Delayed lactogenesis II and unsuccessful exclusive breastfeeding

Abstract

Breast milk is the main source of nutrition for newborns. Nutrients and bioactive substances that are important for babies are found in breast milk. Cells, anti-infectious and anti-inflammatory agents, growth factors, and prebiotics are bioactive factors in breast milk. 1 These contents are essential to ensure the growth, health, and cognitive development of human infants. 2 World Health Organization recommends mothers to exclusively breastfeed infants for the first six months. Adequate nutritional complementary foods begin at the age of 6 months along with continued breastfeeding until the age of 2 years or more. 3 Exclusive breastfeeding has many benefits for both mother and baby. Benefits for babies include reducing the incidence of respiratory tract infections, otitis media, gastrointestinal infections, allergies, obesity, diabetes, and sudden infant death. Breastfeeding also helps the development of nerves and the intelligence of infants. 4,5 Benefits of breastfeeding for mothers include reducing the incidence of postpartum haemorrhage, accelerating uterine involution, risk of hypertension, type 2 diabetes, metabolic syndrome, and hyperlipidemia. 4,6 Although exclusive breastfeeding is known to provide many benefits for mothers and infants, coverage worldwide only reaches 40%. 3 Coverage of exclusive breastfeeding in America is even only 18.8%. 7 In Indonesia coverage of exclusive breastfeeding reaches 49.8%. 8 Some of the factors that contributed to the achievement of exclusive breastfeeding include the knowledge of maternal factors, maternal body mass index, and delayed lactogenesis II. 9,10 Lactogenesis is the activity of the number of mammary cells to producemilk. It takes a two-stage event, the initiation and activation of the secretory. The first stage of lactogenesis (lactogenesis I) occurs in during the second half of pregnancy. The placenta provides elevated progesterone concentrations that prevent further differentiation. The second stage of lactogenesis (lactogenesis II) begins after shipment with abundant milk manufacturing. The rapid drop in progesterone, as well as the presence of elevated levels of prolactin, cortisol, and insulin, stimulates this stage with the removal of the placenta at delivery. 11 Delayed lactogenesis II is a condition that starts from the failure of activation of the lactogenesis II process. In this condition, breast milk does not come out until 72 hours after postpartum. 12 This condition raises the perception of lack of milk production. In the initial condition after giving birth, nursing mothers who experience this condition have the possibility of having difficulty being able to breastfeed exclusively for up to 6 months. 13,14 Some mothers even stop breastfeeding in the first two weeks. 7 If breast milk does not come out within the first 72 hours, it must immediately look for the causes and how to overcome them. 12 This shows the critical point in the early hours of breastfeeding to be an important period for the success of exclusive breastfeeding. In some studies, di...