Breast feeding

BREAST IS BESTBREAST IS BESTAshly Elizabeth Ashly Elizabeth

EmmanuelEmmanuel

Introduction Introduction

Breastfeeding is the optimal source Breastfeeding is the optimal source of nutrition. The Human Milk is of nutrition. The Human Milk is specie specific and it provides all specie specific and it provides all the essential nutrients necessary for the essential nutrients necessary for the growth and development of the the growth and development of the newborn infant.newborn infant.

Breast Anatomy - Breast Anatomy - StructureStructure

fatfat

Prolactin ReflexProlactin ReflexSecretion Secretion continues continues AFTER feed to AFTER feed to produce NEXT produce NEXT feedfeed

To increase milk To increase milk productionsproductions

Infant suckles Infant suckles at the breast.at the breast.

Stimulation ofStimulation ofnerve endingsnerve endingsin mother’sin mother’snipple/areola nipple/areola sends signalsends signalto mother’s to mother’s hypothalamus/hypothalamus/pituitary.pituitary.

Pituitary releases Pituitary releases prolactin and oxytocin.prolactin and oxytocin.

Hormones travel Hormones travel via bloodstreamvia bloodstreamto mammary gland to mammary gland to stimulate milk to stimulate milk production and production and milk ejectionmilk ejectionreflex (let-down).reflex (let-down).

Oxytocin ReflexOxytocin Reflex

For milk ejectionFor milk ejection

Helping and Hindering Helping and Hindering the Oxytocin Reflexthe Oxytocin Reflex

For milk ejectionFor milk ejection

Inhibitor in BreastmilkInhibitor in Breastmilk

Attachment at BreastAttachment at Breast

Mechanism of Mechanism of ‘Suckling Cycle’‘Suckling Cycle’

What Differences Do You What Differences Do You See?See?

GOOD GOOD ATTACHMENATTACHMEN

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POOR POOR ATTACHMENATTACHMEN

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Picture 2Picture 2

What Differences Do You What Differences Do You See?See?

ATTACHMENT, OUTSIDE ATTACHMENT, OUTSIDE APPEARENCEAPPEARENCE

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Consequences of Poor Consequences of Poor AttachmentAttachment

Pain and damage to nipplesPain and damage to nipples Sore Sore nipples nipples

FissuresFissures

Breastmilk not removed effectivelyBreastmilk not removed effectively EngorgementEngorgement

Baby unsatisfied,Baby unsatisfied, wants to feed a lotwants to feed a lot

Apparent poor milk supply Apparent poor milk supply Baby frustrated, Baby frustrated, refuses to sucklerefuses to suckle

Breasts make less milkBreasts make less milk Baby fails to gain Baby fails to gain

weight weight

Causes of Poor Causes of Poor AttachmentAttachment

Use of feeding bottleUse of feeding bottle

Inexperienced motherInexperienced mother

Functional difficultyFunctional difficulty

Lack of skilled supportLack of skilled support

before breastfeeding established before breastfeeding established for later supplementsfor later supplements first baby first baby previous bottle feederprevious bottle feeder small or weak baby small or weak baby nipple poorly protractile nipple poorly protractile engorgementengorgement late startlate start less traditional help and less traditional help and

community supportcommunity support doctors, midwives, nurses not doctors, midwives, nurses not

trained to helptrained to help

Feeding ReflexesFeeding ReflexesRooting reflexRooting reflex

When somethingWhen somethingtouches lips,touches lips,baby opens mouthbaby opens mouthputs tongue downputs tongue downand forwardand forward

Sucking reflexSucking reflex

When something When something touches palate baby touches palate baby suckssucks

Swallowing reflexSwallowing reflex

When mouth fills with When mouth fills with milk,milk,baby swallowsbaby swallows

SkillSkillMother learns to Mother learns to position babyposition babyBaby learns to take Baby learns to take breastbreast

Gag reflexGag reflex

When something When something touches anterior part touches anterior part of the tongue, baby of the tongue, baby pushes it out. pushes it out.

Types and Composition of Types and Composition of Human Breast MilkHuman Breast Milk

Types of Breast Milk:Types of Breast Milk: Colostrum or Early MilkColostrum or Early Milk Transitional MilkTransitional Milk Mature MilkMature Milk

Colostrum or Early Milk is produced in the late stage of Colostrum or Early Milk is produced in the late stage of pregnancy till 4 days after delivery; and is rich in pregnancy till 4 days after delivery; and is rich in antibodies.antibodies.

