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 Pathological Lactation

Milk secretion is normally the outcome of pregnancy and delivery, and is brought about by hormonal action. During pregnancy estrogen and progesterone structurally prepare the breast, and prolactin level rises, that is the hormone responsible for actual milk secretion by the glandular tissue of the breast. However, during pregnancy estrogen renders the breast tissue refractory to he action of prolactin (although estrogen promotes prolactin, secretion) , or else there will be wastage of unwanted milk during pregnancy. After delivery, and as soon as the placenta which is the main supplier of estrogen is out, breast tissue is free to respond to the prolactin stimulus.  Stimulation of the nipple by the suckling baby starts another neuro-endocrine mechanism by which another horomone, oxytocin, stimulates tiny muscle fibres around the milk acini to contract, squeezing milk out in what is called the let-down reflex. Each time the baby sucks the breast this mechanism is activated, as well as stimulation of prolactin production. It is the act of breast-feeding therefore that is responsible for the maintenance if not the initiation of lactation.

Under certain known conditions lactation occurs totally outside the normal mechanism just described. Some endocrine imbalances, hyperplasia or a small tumour involving the prolactin secreting cells in the anterior pituitary gland, certain drugs, traumata or tumours cutting off the normal breaks that inhibit prolactin secretion in the normal nonpregnant person, may result in lactation which is therefore abnormal. There is unanimous agreement between jurists that the ruling on pathological lactation from the point of view of lactational fosterage is the same as for normal lactation. If the criteria we referred to pertain, then the woman is to be considered as lactational mother to the baby she suckled, whether or not she has attained puberty, pregnancy or the menopause.