Ep 108- Lifecycle of the Breast

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This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode. Welcome to the Milk Minute Podcast, everybody. I’m very excited to be back in the studio. We have brand new sound panels and we changed everything we’re doing again. I hope it’s better. I also hope it’s better. We got these cutie little desks that sit right in front of us.

So we are blocking our own sound and our mics are in each other’s blind spots, ideally. So we’re always just trying to get better every day just for you. Yeah. Who knew when we made a podcast, we had to actually like, learn about audio recording? Yeah. Start a podcast, they said. It’ll be easy, they said. The barrier to entry is so low, they said.

But the problem is when you partner with a perfectionist like myself, it’s never good enough. So here we are still on the upward climb to being NPR. Heather, your toxic trait, like love you. Your most toxic trait is thinking that you can always do better. Like that it is always within your grasp.

Hmm. That’s a fact because I can, I can. If I just work harder. It’s not that I don’t think I’m worthy right now. I just think I can always improve just even the slightest bit. We can’t get into that maybe in another episode. That’s a whole six-hour discussion. I accept it. It’s fine. Either way, I am occasionally appreciative of the fact that you push me to want to do better.

I’m appreciative that you’re not just like me, otherwise it would never get off the ground. You’re like, yeah, screw it. Let’s just do it. What’s the worst that could happen? And I’m like, here’s a spreadsheet of all the worst-case scenarios. But anyway, speaking of growing, as people, as a podcast, we would like to talk about growing as a breast.

Oh, yes. That’s our topic for today is actually glandular development, breast development from conception until after breastfeeding. Yes. The whole thing. Our breasts continue to change as do we as human beings and they serve multiple functions. And we would like to highlight the awesomeness and the true magic that is within your glandular loves sacks on your chest.

Okay. But before we do anything else, I would like to also appreciate the people who make this podcast possible. And those are our patrons. Yes. Thank you patrons for always being there for us. And we hope that you feel like we’re always there for you. So I would like to thank Brooke from Dahlonega, Georgia. That’s right. Jennifer A, Laura from Colchester, Vermont, Lindsay C, Sarah from Claremont, Florida, and Phoebe from Oak Park, Illinois. Whoop. Thanks everybody.

Today’s question is from our lovely patron Carmella. Carmella says, I was wondering why do you think mouth ties, tongue, buccal, lip aren’t talked about much?

I feel like it should be a vital part of training for lactation consultants. Me and my daughter suffered for a very long time because of mouth ties. Both our lactation consultant and pediatrician said she didn’t have any, but both were wrong. I feel like if there was more education on mouth ties, we wouldn’t have suffered nearly as much.

So I have a lot to say about this. The first thing I will say is that this has been traditionally acknowledged by midwifery for a very long time. You know, many years ago, kind of every traditional midwife in all different cultures knew about these and they would cut them for babies. Yup. But we had a very sharp rise in bottle-feeding in obstetric providers, doctors, managing pregnancy, birth, postpartum, and kind of a rise in valuing Western evidence-based medicine versus traditional knowledge.

Now, I’m not saying one is better than the other. However, that rise really means that we have devalued traditional knowledge and ignored it. And so if there’s not a clear study on it, it doesn’t exist. Right. And if there’s not a validated screening tool to rely on, which there is now, but there was not before at the peak of bottle-feeding culture in the eighties.

It was you know, one of those things that’s like, well, why would you worry about this thing so much that so many people disagree about when you could just easily feed a bottle? Right. And really like, yes, oral functioning matters for bottle feeding, but not as much, and not when we’re formula feeding and, you know, people are a little bit less stressed about like baby spilling milk out of their mouth.

You know, it’s just like, that was like, oh no, that’s just normal. Just get a different shape nipple and just get a different flow and baby will be fine. Yep. The answer is multifaceted as usual, but we’re seeing more types of professions now coming in with different perspectives on it. Right. We’re seeing OT, we’re seeing PT, dentistry, ENTs, doctors, midwives, and hopefully with all of these professions, acknowledging different parts of the problem, we can actually collaborate and see the whole picture.

There’s a little bit of an ego issue with it too. Can I just say? My God. Cause I think some people are afraid to make the call and then send them to the right person who could, who could and has the power to revise the oral restriction. But it happens often that the person you send them to not only does not stick their fingers in the baby’s mouth to even check, just looks and says, well, the baby’s gaining weight and your nipples aren’t chewed up so they’re fine.

And whoever told you this baby has a tongue tie doesn’t know what they’re talking about. Yeah. There’s a lot of like this downward aggression, which just makes people feel like they are the end all be all. And it’s like, wait a minute. First of all, there are more issues now that we know thanks to talking to Michelle Emmanuelle.