Transitional Milk produced from day 4 – 10 is lower in Transitional Milk produced from day 4 – 10 is lower in protein in comparison to Colostrum.protein in comparison to Colostrum.

Mature milk is produced from approximately ten days after Mature milk is produced from approximately ten days after delivery up until the termination of the breastfeeding. delivery up until the termination of the breastfeeding.

Nutrients in Human & Nutrients in Human & Animal MilkAnimal Milk

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What are the differences between these What are the differences between these milks?milks?

Differences in the Differences in the Quality of the Proteins in Quality of the Proteins in Different MilksDifferent Milks

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Differences in the Fats of Differences in the Fats of Different MilksDifferent Milks

HUMANHUMAN COW`SCOW`S

ContainsContains

Essential Fatty Essential Fatty Acids,Acids,

Enzyme LipaseEnzyme Lipase

ContainsContains

No Essential Fatty No Essential Fatty AcidsAcids

No Enzyme LipaseNo Enzyme Lipase

Vitamins in Different Vitamins in Different MilksMilks

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Iron in MilkIron in Milk1/1/881/1/88

Types and Composition of Human Types and Composition of Human Breast Milk (Cont’d)Breast Milk (Cont’d)

Fat Fat - The main lipids found in human milk are the - The main lipids found in human milk are the triglycerides phospholipids and essential fatty acids. triglycerides phospholipids and essential fatty acids.

Protein Protein – Whey ; lactoferrin, lysozymes, – Whey ; lactoferrin, lysozymes, immunoglobulin , A- lactalbumin, Casein; lower immunoglobulin , A- lactalbumin, Casein; lower concentration in human milk.concentration in human milk.

Carbohydrate Carbohydrate – Include lactose and oligosaccharides. – Include lactose and oligosaccharides.

Leukocytes - Leukocytes - Include neutrophils, marcrophages , Include neutrophils, marcrophages , lymphocytes.lymphocytes.

Non protein nitrogen Non protein nitrogen – urea, uric acid– urea, uric acid

Other constituentsOther constituents : steroid hormones, peptides, : steroid hormones, peptides, insulins, growth factors, minerals, vitamins, lipase.insulins, growth factors, minerals, vitamins, lipase.

Mechanism of Protection Mechanism of Protection Against InfectionAgainst Infection

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When When Mother Mother infecteinfectedd

White cells White cells in mother’s in mother’s body make body make antibodies antibodies totoprotect herprotect herThese These

antibodies antibodies are secreted are secreted in in breastmilk breastmilk to protect to protect babybaby

Some white Some white cells gocells goto her to her breast and breast and make make antibodies antibodies therethere

Storage of Breast MilkStorage of Breast Milk

Human milk can be stored at room Human milk can be stored at room temperature for 6-8 hours. temperature for 6-8 hours.

Expressed milk can be stored in an insulated Expressed milk can be stored in an insulated cooler bag with icepacks for 24hours. cooler bag with icepacks for 24hours.

Breast milk can be stored in the refrigerator Breast milk can be stored in the refrigerator for about 5 days at about 40° F.for about 5 days at about 40° F.

It can also be kept in a freezer compartment It can also be kept in a freezer compartment of a fridge for up to two weeks at of a fridge for up to two weeks at 0 - 5°F

It can be stored in a deep freezer for about 3-It can be stored in a deep freezer for about 3-12 months 12 months

Achieving Optimal Achieving Optimal BreastfeedingBreastfeeding

Activities, attitudes and procedures during the Activities, attitudes and procedures during the delivery and post partum period have an delivery and post partum period have an impact on breastfeeding impact on breastfeeding

There is well documented evidence that skin to There is well documented evidence that skin to skin contact between infant and mother helps skin contact between infant and mother helps to maintain the body temperatures, reduce risk to maintain the body temperatures, reduce risk of hypoglycemia, enhance oxytocin release of hypoglycemia, enhance oxytocin release and beneficial nutrition with intake of and beneficial nutrition with intake of colostrum colostrum

Skin to skin contact should occur for about 1-2 Skin to skin contact should occur for about 1-2 hours after delivery. Procedures after delivery hours after delivery. Procedures after delivery like weighing, administration of vitamin K, eye like weighing, administration of vitamin K, eye prophylaxis and other procedures should be prophylaxis and other procedures should be delayed delayed

Breastfeeding should be started and fully Breastfeeding should be started and fully established before discharge from the established before discharge from the hospitalhospital

Physicians and health care professionals Physicians and health care professionals should observe at least one feeding and should observe at least one feeding and ensure this is done properly and breast milk ensure this is done properly and breast milk is produced is produced

Lactation specialist should also work with Lactation specialist should also work with parents that are having difficulty with parents that are having difficulty with breast feeding. breast feeding.

