Breast milk is commonly known as the best form of nutrition for neonates and infants. Human milk has bioactive properties that facilitate the transition of life from in utero to ex utero. This dynamic fluid provides a diverse array of bioactive substances to the developing infant during critical periods of brain, immune, and gut development. The clinician must be familiar with how human milk is manufactured by the mammary gland and with the properties of human milk that render it nourishing and protective of the breastfeeding infant.
Clinicians play a crucial role in a mother’s decision to breastfeed and can facilitate her success in lactation. Although a mother may not be aware of the evidence indicating that breast milk contributes to her baby’s short- and long-term well-being, she has certain attitudes and cultural beliefs about breastfeeding. The issue of bonding between mother and newborn may be a strong factor; however, stronger cultural or societal barriers may be present that result in formula feeding. Such issues must be understood for successful counseling. The mother makes her decision regarding breastfeeding prior to delivery in more than 90% of cases; therefore, a discussion regarding her choice of infant nutrition after delivery should take place beginning in the second trimester and as part of an ongoing dialogue during each obstetric visit.
This article reviews the development of the mammary gland (mammogenesis), the process by which the mammary gland develops the capacity to secrete milk (lactogenesis), the process of milk production (lactation), and the specific properties of human milk that make it unique and appropriate for human infants. In a related article entitled Counseling the Breastfeeding Mother, the mechanics of breastfeeding and how to evaluate the breastfeeding mother-infant dyad are discussed. These articles are intended to be overviews. For a more in depth treatise, please refer to textbooks by Lawrence and Lawrence (1999) and Riordan and Auerbach (1998).
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