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Lactation is the process of milk secretion from the mother's breasts following childbirth. The placenta not only provides for the development of the fetus through its linkage with the mother, but also produces hormones that prepare the mammary glands for secreting milk. During pregnancy, these same hormones inhibit the pituitary gland from producing the milk-forming chemical until such time as it is needed.

Oddly enough, the milk is not needed by the baby immediately after birth. The need usually arises from two to five days later. The first secretion the baby receives from the breast is colostrum, a substance that is present in the breast immediately after birth. The effect of colostrum upon the newborn is not positively known, but it is of high protein content and is believed to aid in giving the child immunity to many infectious diseases during the early months of his life. Some obstetricians believe that its main function is that of a laxative to aid in ridding the infant's intestines of a substance called meconium, fecal matter consisting of mucus, bile, and epithelial threads. Colostrum disappears two or three days after delivery and true milk replaces it.

After the placenta is expelled and its inhibiting hormones are no longer produced, the pituitary gland begins to produce prolactin, the lactogenic hormone that induces lactation. When lactation first begins, the breasts become swollen and congested. The ducts leading from breasts to nipples fill with milk, and the mother usually experiences an uncomfortable sensation, or even pain, for a period of a day or so.

Lactation is often accompanied by certain psychological and physiological symptoms, such as fatigue, headache, hot and painful breasts, and low-grade fever. The infant's sucking provides relief. In addition, it is the opinion of many doctors that the sucking also prompts certain muscular contractions of the uterus that help to reduce it to its normal size.

Certain substances consumed by the lactating mother, such as alcohol, strong sedatives, and vegetable cathartics, may adversely affect the infant. The concentration of alcohol is the same in the milk as it is in the mother's blood. A nursing mother should consume none of these substances unless they are approved by her physician.

The adverse effects of smoking on the human organism have been well documented and widely publicized, to the extent that the federal government now requires a caution about possible health hazards to be printed on each cigarette package. The deleterious effects of smoking on a fetus during pregnancy have not been so carefully investigated, but current research indicates some danger. The facts that tobacco smoke contains over 250 chemical compounds and substances, many of which, such as nicotine and tars, are noxious, and that the smoke can be absorbed through the membrane tissues of the mouth as well as by inhalation, should be enough to deter any pregnant woman from smoking. If not, recent research findings should serve as an additional warning. When the mother smokes, the heartbeat rate of the fetus is affected, her infant is likely to be born weighing somewhat less than the baby of a nonsmoker, and the chance for a premature birth is doubled. Furthermore, the rate of death or malformation for infants of mothers who smoked during pregnancy is higher than among babies of nonsmokers.

There are occasionally encountered certain physiological difficulties in nursing a baby, in which case the physician can usually offer a solution. One of the most recurrent of these problems is an inverted nipple, which is a congenital anomaly and is the result of fibrous bands that hold the nipple in rather than allowing it to protrude in the normal manner. At the time of lactation, severe pain may be experienced by the mother if the condition is not corrected. Sometimes a small suction cup may be used successfully to draw out the nipple, and in other instances nursing will serve to correct the inversion.

A recent issue of Medical Economics revealed the fact that only 12% of the babies leaving the hospital in 1956 were breastfed. In 1946, the figure had been 23%, and in the not too distant past, as many as 90% of all babies were breastfed. Women reveal genuine anxiety over the shape and size of their breasts, and often feel inferior in their role as a woman and sexual being if they consider their breasts too small. Indeed, sweater and brassiere-padding enterprises have benefited from this excessive concern over breast size (if, indeed, they have not deliberately encouraged it). At least one shop advertises, "We fix flats!" Plastic surgeons have devised ingenious methods for remolding breasts into desired shapes and sizes through the use of surgery, plastics, and silicone, although this means of increasing a woman's narcissistic image is ill-advised in the majority of cases because of certain physiological complications that sometimes develop.

It is little wonder that people consider breasts a symbol of ultimate sexuality in view of the emphasis placed on them in advertisements and clothing styles. Even toy stores pander to this mammary preoccupation by keeping their shelves well stocked with the high-bosomed dolls for which little girls clamor.

In view of the near-fetishism over the female breast, it would appear that neither men nor women realize that the appeal of the breast varies widely from culture to culture, and from era to era; or that breast size and shape have nothing to do with sexuality, except insofar as psychological factors are concerned. The erotic quality of breasts apparently has more psychological than physiological content, it would appear, since about 75% of men receive sensual excitement from the stimulation of a woman's breasts, while only slightly more than 50% of women find this sort of sex play to be sexually exciting.

It cannot be denied, of course, that both male and female breasts have many nerve endings which, when properly stimulated, often afford sexual excitement and pleasure, but there are an equal number of these endings in small breasts and in large ones. Since the supply of nerve endings is the same, regardless of breast size, it is a simple matter to make the calculation that small breasts are per square inch by far and away more erogenous than larger ones, and may in fact be a distinctly pleasurable advantage for both husband and wife during sex play. Furthermore, very large breasts are not necessarily an advantage in lactation, because they often contain an excessive amount of fat tissue that can interfere with the function of the milk glands.

The development of the breasts in a hormonally normal woman is largely a matter of heredity, and little can be done by way of exercise, injection of hormones, or application of creams and salves to alter nature's design. Nevertheless, many persons of questionable ethics continue to bilk the small-breasted female public with various worthless and often expensive preparations and mechanical devices, as the National Better Business Bureau can testify. Sagging of the breasts can to some degree be prevented by well-designed and properly fitted brassieres. However, a good posture, sensible nutrition, and proper hygiene remain the biggest assets to an attractive figure. A physician can offer the best advice for preventing breast-tissue breakdown during pregnancy, lactation, and weaning. If a woman finds the dimensions of her breasts unsatisfactory, the use of a padded and properly supportive brassiere is the most sensible solution.

Women who are caught up in narcissistic breast symbolism too often avoid proper physical examinations for fear that some previously undetected abnormality of the breast will be discovered which will necessitate surgery, thus destroying their femininity. This refusal to face the possibility of a breast malignancy needlessly endangers the lives of many women, and a reassessment of their system of values is certainly indicated.

It is a normal phenomenon for many of the lower mammals to have multiple breasts and a milk-line that the mammary glands follow. About 1% of human females, however, have more than the normal two, making the condition less uncommon than many would believe. There is usually only one extra breast in these cases, and it is usually nonfunctional, but it can be quite normally developed and functional. Men occasionally have breast development nearly identical to that of a normal woman. Surgery will usually remedy the anomalies of extra and abnormally oversized breasts, and thereby reduce or remove altogether the stresses that "being different" create.

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