Oh yeah. And we will link our interview with Michelle in the show notes for our oral restriction episode that we did with her. But there are so many more issues other than weight gain and nipple injury that go along with oral restrictions later in life. Absolutely. And I think also this goes hand in hand with healthcare providers, not understanding lactation and blaming women being the easy way out.

Yes. Right. So do you know how to position your baby? Right? Maybe there’s a problem with your milk supply. I that’s, you know, every doctor’s first go-to and it’s not their fault. That’s how they’re trained. So we need to fix the training. We need a more cohesive training and a training that maybe starts with here are all the people that could be involved in a tongue tie issue.

And let’s respect and appreciate where everyone’s specialty is coming from and not devalue their opinion. And thank them for the referral. I was just going to say it all comes down to knowing the resources available to you and the appropriate person to refer to. So the answer to your question, Carmella is it’s complicated. As always.

Thanks to squeaky wheels like Maureen and I and Michelle Emmanuelle, and a few other like pediatric dentists are come to bat for people a lot now. We are starting to have these conversations a lot more, especially as people are encouraged to breastfeed more, and we’re trying to claw our way out of this bottle-feeding culture.

The resources need to be available to support those people that you are encouraging to breastfeed. So. Wait and see, let’s see what happens here.

All right. It’s Maureen here and I want to tell you that I have finally set up a link so you can instantly book virtual lactation consults with me. Thank the Lord. I know Heather, it took me a long time to take the leap from in-person visits to virtual, but I did it. You’re going to love it. I love doing virtual consults.

They are the best. It serves more people. I’m so glad you took the plunge. Thank you. And if you guys out there want to book some time with me, you can go to HighlandBirthSupport.com and then click on my lactation services tab. Is that H I G H L A N D? Yes. Okay. I will see you on zoom, everybody.

Alright. In the beginning before time began. In the beginning of time, there were cells. Before that. No, I’m just kidding. But really the development of glandular tissue of breasts, all of that begins in utero. When we have just a wee cluster of cells at four to six weeks gestation. Oh, wee cluster and by the way, everyone starts out as a girl.

Pretty much yeah. We all start out basically the same. And then as we begin to develop these cells that have just it, you know, so many capabilities and can become anything. They begin to get specific with their goal. And at four to six weeks is when we see cells beginning to get specific as mammary glands, which is really cool. That’s early.

Can you imagine being that cell that like gets your assignment and you’re like, oh my God, I’m a mammary gland? That’s amazing. I would be excited about a mammary specific progenitor cell. Yeah. Much better than being like a toenail. Okay. So at about five weeks we see the formation of ridges called the mammary crests or the milk lines.

Right. And we talk about the milk lines most often when we’re talking about accessory nipples. Yes. The nubbins if you will. Yeah. It’s kind of like puppies, you know how they have nipples all down that line. We also have that line so we could have many nipples. A supernumerary, numerary? Supernumerary nipple, which could be above the nipple line, or you could have a supro, right?

Am I making that shit up? I just call them nubbins. No, you’re right. I just called them extra nipples and I don’t bother with the. Do you tell people like, oh, you have an extra nipple? Well, usually they point it out to me and then I just use the terms that they use to refer to their own body. And mostly people say I have a third nipple and I’m like, wow, look at your third nipple.

Awesome. So then about 12 weeks, we actually have our breast buds, our mammary buds developing and enlarging and every baby is born with these, right? The second trimester, we have epithelial cells beginning to make like framework for actual milk ducts and glandular tissue. It’s wild.

That’s neat. I mean, I don’t know if anyone here has tried to work with fabric. It’s not my medium but trying to make a sleeve or anything that’s a tube, it’s hard. Really hard, and there are so many of those in our body. I know. And we grow from the inside out by the way. So we almost grow inside and then expand out and balloon out, which is why we end up with inverted nipples sometimes. It’s basically just, it didn’t balloon out enough and those internal nipple structures are kind of left, tucked in.

And then by 28 weeks, we basically just have this very well-defined network of ducts and fiber connective tissue in every fetus that is developing normally. That’s why men have nipples. Right. There’s a little bit more development of in the third trimester, but not that much.

We’re pretty much there by the end of the second trimester. You know, and we’ve got like, the nipples are delineating from the surrounding tissue. And by then, we actually have like 15 to 20 distinct lobes in that tiny little nubbin. So if anyone else out there performs newborn exams, we look for the breast buds.

