Study of Effect of Stress on Lactation in Postnatal Women

BACKGROUND Stress is a physiological response to psychological and physical demands. Cortisol is a stress hormone that is released in increasing quantities as pregnancy progresses. Stress is a cumulative effect of changing life events with failure of coping reflex that leads to chronic stress which repeatedly activates hypothalamic–pituitary-adrenal (HPA) axis without relaxation response, to release excess cortisol. Duration of stress and its sites of action lead to decrease in lactation. In this study, we wanted to determine the relationship between stress and levels of maternal serum cortisol before and after the delivery and assess the relation between stress and milk output in the first week of post-partum period. METHODS A cross-sectional study was carried out among 96 pregnant women, using HOLMES-RAHE STRESS SCALE: categorized into mild, moderate, and severe stressed. Serum cortisol levels are assessed using electrochemiluminescence immunoassay before and after delivery. Postnatal mothers were advised to breastfeed their newborns ten times a day after delivery and the baby's weight is measured using the baby-test weighing method using digital weighing machine at regular intervals for seven days. Mean serum cortisol levels were computed and compared with milk production. RESULTS 48.9 % pregnant women were mildly, 29.1 % were moderately and 21.8 % severely stressed. Serum cortisol levels were significantly high (p < 0.05) in moderately and severely stressed women with significant reduction in milk volume when compared to mildly stressed women. CONCLUSIONS Findings of this study indicates that moderate and severe stressful events reduce lactation in post-natal women. More research is needed to understand relationship between stress, other maternal factors, and their impact on breastfeeding outcomes.