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- Delayed onset of lactation (DOL) describes the absence of copious milk secretion (onset of lactation) within the first 72 hours following childbirth. It affects around 20-40% of lactating women, the prevalence differs among distinct populations. The onset of lactation (OL), also referred to as stage II lactogenesis or secretory activation, is one of the three stages of the milk production process. OL is the stage when plentiful production of milk is initiated following the delivery of a full-term infant. It is stimulated by an abrupt withdrawal of progesterone and elevation of prolactin levels after the complete expulsion of placenta. The other two stages of milk production are stage I lactogenesis and stage III lactogenesis. Stage I lactogenesis refers to the initiation of the mammary glands' synthetic capacity, indicated by the onset of colostrum production that takes place during pregnancy. Stage III lactogenesis refers to the continuous supply of mature milk from day nine postpartum, until weaning. Late-onset of lactogenesis II can be provoked by a variety of pathophysiological, psychological, external and mixed causes. The delay of the process is associated with a range of complications such as excessive neonatal weight loss and early cessation of breastfeeding, which can lead to undesirable outcomes for the infant and the mother. These problems can be addressed by different interventions targeting the underlying cause of the delay. (en)
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