Pathways to lactogenesis: Disruptors and Facilitators

Several pathways may explain the relationship between the maternal and infant factors and institutional practices (including maternity care and hospital) that have protective or detrimental effects on lactogenesis, in turn the establishment of adequate milk supply and ultimately BF outcomes. These pathways can be disrupted or delayed by interventions during labor (pharmacologic or mechanical) or supported through early BF initiation, skin-to-skin and hospital practices (such as Baby Friendly's 10-steps). Maternal factors such as smoking, obesity and stress can also interfere with BF thereby moderating the physiologic processes essential for the establishment of mature milk. Other maternal factors such as prior BF, BF intention and BF confidence also affect early BF. The infant may be affected by maternal stress or other maternal or prenatal factors leading to less effective suckling. Furthermore the administration of fluids during labor can lead to maternal postpartum edema (making latch more difficult). Excess fluid in the infant that when lost, may be interpreted as actual weight loss. These events and other clinical and hospital practices can lead to early introduction of formula that can delay or impair lactogenesis and BF outcomes.