Early follow up after leaving the hospital is Early follow up after leaving the hospital is required. required.

Achieving Optimal Achieving Optimal Breastfeeding (Cont’d)Breastfeeding (Cont’d)

Signs of Effective Signs of Effective BreastfeedingBreastfeeding

Frequent feedings 8-12 times daily. Frequent feedings 8-12 times daily.

Intermittent episodes of rhythmic sucking with audible Intermittent episodes of rhythmic sucking with audible swallows should be heard while the infant is nursing.swallows should be heard while the infant is nursing.

Infant should have about 6-8 wet diapers in a 24 hour Infant should have about 6-8 wet diapers in a 24 hour period once breast feeding is established.period once breast feeding is established.

Infant should have minimum of 3-4 bowel movements Infant should have minimum of 3-4 bowel movements every 24 hours.every 24 hours.

Stools should be about one tablespoon or larger and Stools should be about one tablespoon or larger and should be soft and yellow after day 3.should be soft and yellow after day 3.

Average daily weight gain of 15 -30g.Average daily weight gain of 15 -30g.

Infant has regained birth weight by day 10 of life.Infant has regained birth weight by day 10 of life.

Good Breastfeeding Good Breastfeeding TechniquesTechniques

The baby should be properly positioned to achieve The baby should be properly positioned to achieve effective latching. effective latching.

The mother should wear comfortable apparel, with the The mother should wear comfortable apparel, with the breast well exposed for the infant to be able to latch. breast well exposed for the infant to be able to latch.

The infant’s mouth, chin and umbilicus should be lined The infant’s mouth, chin and umbilicus should be lined up with the head in a neutral position. up with the head in a neutral position.

The infant is brought to the breast, with the nose The infant is brought to the breast, with the nose touching or close to the breast. touching or close to the breast.

The gum line should overlap the areola, and the nipple The gum line should overlap the areola, and the nipple straight back into the mouth. straight back into the mouth.

The tongue moves forward beyond the lower gum, The tongue moves forward beyond the lower gum, cupped and forming a reservoir. cupped and forming a reservoir.

Milk is removed for the lactiferous sinuses, the jaw Milk is removed for the lactiferous sinuses, the jaw moves down creating a negative pressure gradient that moves down creating a negative pressure gradient that helped transfer milk to the pharynx. helped transfer milk to the pharynx.

Breastfeeding PositionsBreastfeeding Positions

Cradle HoldCradle Hold

This is the most This is the most common position used common position used by mothers.by mothers.

Infant’s head is Infant’s head is supported in the supported in the elbow, the back and elbow, the back and buttock is supported buttock is supported by the arm and lifted by the arm and lifted to the breast.to the breast.

Football Hold PositionFootball Hold Position The infant’s is placed The infant’s is placed

under the arm, like under the arm, like holding a footballholding a football

Baby’s body is supported Baby’s body is supported with the forearm and the with the forearm and the head is supported with head is supported with the hand. the hand.

Many mothers are not Many mothers are not comfortable with this comfortable with this positionposition

Good position after Good position after operative proceduresoperative procedures


Side Lying PositionSide Lying Position

The mother lies on her The mother lies on her side propping up her head side propping up her head and shoulder with pillows. and shoulder with pillows.

The infant is also lying The infant is also lying down facing the mother. down facing the mother.

Good position after Good position after Caesarean section. Caesarean section.

Allows the new mother Allows the new mother some rest. some rest.

Most mothers are scared of Most mothers are scared of crushing the baby. crushing the baby.


Cross Cradle Hold PositionCross Cradle Hold Position

Ideal for early Ideal for early breastfeeding. breastfeeding.

Mother holds the baby Mother holds the baby crosswise in the crook of crosswise in the crook of the arm opposite the breast the arm opposite the breast the infant is to be fed. the infant is to be fed.

The baby's trunk and head The baby's trunk and head are supported with the are supported with the forearm and palm. forearm and palm.

The other hand is placed The other hand is placed beneath the breast in a U-beneath the breast in a U-shaped to guide the baby's shaped to guide the baby's mouth to your breastmouth to your breast. .


Australian Hold Australian Hold PositionPosition

This is also called This is also called the saddle hold the saddle hold

Usually used for Usually used for older infants older infants

Not commonly used Not commonly used by mothers.by mothers.

Best used in older Best used in older infants with runny infants with runny nose, ear infectionnose, ear infection..


Can You Identify the Can You Identify the positions??positions??