Right. That’s part of it. And they’re just like this little, like I don’t know. They’re like a little ball trying to think what size it is. Bigger than a bean, smaller than a marble, right. I’m like, yeah, I about a marble is pretty accurate, not a lentil. Garbanzo bean, a garbanzo bean. Anyway, you know, we check that they’re present on every baby and then after birth, as much as seventy, 70% of term infants, their parents report temporary lactation.

Which is milk if you will. And that’s simply a reaction to maternal hormones that they’re getting. It’s it, nothing’s wrong with your baby. If, and it’s not a lot, it’s like one drop of milk, two drops of milk. And by the way, you can usually like squeeze it out and pretty sure, correct me if I’m wrong, I’m pretty sure this used to be a part of the regular pediatric assessment when you bring your baby and they would literally pinch your kids’ nipples and see if milk came out.

I don’t know. I don’t do. I don’t know what that was trying to show them. Most people don’t do that anymore because it doesn’t matter. Right. But it’s also, like, I know there’s some cultural significance to that in different places around the world.

Anyway, it’s kind of just an interesting phenomenon, nothing wrong or right about that. And then we have a little bit of changes and development until about age two, and then things go quiet for a while. And after that, those breast buds are significantly less noticeable.

So basically that takes us all the way until puberty, which is a fun time. Yeah, that’s interesting, by the way that we have so many cells in our body that can be kind of dormant until hormonally activated. But you have to wait until the gonads are activated, which then secondarily activate these cells. I mean, the complexity of that is crazy you guys.

Yeah. And that’s really why there’s a lot of controversy over what defines sex in humans and other animals too. Because yes, we have this chromosomal sex where you have an XX or an X, Y, and that’s not even that simple, right. That turns out to be extremely complicated and not black and white and not simply bifaceted.

Then we also have hormonal sex where yes, say most people who are assigned female at birth who have XX chromosomes will then have a certain set of hormones at puberty, but not everybody. Right. And we have this really wide range of what’s normal and we’re actually still defining what’s normal.

And I wanted to just take a moment and acknowledge current events here, because this is coming into question in the news a lot, especially around trans athletes. Right. And people are trying to decide like, how do we tell what sex they really are? And then like, there are all these controversies where they’re testing hormonal levels of like cis-gender females and realizing, oh my gosh, some of the best athletes have really high testosterone levels.

No shit like, yeah. Maybe that’s why they’re great athletes. Also, maybe it’s normal. Like it’s just. I just want to acknowledge that this is a really big spectrum. We do not fully understand it. And it’s something that I cannot go into detail in, in this episode, this would be like a 10-part episode too, to begin with if I even started that.

But also with that, and we’ll kind of talk about it a little bit, you’ll understand why I’m acknowledging this here is that when pre-teens and children come out as trans to their parents there’s a lot of controversy over offering them hormones, but what they really do, what we’re doing medically at that time for kids is basically giving them puberty blockers.

That shuts down some of this hormone production, pauses puberty until a later age. And I mentioned that because like we’re saying sex is a really multifaceted thing and there’s chromosomes and there’s hormones and there’s all these different aspects. But these, this hormonal like awakening in the preteen years is what determines maturation of gonads, of secondary sex characteristics.

It’s what determines hair growth and fat deposits and all of that. But before then, all kids are kind of really similar, right? Like they might have a penis, they might have a vagina, they’re not really all that useful. So question, are we blocking puberty and trans kids to give them time, like more time to think about and explore?

Because essentially, if they want to start hormone therapy, it’s going to be easier if they have not gone through puberty with different hormones than their intended hormone therapy. Right? So like if we do puberty blockers for a child who was assigned male at birth, and then they go on to do like an estrogen hormone therapy, when they’re older, they’re going to have a much better chance of naturally developing breast tissue, of naturally widening their hips.

Like things like that, that estrogen is going to influence versus if they’ve already gone through this whole like testosterone shit show that boys go through. It’s like, it changes the way that that works later. Okay. Yeah. And yeah, it’s like a way to give them some time to think through things and make plans and do it safely.

Cool. Yeah. Anyway.

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So that was a really long introduction to puberty. Woo. Okay. So puberty is ruled by hormones and this is really interesting. So breast development is usually the first sign of puberty. For those of us with a vagina. You don’t start bleeding the second your ovaries get turned on. And this begins typically between the ages of 8 and 13, your first signs of puberty.

Which is getting younger and younger as we get, a whole other episode, as we evolve more, we’re starting to see. Could it be something in the water or are we just too damn healthy? Should we not give our kids Flintstone vitamins to let them be all they can be? Because it’s throwing them into puberty too soon.

