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From:
Helen Ball <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 29 Feb 2008 17:28:16 -0500
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Hi Casey,
I'll try tackling this one for you. I think you are onto something -- but perhaps 
not quite. The key parts of your explanation that are problematic 
are: "Copious milk production will begin in 3 – 5 days regardless of breast 
stimulation and/or milk removal" and "frequent and early breast stimulation 
does not bring the milk ‘in’ any more quickly".

There are a number of studies that have demonstrated that frequent feeding 
in the 1st 24-48 hours after birth results in earlier LII and more copious milk 
production at LII. Here are a couple of paragraphs I wrote for a recent book 
chapter summarising this topic:

"Very high levels of prolactin and glucocorticoid are required for milk 
production to begin in earnest.  Following delivery of the placenta maternal 
progesterone levels fall, and prolactin levels (which are suppressed throughout 
pregnancy by progesterone) begin to rise [74] and further rise and fall in 
relation to the frequency, duration, and intensity of nipple stimulation.  In the 
early post-natal period, each time the infant stimulates the nipple via suckling 
or touch, the mother experiences a rapid increase in prolactin secretion [58, 
59]. It is well recognised that feeding frequency in the early post-natal period 
is a key factor in establishing milk production and in learning how to suckle [83-
86], with the frequency of night-time feeds being of particular significance 
[76]. In these early days of breastfeeding the amount of prolactin released is 
directly related to the intensity of nipple stimulation [75], and breastfeeding 
at night is associated with greater prolactin release than daytime feeding [76, 
77]. Prolactin concentrations in maternal blood have been reported to double 
in response to suckling [74]. Neville et al. reported that the time of first 
breastfeeding, and the frequency of breastfeeding on the 2nd post-partum 
day, are positively correlated with milk volume on day 5 [75], suggesting that 
frequent stimulation of prolactin secretion in the period between birth and 
lactogenesis II increases the efficiency of subsequent milk production [74, 
76]. These findings lead to the conclusion that frequent nipple stimulation, 
frequent suckling, and particularly frequent attempted and successful feeds at 
night, in the period immediately preceding lactogenesis II will lead to an earlier 
onset of lactation and more prolific milk supply. 

In addition to being critical for breastfeeding initiation, high initial prolactin 
levels are also important for successful long-term lactation. According to the 
prolactin receptor theory the maintenance of lactation after lactogenesis II 
(galactopoeisis) is dependent upon the successful development of prolactin 
receptors, which occurs in the early postpartum period and also depends upon 
frequent feeding [74, 78]. These prolactin receptors are crucial in maintaining 
lactation following the switch from endocrine to autocrine control. This 
suggests that frequent early feeding attempts will not only lead to effective 
establishment of milk production, but will enhance its continued maintenance."

My understanding is that the key issue therefore lies with stimulating prolactin 
secretion via nipple contact rather than removal of colostrum.

References cited in text above:
58	Johnston, J.M., Amico, J.A. A prospective longitudinal study of the 
release of oxytocin and prolactin in response to infant suckling in long term 
lactation. J. Clin.  Endocrinol. Metabol. 62, 653, 1986.
59	Uvnas-Moberg, K., Widstrom, A-M., Werner, S., et al. Oxytocin and 
prolactin levels in breast-feeding women. Correlation with milk yield and 
duration of breast-feeding. Act. Obst. Gyn. Scand. 69, 301, 1990.
74	Riordan, J., Breastfeeding and Human Lactation, 3rd ed. Boston and 
London: Jones and Bartlett, 2005.
75	Neville, M.C., Morton, J., Umemura, S. Lactogenesis. The transition 
from pregnancy to lactation. Pediatr Clin North Am. 48, 35, 2001. 
76	Tennekoon, K.H., Arulambalam, P.D., Karunanayake, E.H., et al. 
Prolactin response to suckling in a group of fully breastfeeding women during 
the early postpartum period. Asia Oceania J. Obstetr. Gyn. 20, 311, 1994.
77	Woolridge, M.W. Baby-controlled breastfeeding, in Breastfeeding: 
Biocultural Perspectives, P. Stuart-Macadam and K. Dettwyler, Eds., New 
York, Aldine de Gruyter: 1994, 217-242.
78	Marasco, L., Barger, J. Cue Feeding: Wisdom and Science. 
Breastfeeding Abstracts 18, 28, 1999.
83	Salariya, E.M., Easton, P.M., Cater, J.I. Duration of breast-feeding 
after early initiation and frequent feeding. Lancet 25, 1141, 1978.
84	Hornell, A., Aarts, C., Kylberg, E., et al. Breastfeeding patterns in 
exclusively breastfed infants: a longitudinal prospective study in Uppsala, 
Sweden. Acta Paediatr 88, 203, 1999.
85	Auerbach, K. Evidence-based care and the breastfeeding couple: 
key concerns. Journal of Midwifery and Women's Health, 45, 205, 2000.
86	Inch, S. Postnatal care relating to breastfeeding, in Midwifery 
Practice Postnatal Care. A Research Based Approach, J. Alexander, V. Levy, 
and S. Roch, Eds. Macmillan. 1990 19-44.

Helen Ball
Professor of Anthropology
Durham University, UK

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