••• Chapter 22^ Lactation^225
❍ What is the primary carbohydrate in human milk?
Lactose. Cow’s milk is primarily sucrose. The lactose in humans is broken down into lactic acid, decreasing stool
pH and giving the breastfed infant the characteristic loose stool. This should not be confused with diarrhea. Using
a cloth diaper or smooth towel, the stool can be checked. If there is no ring of water around the stool, this is not
diarrhea and should be considered normal.
❍ What are the major macronutrients of human milk?
Lactose and oligosaccharides, milk fat (including triglycerides, cholesterol, phospholipids, and steroid hormones),
proteins (including caseins, alpha-lactalbumin, lactoferrin, secretory immunoglobulin), and minerals (including
sodium, potassium, chloride, calcium, magnesium, phosphate).
❍ How much milk should a breastfeeding woman drink?
There is no minimum amount needed but she should have calcium supplements if she is not getting dairy
products. A woman who drinks large quantities (>1 quart/day) of cow’s milk runs the risk of sensitizing her infant
to cow’s milk protein, which can cross into her milk.
❍ Of an average 25-pound weight gain in pregnancy, what portion is considered to be lactation stores?
What happens to this weight if the patient does not breastfeed?
About 8 to 9 pounds or 3 to 4 kg. If she bottle feeds, she will have to diet it off—a great piece of propaganda to
encourage someone to breastfeed!
❍ How long can breast milk be stored in the refrigerator?
Approximately 48 hours, after which it should be frozen. Breast milk can be stored for up to 3 months in a daily-use
freezer and for up to 6 months in a deep-freezer or chest freezer. Freezing will decrease the immunologic value, but
not the nutritional component. Thaw under warm or hot running water or in a pan. Do not microwave.
❍ A mother calls you to say her pumped breast milk is “spoiling” in the refrigerator. What is wrong?
The milk has separated! In our modern society, most people have only seen commercial homogenized milk.
The separated milk (fat and water) can be reconstituted with gentle shaking.
❍ What is the term used to describe the presence of milky secretions from the breast of a newborn infant?
Witch’s milk. Can be found in both sexes and is due to the effect of maternal hormones on the fetal tissue.
It generally disappears rapidly postpartum and no treatment is needed.
❍ What is the proper postpartum management of a mother who chooses not to breastfeed?
A firmly fitting (but not binding) bra, ice packs as needed, and decreased stimulation to the nipples. Pharmacologic
suppression is frequently ineffective because it is improperly prescribed and/or used. Bromocriptine is no longer
indicated due to severe maternal side effects and should not be prescribed.
❍ What are the two major maternal illnesses in which breastfeeding is truly contraindicated?
HIV infection and active untreated TB.
[Mothers with human T-lymphotropic virus type I or II (HTLV-I or HTLV-2) and untreated brucellosis should
not breastfeed either, but these infections are less common.]