We don’t know, but it is a fact that it used to be more like 10 to 13, and now it’s like 8 to 13. So as the average. Yeah. Kids experience that even younger. Yes. And the first hormone that we see influencing that is estrogen, and that actually controls the growth of your milk duct. Did you know that? Cause I did not.

Well, I assume that because when we, when we give people birth control pills that are high estrogen, we will often see breast changes there. You know, in people that are already, they’ve already gone through puberty and then we give them birth control pills and their breasts increase a cup size. Same with pregnancy, you know, when you have all the estrogen floating around in your body.

So I assumed, but it’s good to know that my assumption is correct. Well, it’s interesting. So estrogen controls the growth of, you know, your milk tubes essentially, but progesterone controls the growth of like your lobules and your glandular tissue. So the first thing we have growing our milk tubes, our milk ducts, and the first things we’ll see is like, you know, maybe some nipple changes, maybe a little bit of size change, some tenderness, and then your body at that point is going to start storing more fat on your chest.

And that’s usually the first culprit to blame for size changes is the fat. And then, you know, as we get closer to our first period, right. That’s when we start to see more of the like lobes growing because we’re seeing progesterone coming to play. Interesting. Yeah. And the whole process of this initial development takes about four years of consistent hormonal messaging.

Or for me, it took 10 years. Well, it’s not the only stage in development though. Right? So the interesting thing is that your breasts then continue to develop past this primary stage until you’re about 18 or 20 years old, but it slows down and what influences that is your monthly menstruation. Your monthly rise of estrogen and progesterone.

Yeah. So every time you cycle your body gets more and more towards trying to find a mate. I mean, we do it by being soft and squishy in all the right places, every month. Your uterus is like, what if we had a baby and I redecorated? Your breasts do that too. Your breasts are like, I see that you once again, failed to get pregnant this cycle.

So we will, we will deflate and then we will actually pump it up even more and make you more voluptuous. So you should go find one, finally. You’re welcome. So essentially the continuation of breast development past puberty, you know, is then what’s causing our symptoms of PMS that involve the breasts, like the tenderness and the soreness and getting a little bit fuller.

So anyway, you know, just everything is in cahoots to have that baby every month. And I feel that so hard in my body. You know, there’s all these, I don’t know if we’re going to talk about this today. Probably not, but there is some research that shows that older women, so like 35 plus, their bodies do crazy things to just try to squeak one more out, like twins.

That’s why it’s like, are your ovaries tired? Is your body kind of like, let’s do two more at once because this is less likely to keep cycling? Also you’re more likely to have a baby with a genetic issues because your body is less likely to get rid of it in a miscarriage. And it’s like, well, this is your last one.

So we’ll just keep this one, you know? And it’s like, I wonder if something is mirroring that in the breasts as well? Yeah. And, and I, it was interesting. I had a conversation with a friend of mine about this, where she was asking for resources for people who got unexpectedly pregnant in their forties, and I was like, turns out there’s a lot.

Cause this happens a lot. Yeah. You’re like, oh, you’re cycling off time? You’re cycling twice a month? Great. Also like maybe you’re not thinking about birth control as much because you’re getting close to you know, menopause. I was like, menstruation? It’s not menstruation. What is the word? Menopause?

That’s it. That’s where we’re all going. Okay. So then after, you know, your body has prepared and thrown a fit every month because you are not pregnant, you finally get pregnant. Okay, let’s talk about what happens then. You did it. You did it, did it. Of course breast changes are usually the first sign of pregnancy for people.

This is called stage two of mammogenesis. I love that word. Yes. Sorry. This whole thing we’re talking about is mammogenesis, by the way, it’s like a pretty bad ass name. Actually. I feel like lactogenesis and mammogenesis just make me feel like some kind of anime superhero. Just reminds me of a Phil Collins song.

Anyway, this is stage two. And your body’s like, yes, we’re actually getting ready to lactate. It’s our big moment. So during pregnancy, we experience the maturation of your actual glands. So your alveoli, like the little sacks for the milk actually comes from way deep in there. And the maturation of like all of the cells that are just part of this glandular tissue.

Alveoli kind of look like little bunches of grapes with a stem. One stem, right? Yeah. Yeah. They’re cute. They’re real cute. And they’re the ones that kind of make the milk and drip it down into the duct. I think of them like little boob juice, bubbles. Boob juice bubbles, that’s so adorable. Yeah, they’re very, they’re real cute.

They’re real tiny. And then our lobes increase in number, in size. Like those cells get nice and juicy and basically all this is triggered by our raising levels of progesterone. And progesterone also primes our prolactin receptors in our milk making cells, in the lactocytes, and readies them to receive prolactin.

