also transfers to the breast milk. Some research indicates that prolactin in milk is greater at times of higher milk production, and lower when breasts are fuller, and that the highest levels tend to occur between 2 a.m. and 6 a.m.
Other hormones—notably insulin, thyroxine, and cortisol—are also involved, but their roles are not yet well understood. Although biochemical markers indicate that Secretory Activation begins about 30–40 hours after birth, mothers do not typically begin feeling increased breast fullness (the sensation of milk "coming in the breast") until 50–73 hours (2–3 days) after birth.
Colostrum is the first milk a breastfed baby receives. It contains higher amounts of white blood cells and antibody than mature milk, and is especially high in immunoglobulin A (IgA), which coats the lining of the baby's immature intestines, and helps to prevent pathogens from invading the baby's system. Secretory IgA also helps prevent food allergies. Over the first two weeks after the birth, colostrum production slowly gives way to mature breast milk.
During this stage, the more that milk is removed from the breasts, the more the breast will produce milk. Research also suggests that draining the breasts more fully also increases the rate of milk production. Thus the milk supply is strongly influenced by how often the baby feeds and how well it is able to transfer milk from the breast. Low supply can often be traced to:
Milk ejection is initiated in the mother's breast by the act of suckling by the baby. The milk ejection reflex (also called let-down reflex) is not always consistent, especially at first. Once a woman is conditioned to nursing, let-down can be triggered by a variety of stimuli, including the sound of any baby. Even thinking about breastfeeding can stimulate this reflex, causing unwanted leakage, or both breasts may give out milk when an infant is feeding from one breast. However, this and other problems often settle after two weeks of feeding. Stress or anxiety can cause difficulties with breastfeeding. The release of the hormone oxytocin leads to the milk ejection or let-down reflex. Oxytocin stimulates the muscles surrounding the breast to squeeze out the milk. Breastfeeding mothers describe the sensation differently. Some feel a slight tingling, others feel immense amounts of pressure or slight pain/discomfort, and still others do not feel anything different. A minority of mothers experience a dysphoric milk ejection reflex immediately before let-down, causing anxiety, anger or nausea, amongst other negative sensations, for up to a few minutes per feed.
A poor milk ejection reflex can be due to sore or cracked nipples, separation from the infant, a history of breast surgery, or tissue damage from prior breast trauma. If a mother has trouble breastfeeding, different methods of assisting the milk ejection reflex may help. These include feeding in a familiar and comfortable location, massage of the breast or back, or warming the breast with a cloth or shower.
Following the electrical impulse, oxytocin is released into the bloodstream. Through the bloodstream, oxytocin makes its way to myoepithelial cells, which lie between the extracellular matrix and luminal epithelial cells that also make up the alveoli in breast tissue. When oxytocin binds to the myoepithelial cells, the cells contract. The increased intra-alveolar pressure forces milk into the lactiferous sinuses, into the lactiferous ducts (a study found that lactiferous sinuses may not exist. If this is true then milk simply enters the lactiferous ducts), and then out the nipple.
Lactation can be induced in humans by a combination of physical and psychological stimulation, by drugs, or by a combination of those methods. Several protocols for inducing lactation were developed by Dr. Jack Newman and Lenore Goldfarb and are commonly called the Newman-Goldfarb protocols. The "regular protocol" involves the use of birth control pills to mimic the hormone levels of pregnancy with domperidone to stimulate milk production, followed by discontinuing the birth control and the introducing use of a double electric breast pump to induce milk production. Additional protocols exist to support an accelerated timeline and to support induced lactation in menopausal parents.
Some couples may stimulate lactation outside of pregnancy for Erotic lactation.
Rare accounts of male lactation (as distinct from galactorrhea) exist in historical medical and anthropological literature, although the phenomenon has not been confirmed by more recent literature.
Domperidone is a drug that can induce lactation.
As all mammals lactate, lactation must have evolved before the last common ancestor of all mammals, which places it at a minimum in the Middle or Late Triassic when monotremes diverged from therians. O. T. Oftedal has argued that evolved a proto-lacteal fluid in order to keep eggs moist, an adaption necessitated due to diapsids parchment shelled eggs which are more vulnerable to evaporation and dehydration than the mineralized eggs produced by some sauropsids. This protolacteal fluid became a complex, nutrient-rich milk which then allowed a decline in egg size by reducing the dependence on a large yolk in the egg.20 The evolution of lactation is also believed to have resulted in the more complex dentition seen in mammals, as lactation would have allowed the prolonged development of the jaw before the eruption of teeth.
During early evolution of lactation, the secretion of milk was through pilosebaceous glands on mammary patches, analogous to the areola, and hairs on this patch transported the nourishing fluids to the hatchlings as is seen in . The development of the nipple occurred in the mammal lineages that diverged after monotremes, metatheria and eutheria.
The discus fish ( Symphysodon) is known for (biparentally) feeding their offspring by epidermal mucus secretion. A closer examination reveals that, as in mammals and birds, the secretion of this nourishing fluid may be controlled by prolactin. Similar behavior is seen in at least 30 species of .
Lactation is also the hallmark of adenotrophic viviparity - a breeding mechanism developed by some insects, most notably tsetse flies. The single egg of the tsetse develops into a larva inside the uterus where it is fed by a milky substance secreted by a milk gland inside the uterus. The cockroach species Diploptera punctata is also known to feed their offspring by milky secretions.
Toxeus magnus, an ant-mimicking jumping spider species of Southeast Asia, also lactates. It nurses its offspring for about 38 days, although they are able to forage on their own after 21 days. Blocking nursing immediately after birth resulted in complete mortality of the offspring, whereas blocking it 20 days after birth resulted in increased foraging and reduced survival. This form of lactation may have evolved from production of .
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