Breastfeeding

Anatomy

• Montgomery’s tubercules

• lactiferous sinuses

• lactiferous ducts

Anatomy

• Nipple-contains 25 nipple pores

• Areola-houses Montgomery’s glands

• Montgomery’s glands-secrete a protective lubricant

• Lobe-one of divisions of glandular tissue

• Lactiferous sinuses-milk collecting sinuses

• Alveoli-milk production glands

• Nerves-strong sucking elicits a response

Suclking Let Down Reflex

• Stimulates anterior pituitaryprolactin

• Prolactin Stimulates alveoli

• Alveoli milk

• Stimulates posterior pituitary oxytocin

• oxytocin alveoli contract

• Alveolar contraction milk ejection

Hormones of Lactation

• Estrogen-growth of ducts, inhibits milk production

• Progesterone-growth of lobules

• Prolactin-milk production,mothering behavior

• Oxytocin-milk ejection reflex

Advantages of Breastfeeding• Natural food• +bonding• no sanitation or refrig. • Fewer illnesses• less constipation• colostrumantibodies• develops dig. Enzymes• saves $

• No mixing/mistakes• stools/reg. no bad smell• no weight problems• speeds involution• less br. Cancer later• easier to travel• allergies • longer birth control• Mothers don’t make much• methane

Keys to successful breastfeeding

• Graspable Nipples

• Positions

• C hold

• Latch on

• Support

• Signs of Effective Suckling

Graspable Nipples

• Compression test

• flat inverted, and retracting nipples

• breast shells

Positions

• Cradle

• Football

• side-lying

• other

Latch on

• C-hold

• baby’s mouth open wide

• center nipple and areola in mouth

• baby’s chin and nose touch breast

• baby’s body facing mother

• baby’s lips flanged out

Support

• Use lots of pillows for baby and mom

• Mother should always bring baby to her

• sitting upright requires foot support

Signs of effective suckling

• Baby’s lips flanged out

• baby’s cheeks puffed out

• ears wiggle

• baby’s tongue down and over gumline

• no pain

• audible swallow

Signs of Letdown Reflex• Uterine cramping

• sleepiness

• thirst

• tingling, filling or tightening sensation

• leaking from opposite breast

• audible swallowing at regular intervals

• by 7 days, minimum 6 wet diapers/day

• by 7 days, minimum 4 BM’s q 24 hrs

Supply and Demand

• Do not time feedings

• nurse on one breast til baby asleep or comes off

• burp and diaper, offer second breast. Baby may or may not feed on second breast

• Sucking produces demand, body will respond with adequate supply

Baby is eating enough if:

• He nurses often

• seems relaxed after feeding

• adequate number of wet/messy diapers

• baby seems happy, alert and growing

Hunger cues

• Hands in mouth/clenched fists

• sucking motions

• rooting

• crying

Temperament

• Sleepy baby-unwrap, change diaper, situps, undress, talking

• Excited baby-swaddling, talking, rocking, bouncing, dim lighting

• sleeping patterns

• eating patterns

Days 1-7• Nurse within 1 hr birth

• nurse on demand

• room-in

• wet messy diapers will increase from one of each on day 1 to 6wet and 4bm by day 7

• Milk comes in on day 3-7

• avoid supplemental bottles

• initial nipple soreness common

• wear supportive nursing bra

after week 1, growth spurts, relief bottles

Nutrition during lactation

• 500-1000 additional calories

• 2500-3000 cc/day fluid

• protein 62-65 gms/day (4 servings)

• calcium, 1200 mg/day

• phosphorus-400mg additional/day

• niacin 20mg/day

• riboflavin 1.8mg/day

• increased vit A,C,E

Lactation diet

• 2-3 qts fluid

• 4 servings protein

• 4+ servings grains

• 5 servings dairy

• 6 servings fruits and veggies

• prenatal vitamins with iron

Common problems

FLAT AND INVERTED NIPPLES

• Compression test

• Milk cups prenatally

• Milk pump to pull out nipple

• avoid nipple shields

• football hold allows more control

Common problemsSORE NIPPLES

• occurs in almost everyone--first 3-4 minutes

• lasts 1-2 wks

• allow nipples to air dry

• aim nipple straight into mouth

• support breast with C hold

• football hold

• Always break suction before removing nipple from mouth

Common problems

ENGORGEMENT

• nurse frequently

• before feeding warm shower

• feed baby on both breasts

• gentle massage while nursing

• avoid pumping--unless baby refuses 2nd breast

Breast assessment

for lumps for cysts size and shape symmetry for engorgement for inverted, everted, or flat nipples