So it goes into these little like, like, you know, if you imagine prolactin like a key and the receptors like a key slot, progesterone just hops right in there. And it’s like, Hey, make some colostrum. Get ready. What you’re really waiting for is coming soon. Yeah. And actually around 18 weeks is when you start to have colostrum in your breasts.

Yes. And we call that lactogenesis one. One! Yay. How many phases are there? 3? 4, 4, 4. We will get all the way to there, but, but for most of your purposes out there, there’s three. Okay. So lactogenesis one, we’re basically creating a primer. Yes. This is colostrum. And you guys know a little bit about colostrum, but we’ll say it again.

It’s baby’s first milk. It’s that really thick yellow stuff. It has all the good like enzymes and immune factors and all of that, that like wakes up your baby’s digestive system and gets it ready to eat. And so you might leak around 18 weeks and that’s normal, it’s normal to leak, and it’s also normal not to leak.

So I’ve had a lot of patients say, oh my gosh, I’ve never leaked during pregnancy. Does that mean I’m not going to have any milk? Absolutely not. If you leak, your body will replace what was in there. So it’s not like you’re going to leak it out and then you have no colostrum because I’ve heard that one too.

And we absolutely will record an episode on prenatal colostrum expression and more about what colostrum is and all of that, but we’re going to kind of fly through it right now cause we don’t really need to know that for today.

Anyway, it takes a couple of weeks from the initiation of lactogenesis one until the time that we have kind of our mature colostrum. So this is also when some people are like, oh my gosh, my nipples are crusty. Or like, they’re leaking clear fluid, what is that? Sometimes we have pieces of colostrum in there, but not everything we need and your breasts are kind of just like working through it.

You know, it’s a process, especially if they’ve never done this before, especially if it’s your first time. Anyway, are you ready for what we call this also? Because it’s another, like, it makes me feel like it’s a superpower. Yes. We call this secretory initiation. Oh. Oh. I feel like we secretarially initiate in many ways, do we not?

Yes. Okay. So then we have our baby and we shoot a placenta out and that is what triggers the next stage. I love this stage. I think this is the coolest part. So when your placenta detaches, it releases HPL, human placental lactogen, which basically says, it’s go time. Let’s make some milk. We got a kid here!

But here’s the cool part. If you have two placentas, you have even more HPL so your body already knows that there’s twins. So people, I mean, that’s assuming you have twins with two placentas. Sometimes you have twins with one. But usually if they have one placenta, it’s a big placenta, it’s a big juicy one.

Because your placenta wants as much oxygenated blood as possible so it will increase its surface area to increase the amount of real estate available to snag oxygenated blood, which I think is freaking fantastic. And I’m such a placenta nerd, and I could talk about it all day, but I won’t. Not here. So. If you are pregnant with twins, do not fear. Your body has your back and your front.

I think we should actually maybe do a placenta episode because it is related to lactation. And it’s really interesting. Okay. Fingers are burned and trying to get all these things on the list. Get it on the list. Okay. But postpartum, this is your time to shine. You know, this is like the golden years of, of lactation, right?

We are actually making milk. This is lactogenesis two, two. Yes. So this is what we call secretory activation. Mm. Hmm. It’s triggered by, as you said, the delivery of the placenta. With that, we also have this rapid decline in progesterone. We have the suckling of the infant. We have our body now releasing tons of prolactin and oxytocin, and it’s this really lovely recipe for milk.

And it usually takes about, you know, three to five days for your colostrum to transition fully to mature milk. There’s a lot more going on in that phase. So much. There’s so much going on in that phase. And there’s so much also going on in baby’s body too, which is really fascinating, but we’re just going to have to gloss by it because we don’t have the time today.

Yeah. But. Regardless, you know, we have those little receptors that had progesterone, now are like, boom, there’s prolactin in there. And your body’s like, it’s go time, real milk! You know, let’s do it. And then everything gets bigger. And that’s when you have like, sometimes engorgement.

And this is when like your little alveoli, those little bubbles that make milk, get like real big. Things get a little backed up from time to time. Yes. But the volume of mature milk versus colostrum is really different. So that’s why you experience so much of like a sensory change on your breast. And oxytocin is also involved now because every time the infant suckles or even cries, oxytocin is released, which also plays a role in the milk ejection reflex.

And now, like we’re not only making it, we’re stimulating it by the baby, we’re making it and we’re squirting it out and replacing it immediately. So it’s like when you first turn on the plumbing in your house and it’s like a little sputtering, but like then all of a sudden it starts shooting out of the faucets and you’re like, whoa! You realize you have a leak in the bathroom. You’re just like you get out of the shower and you’re already spraying.

