Pathology of the mammary glands in the postpartum period
- Changes in the amount of breast milk in the postpartum period:
1.1. Lack of breast milk – agalactia.
This is a rare condition. It can be associated with Sheehan’s syndrome – postpartum reduced function of the pituitary gland as a result of shock, blood loss. The diagnosis of agalactia should not be rushed, as it may simply refer to a later onset of milk secretion. Usually, the release of breast milk begins on the 2nd-3rd day after birth. Later onset of milk secretion is also possible – on the 6th-7th day. To stimulate the process, the baby should be put to the breast for sucking as early as possible and this should be repeated regularly.
1.2. Decreased amount of breast milk – hypogalactia.
It is observed in about 20% of women in labor. Hypogalaxia can be primary, secondary and relative.
Primary hypogalactia – the breast milk produced is initially in a smaller amount:
– in the case of disorders in the development of the mammary glands (absence or insufficient development);
– underdeveloped nipples;
– insufficiently high levels of the hormone prolactin, responsible for lactation (breast milk production);
– endocrine diseases – hyperthyroidism, diabetes mellitus, etc.
Secondary hypogalactia – reduction in the amount of breast milk produced after a period of normal lactation:
– unjustified transition to mixed feeding of the baby (with mixed feeding, the baby also receives another type of milk in addition to mother’s milk), as the breast milk substitute was given before breastfeeding and with a pacifier (in sucking from a pacifier, the baby may refuse to suckle from the breast);
– mental stress;
– disorders in the general condition of the mother in case of infectious, systemic diseases;
– improper nutrition of the mother before and after childbirth, adherence to diets after childbirth;
– retention of parts of the placenta in the uterine cavity, which suppresses lactation;
– causes of the newborn – prematurity, low body weight, impaired swallowing reflex, difficulty breathing due to various anomalies and diseases. These factors disrupt the lactation process, in which breast milk remains in the breast, which reduces its further production;
– new pregnancy in the postpartum period.
Relative hypogalactia – in twins, when more breast milk is needed.
The prevention of hypogalactia includes preparing the breasts for breastfeeding already during pregnancy, ensuring peace of mind for the mother, adequate nutrition, regular breastfeeding, observing the correct breastfeeding technique – in the first days after birth, the mother breastfeeds in a semi-reclining position, and then – sitting in a chair, the duration of each breastfeeding is 15-20 minutes, with each breastfeeding the child should suck from only one breast, if necessary, the breasts are pumped to prevent stagnation of milk.
1.3. Increased formation of breast milk – hypergalactia . Hypergalaxies are rare. In some cases, the amount of breast milk in one day can exceed 5 liters.
- Disturbed flow of breast milk:
– galactorrhea – spontaneous leakage of breast milk between feedings. Galactorrhea can lead to the formation of sores and eczema on the breasts due to frequent urination, malnutrition of the baby due to lack of breast milk. In such cases, massage of the nipples is applied to tone the muscles of the outlet ducts of the mammary glands.
- Abnormalities of the nipples:
– flat and sunken nipples – can make breastfeeding difficult. In the preparation of the breasts for breastfeeding during pregnancy, massages and withdrawal of the nipples are applied. When using a pump in the postpartum period, the nipple is also withdrawn.
- Diseases of the nipples – ragades:
Ragadas represent damage to the epithelium of the nipples. Most often, hemorrhoids occur in the first week after childbirth and in women who have given birth for the first time.
The ragads are:
– superficial;
– deep.
Reasons for the development of sores:
– nipples not prepared for breastfeeding;
– abnormalities of the breast nipples;
– incorrect breastfeeding technique – leaving the baby at the breast for too long when sucking, not drying the nipple and frequent wetting;
– poor breast hygiene;
– reduced immunity of the mother in case of systemic diseases, lack of vitamins, etc.
Clinical picture:
– pain;
– bleeding from the vagina;
– on inspection, the nipples appear swollen and bluish, sores are visible. The udders carry a risk of infection, and postpartum (puerperal) mastitis
can develop .
Treatment of ragades:
– stop breastfeeding and ensure rest of the respective breast;
– express the breast by hand. The baby is fed the expressed breast milk using a spoon, not a pacifier;
– drying and cleaning the nipple before and after breastfeeding;
– local use of antibiotics, anesthetics and epithelizing agents.
The prevention of ragades consists in:
– correct breastfeeding technique;
– good hygiene;
– nipple preparation for breastfeeding.
