When does a pregnant woman start producing breastmilk?

I am four months pregnant but already producing breastmilk.  Is it true that I will lack breastmilk after giving birth? Tania

Dear Tania,
Pregnant women may start producing milk (colostrum) between four and five months of pregnancy. The amount of milk produced may not be significant because during pregnancy, the hormones (oestrogen and progesterone) produced in large amounts in the placenta may block the brain from producing another hormone prolactin, hence interfering with milk production in pregnancy.

However, breastfeeding in pregnancy may release hormones oxytocin and prolactin, enabling a pregnant mother to continue breastfeeding. Also, the death of the baby in the womb, a miscarriage or abortion are likely to interfere with the placental production of hormones, which stop milk production resulting in milk production during pregnancy.

Since there are medical reasons a mother may produce noticeable amounts of milk during pregnancy, any mother doing so should have proper medical investigations done. If investigations yield nothing, reassurance instead of treatment may be all that is needed.

Although milk production by a mother during pregnancy may not lead to one failing to have enough milk after giving birth, a mother producing milk during pregnancy may cause stress and anxiety, leading to the production of low amounts of breastmilk. 

Other reasons, including use of contraceptive pills, not taking enough fluids or food and poor methods of breastfeeding have to be investigated and corrected to make a mother produce enough milk for the baby.

##########################################

How will Hepatitis B affect my unborn child?

I am pregnant with my third child but recently tested positive for Hepatitis B. Will this affect my baby in any way? Anita

Dear Anita,
Hepatitis B is a liver virus infection usually transmitted through sexual intercourse or sharing needles or syringes. A baby can get infected with Hepatitis B during pregnancy or delivery.

After infection, one may get mildly sick (or may not even fall sick at all) in what is called, ‘acute’ hepatitis infection.

Although the majority of people may clear the acute infection within six months, a few others may not do so, with the infection going on to become chronic. Chronic infection may eventually damage the liver (liver cirrhosis) or lead to cancer of the liver, risking death in both cases.

Those under the age of five are more likely to have the acute infection turning chronic, meaning that those who get the infection from their mothers (mother to child transmission) are more likely to suffer from chronic disease. This makes preventing mother to child transmission of the virus important in the overall prevention of Hepatitis B.

Mothers who have never been immunised may require to be checked and immunised if found negative for the disease as one way to prevent Hepatitis B transmission to their unborn babies.

If a woman is pregnant, she has to be checked together with her partner and if both are found negative, both should be immunised against Hepatitis B if they have never been immunised.

In case the mother tests positive for Hepatitis B and has a high viral load, a drug called Tenofovir should be started at seven months of pregnancy and the baby delivered by caesarean section if the doctors recommend so. Then, within 24 hours after delivery, the baby should be given the hepatitis B vaccine with two more doses being administered four weeks apart. The first dose should be given with already formed hepatitis B antibodies (Hepatitis B immunoglobulin) to improve the vaccine effectiveness.

Though it is rare for breastfeeding to transmit Hepatitis B, a good breast-feeding latch to the breast is necessary to prevent getting cracked nipples, which may allow blood carrying the virus to be exposed to the baby. A mother with Hepatitis B can breastfeed since breastmilk does not usually transmit the virus.