And you’re like, wait, I thought I turned the shower off? Am I peeing? No milk is just falling out of my body. I actually had that experience the other day. I don’t leak that much anymore. You know, my baby’s a year old. But I was like, I was wearing her on my back and I think the way I had my wrap done had just like a little bit of pressure on my breasts and I, and it was hot.

So I thought I was just sweating. You know, I was like the under-boob sweat is real today. No, it was all milk. Like I finally looked down and was like, oh, I’ve just been leaking milk this whole time. Not sweat. Oh, well. Anyway, so what. Everything about just like sex and pregnancy and postpartum. It’s just so wet. Secretary. Everything. Oh, goodness. Yes. Okay.

So the next thing we have is what we call lactation maintenance. So this is lactogenesis three. We also call it galactopoiesis. You got it. Yes. Okay. And this is the process of maintaining your milk supply as long as your baby wants it. Right. And this is what we talk about more than anything.

And it is maintained by the regular removal of milk and stimulation of the nipple, which triggers prolactin release from the anterior pituitary gland and oxytocin from the posterior pituitary gland for the ongoing synthesis and secretion of milk. Yeah. So in the beginning, your body helps you out a little bit and gives you like the push start key.

And it primes your engine, you know, like right before you mow the lawn, you push the button a couple of times to prime the engine, your body is doing that for you. But in galactopoiesis, you have to do some work and your baby has to do some work. And this is where you guys have to work as a team.

And this is also where working moms get completely screwed. Yeah. With schedule and pumping and things just get really complicated for us anymore because of it. So, right. And, and this is what I like to think of as a responsive feedback loop, because the mammary glands have to receive consistent hormone signals, right?

And although prolactin and oxytocin act independently and they have different cellular receptors, it’s their combined action that is essential for successful long-term lactation. Is long-term lactation considered a year and beyond? I don’t know, I just made that term up right this second. Okay. That I’m, I, I was thinking of it as like past the first week.

Right? Like we’re doing this for the long haul because even when we aren’t stimulating the breasts at all and we’re trying to suppress lactation most people feel their milk still come in at some point in that first week. So, you know, we’re beyond that and we’re just trying to maintain. And by the way, this is why certain cultures that don’t believe in giving colostrum, because that’s a thing, where they think the colostrum is like the dirty milk, you know.

Or in some cultures they will feed formula now for the first few days until the milk comes in and it still comes in, but it might not come in for the long haul like it does if you use the baby in the beginning. Because those first few days are essential for priming the receptors in your mammary glands. And we can actually create new receptors there in those first few days.

And that’s why the research that we have is really supportive of the relationship between how often baby nurses in the first 48 hours and long-term milk supply and longevity of the breastfeeding relationship. Right. There are research studies that show that the frequency of feeding on day three of life directly correlates to your milk supply at six months.

So if you’re spending the first three days, just waiting for your milk to come in and not feeding that colostrum and not letting baby latch, we will, just like Maureen said, see that those glands just can’t perform at their peak performance or those glands won’t be at their peak performance for the long-haul milk game.

And this is actually why I’m not super supportive of prenatal expression because there’s a lot of myths around like, does it help your milk supply? But here’s the thing. When you’re taking colostrum, you’re not doing anything to those cellular receptors. They’re full of progesterone. Yeah. They’re not like, it’s not that oxytocin prolactin feedback loop.

Right. And the only, I mean, we can do a whole episode on that as well, but I don’t ever tell people to express colostrum prenatally for a milk supply, you know. I do it, there’s other good reasons to do it, but that’s not one of them. So if you’re like trying to get ahead on your freezer stash, which you probably don’t need, that’s not a good reason to do it.

Yeah. I just had to mention that now, because I’ve seen that, especially going around our Facebook group a bunch recently, and I just like, that’s the physiology behind it. And that’s the work that you’re doing in those first couple of days postpartum when you’re into, you know, you’re engaging in that feedback loop is you’re really affecting how many cellular receptors you have in your glandular tissue.

And that really affects how much milk you make and how responsive your tissue is to the hormones your body’s making. Right. So lactogenesis three is kind of what we think of when we consider your supply is regulating. Right. And it continues beyond then. And after that point, we are slightly less sensitive to the day-to-day changes in your feeding patterns, but we can still absolutely affect supply.

Okay. The last stage of development is weaning or lactogenesis four. And this is the involution of the breasts, or rather they’re getting smaller, your milk making cells, your lactocytes are shrinking. Your breast tissue is shrinking, and we’re also seeing apoptosis or a cellular death of lactocytes.

