Melanie writes:
<.I haven't heard the stronger let down with smaller breasts idea, but I
hear a lot about a stronger let down the more babies you have. . . . . I
find it interesting that afterpains also increase in strength with more
births and I'd be very interested in why -- there is a huge discussion on
a list for large families I'm on about how to mitigate afterpains. >
Pat writes:
<I always thought that the increasing after pains was due to the fact
that the uterus had been stretched "again' and was trying to get back to
normal and had a harder time of doing it. Just MHO. Maybe a midwife on
the list can tell us the actual mechanics. Pat in SNJ >
I am not a midwife, but I remember reading a 1974 Israeli medical article
on the use of a breast pump when it was necessary to induce labor on
grand multiparas (Sorry, that's the term in medical use to refer to the
mothers to which they were ascribing a particular kind of risk common to
such mothers. I don't think it was meant to be insensitive to mothers
with a larger number of pregnancies. I don't know at what number that
term begins to apply.). The study was undertaken because at that point in
medical development, they apparently could not titrate the delivery rate
of exogenous pitocin to such a dilution to avoid tetanic contractions in
such mothers. This leads me to believe it may have something to do with
either more oxytocin receptors or more sensitive receptors.
I suppose this could be equally true of the myoepithelial cells/OT
receptors in the breasts. I seem to remember something about
prostaglandins being involved, and I believe that NSAIDS such as aspirin,
ibuprofen, naproxyn, etc. inhibit prostaglandins. Taking some form of
NSAID regularly for a while after birth might be something to discuss
before birth with your HCP..
On the subject of small breast size and more powerful milk ejection
reflex, beneath the skin of a breast, it's not possible to determine
easily at any stage in reproduction what % of the size is due to fat,
what % to connective tissue, and during pregnancy/lactation, what % is
due to glandular tissue, full, or partially full ducts, nor how many
lobes a particular mother may have in an individual breast.
I imagine some mothers have small breasts because they don't have as many
lobes as some other mothers, which seems to be what has been described in
literature as ISG, or insufficient glandular tissue. Other mothers may
have small breasts but with more glandular tissue, and correspondingly
less fatty tissue and connective tissue.
From that it follows logically that mothers with more glandular tissue
would have more myoepithelial cells in the breast, to contract. Perhaps
those mothers might have a different experience and a different sensation
from those mothers whose size is due to ISG, with fewer myoepithelial
cells.
OTOH, no matter the total # of lobes, it seems to me that when I see
mothers with "overactive" milk ejection reflex, that phenomenon seems to
happen when the ducts are at their fullest, but not necessarily each time
during a feeding another MER happens, when part of the fullness has been
drained.
That leads me to believe that it is not always the MER that seems to be
"out of kilter" but the same speed of reflex is delivering a larger
volume of milk causing the baby to gulp, etc. Perhaps it the collection
of a relatively larger volume of milk, causing greater stretching of the
ducts, that may also be responsible for the seeming "strength" of a
particular mother's MER.
Just today's musings to avoid housework:-)
Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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