Those little milk making cells are like, I see I’m not needed here. And they go and they kill themselves. Yeah. And we also naturally just see this. Like whether or not you’ve had babies and breastfed. After 35, we do see people have some reduced glandular tissue. Not to say you can’t breastfeed after that, people.

But you know, and as you’re getting into menopause, we see reduction in breast tissue. And also any time you’re a person that has previously lactated, pretty much at any point in your life, you’ll be able to hand express something out if you try hard enough. Now, if you’re actively leaking and it’s been three years since you’ve breastfed, that, you might want to get checked out. But if you’re like actually working to express milk, like you take a shower and then you’re like, oh, I wonder if I still have milk in there.

You can probably still get some out. And that’s not as concerning. It’s just in there. And there are a lot of places where it’s very normal for grandmothers to breastfeed their grand baby. If they’ve gone through menopause, they probably don’t have the capability to develop like a super robust milk supply, unless they’ve never ceased lactation.

Right. Unless they’re just like always been lactating, which is possible. But it’s like, you know, because their children are the ones who have the better capability for working and making money, like it makes sense for them to stay home with their grandbabies and nurse them.

And also, I just want to go back to what you said before and give an example of someone is it a little bit older, like beyond what you would consider like normal childbearing age. And she’s 46 and she carried her own baby to term and delivered her baby. And the lactation consultant in the hospital went in and the first thing out of her mouth was, you’re probably not going to be able to exclusively breastfeed because of your age.

So let’s go ahead and start talking about ways that we can try to boost your supply and also how to safely supplement with formula. I just have to say that any healthcare professional who comes in like that and is just like, based off this single factor that I saw in your chart, here are 10 assumptions I’ve made about you and predictions for your body and I know nothing about you, screw that.

And, you know, it was a self-fulfilling prophecy because you know, one tiny thing goes wrong and then if lactation isn’t even there supporting you, of course, you’re going to do formula. If the doctor, your OB GYN, your pediatrician and your lactation consultant, all have no faith in you, you are much less likely to leave that hospital exclusively breastfeeding.

Yes. And we know that. It’s, that’s not just us being like, well, it sounds true. No, statistically that is true. People with less support breastfeed for less time. So don’t be that person. And also don’t take that. If you’re, if your team looks like they’re not batting for you, phone a friend.

Tele-health is a wonderful thing for that reason now. Yeah. I might not be able to physically go to your hospital room, but we could do a tele-health while you’re lying in the hospital bed and be like, what’s going on? Tell me more about that. Let me just tell you guys, like reassure you that it’s okay to go to an LC even if you think you just have anxiety.

Probably 50% of my visits are just, I mean, they, they start out with somebody explaining about a hundred different things that could be wrong. And we end up at the end of the visit realizing that nothing is wrong with the actual physical breastfeeding stuff, but the thing we need to address as mental health. And that’s okay.

Or maybe you have anxiety because of what you went through with all of these other professionals who basically filled your head with fear and doubt about your ability and your body’s ability. And is it true sometimes? Sometimes. Yeah. Sometimes we can’t exclusively breastfeed. But I don’t come in hot like that before I even had one conversation with you.

And there’s a way to talk about that too that’s not disempowering. Like if you’re like, okay, last time, we know you have IGT, you had a really hard time. Here was your trajectory then. So you know what, like, yeah, maybe we won’t be exclusively breastfeeding, but let’s give it our best shot. Let’s see what we can do.

What’s your goals? How can we support you; you know? I mean, I don’t know. And also my other thing is if your body is capable of getting pregnant and carrying a pregnancy to term, and then actually preparing a hormonal cascade for labor and ejecting that fetus from your uterus, why would we think your body could not provide the hormones to mechanically and hormonally support lactate? The end.

Yeah. And then even people who can’t go into labor on their own, can’t birth on their own, still usually can breastfeed. Exactly. People who’ve never been pregnant can usually lactate. Yeah. And actually let’s talk about the military dudes, like when they wear their backpacks and they take 10-mile humps in the woods. And they’re holding their backpacks and they’re humping, humping, humping, and then they all start lactating and it’s like, yep.

Well, because stimulation. You’ve had enough nipple stimulation and member, member before all the testosterone was added in utero how you used to be a girl, right? And that’s what I kind of hope like you guys take away from this episode is that everybody has the potential to do this. And that is incredible. And trans women can lactate, cis men can lactate, cis women can lactate.

I mean, it’s just like everybody with mammary tissue still on their chest has the capability and the potential to do that. Yeah. You work hard enough at it, most of the time, you can get something out. Yeah. It’s like, what would you bring with you if you were stranded on an island? I’d be like, uh, Maureen. Probably my breasts is what I’d bring with me. I’d bring my breasts and Maureen’s breasts.

So we just suckle off each other until someone came to rescue us. Anyway. So I just, I kind of, I hope this is interesting and like hopeful for you, especially if you guys are still pregnant out there listening. And you’re like, what if I can’t lactate? What if you can? What if you can! What if your little embryonic skin tubes that your body decided to make when you were just a wee five-week-old zygote came through for you and what if you could do it?

Yeah. Amazing. Oh, and if you have, if you have relactated or induced lactation, we would love to hear about it. Please email us at MilkMinutePodcast@gmail.com. Relactation is fascinating and can be difficult, but I think the majority of the time it’s difficult because there’s people that don’t know how to help you.

But we are willing to help you and we will go for it if you’re going to go for it. So tell us your story.

Are you guys tired of not knowing what to do with a little amounts of haakaa milk and how to store them? Or are you worried about what is going to happen to your milk in the car if your ice packs don’t last? Are you also worried about what you’re doing with all the single use plastics that you’re storing your milk in?

And are you ready for products that are going to last you beyond breastfeeding? I know I am. Me too. And that’s why I use the Ceres Chiller and the Milkstache from Ceres Chill. First of all, it’s a woman owned company, which I love to support and it’s changed the lives of us and our patients. These products are very well-made and they’re made to last beyond breastfeeding.

Yeah. They’re good-looking products that you can use again and again, maybe even for a bottle of wine on the beach. I use my Ceres Chiller every single time I pump out of the house and I never have to worry about having access to a fridge, bringing a cooler, making sure I put my ice packs back in the freezer after I use them, none of it.

It’s a very high-quality thermos that keeps your milk cold or warms it up depending on how you want to use it. So if you would like to get your very own chiller or other products from Ceres Chill, follow the link in our show notes and use code MILKMINUTE15 at checkout for 15%. That’s MILKMINUTE15 for 15% off.

All right. Well, I hope that episode was helpful for you all. And I would like to wrap up with a very awesome award. Guess what time it is? Awards in the Alcove! Awards in the Alcove. And then we’re supposed to harmonize on the third one, but we’ll skip it. Let’s skip it.

So today’s award goes to Sarah Thompson. And Sarah says that a few months back her then 13-month-old had to have an echocardiogram and had a really hard time sitting still. The provider that did the echo called after the echo was over and said that the image was no good because her baby was not able to sit still for the entire appointment, for the entire echo.

So she asked if they could try again and asked her if there was a bottle that she could give to help keep her quiet and still. So without hesitation, Sarah whipped out her boob. Her daughter quickly latched and was a perfect angel for the 20 minutes that it took to do the echo.

She said, I was so proud of us. Being able to nourish, comfort, and be there for my baby in that moment was such a triumph. There are countless advantages to breastfeeding, and I’ve learned so much from this page and the Milk Minute Podcast. Thank you for your support, passion, and all you do. The woman taking the images was incredibly professional, but also realistic.

She made a suggestion and this is how I took it and she quietly worked around us. I feel I didn’t give her the proper acknowledgement. It was a win on all fronts.

I love that. That’s such a good story! So two awards, one for Sarah and one for the lady doing the echo who just didn’t even bat an eye and was just like, whatever you need to do you go ahead and breastfeed that baby while I do my little echo imaging.

And I’m just so pumped for both of you, all three of you. So great job, Sarah. We’re going to give you, you’re The Breast Adapter.

Love that. Cause that was the best adaptation of the advice you could have possibly done. Yes. You’re The Breast Adapter. And also for the lady doing the echo, you are also The Breast Adapter for being able to adapt to a new circumstance and a new situation that maybe you’ve never seen before and you handled it with calm and ease, and we appreciate that so much.

We are going to be putting an image of Sarah with her award on our Instagram story highlights, and we would love it if you would show her some love. Well, everybody, thank you so much for listening once again, to The Milk Minute Podcast. The way we change this big ginormous system that is not set up for lactating parents is by educating ourselves, our friends, our echo ladies and our providers, and literally anyone that will listen to you talk about it.

If you guys want to support the podcast, you can go to Patreon.com/MilkMinutePodcast and join us there for as little as $1 a month, or you can simply tell a friend about the podcast. Yes. Tell a friend, tell a random guy on the street. He needs to know. All right, guys, we will see you next week. Bye-bye.

Sources:
http://californiabreastfeeding.org/wp-content/uploads/2016/02/Cole-Table-1-stages-of-lactation.pdf

https://www.ncbi.nlm.nih.gov/books/NBK499981/