Benefits of Breastfeeding to Benefits of Breastfeeding to InfantsInfants

Helps in Gastrointestinal Helps in Gastrointestinal development and functiondevelopment and function

Helps in development of the Helps in development of the immune systemimmune system

Helps in cognitive development Helps in cognitive development of the infantof the infant

Infants who are breastfed have Infants who are breastfed have reduced risk of infection reduced risk of infection compared to formula fed infants.compared to formula fed infants.

Breastfed infants have reduced risk of Breastfed infants have reduced risk of obesity later in life compared to formula obesity later in life compared to formula fed infants.fed infants.

Reduced risk of sudden infant death Reduced risk of sudden infant death syndrome, Hodgkin's lymphoma, Leukemia syndrome, Hodgkin's lymphoma, Leukemia and Type 1 Diabetes.and Type 1 Diabetes.

Lower risk of infections e.g. otitis media, Lower risk of infections e.g. otitis media, Lower respiratory tract infection, Diarrheal Lower respiratory tract infection, Diarrheal diseases, Allergies , eczema, Meningitis diseases, Allergies , eczema, Meningitis and inflammatory bowel diseases.and inflammatory bowel diseases.

Benefits of Breastfeeding to Benefits of Breastfeeding to InfantsInfants

Benefits of Breastfeeding to Benefits of Breastfeeding to MothersMothers

Enhance early maternal – infant bond.Enhance early maternal – infant bond. Aids involution of the uterus.Aids involution of the uterus. Long term breastfeeding helps in loss Long term breastfeeding helps in loss

of the excess weight acquired during of the excess weight acquired during pregnancy.pregnancy.

Prolonged Breastfeeding prolongs an Prolonged Breastfeeding prolongs an ovulation. ovulation.

Documented long term effect of Documented long term effect of breastfeeding include reduced risk of breastfeeding include reduced risk of breast, ovarian and endometrial breast, ovarian and endometrial cancers.cancers.

Socio-economic Benefits of Socio-economic Benefits of BreastfeedingBreastfeeding

Income savings Income savings Reduced risk of infections and Reduced risk of infections and

diseases hence reduced hospital diseases hence reduced hospital visits and attendant medical cost.visits and attendant medical cost.

Mothers are more economically Mothers are more economically productive since they will spend productive since they will spend less time caring for a sick child.less time caring for a sick child.

Advantages of Advantages of Breastfeeding (contd.)Breastfeeding (contd.)

MotherMother Reduces post Reduces post

delivery bleeding delivery bleeding

and anemiaand anemia

Delays next Delays next

pregnancypregnancy

Protects breast Protects breast

and ovarian cancerand ovarian cancer

Protects obesity Protects obesity

and shapes bodyand shapes body

ConvenientConvenient

SocietySociety Eco-friendly Eco-friendly

Human Human

resource resource

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Economy Economy

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FamilyFamily

Low cost Low cost

involvedinvolved

Less Less

illnessesillnesses

Family Family

bondingbonding

Barriers To Effective Barriers To Effective

BreastfeedingBreastfeeding Lack of confidence in motherLack of confidence in mother

Belief that breast milk is not sufficientBelief that breast milk is not sufficient

Lack of adequate support systemLack of adequate support system

History of previous breast surgeryHistory of previous breast surgery

Breast engorgement, cracked and sore Breast engorgement, cracked and sore nipplesnipples

Retractile nipplesRetractile nipples

Barriers To Effective BreastfeedingBarriers To Effective Breastfeeding

Embarrassment by motherEmbarrassment by mother

Jealousy by siblingsJealousy by siblings

Chronic illness in mother; Chronic illness in mother; psychosis, Cancer.psychosis, Cancer.

Contraindication to BreastfeedingContraindication to Breastfeeding HIV , HLTV 1 & 11 infections. (Adult T-HIV , HLTV 1 & 11 infections. (Adult T-

cell lymphoma virus)cell lymphoma virus)

Active Tuberculosis.Active Tuberculosis.

Herpes lesions on mother’s breast.Herpes lesions on mother’s breast.

Infant with Inborn error of metabolism; Infant with Inborn error of metabolism; galactosemia, phenylketonuria.galactosemia, phenylketonuria.

Mothers on certain medications ; Mothers on certain medications ; anticancer therapy, radioactive isotope anticancer therapy, radioactive isotope etc.etc.

Role of the NurseRole of the Nurse

Provide education about breastfeeding at Provide education about breastfeeding at first prenatal visitfirst prenatal visit

Physical exam should include breast examPhysical exam should include breast exam

Ensure rooming-in after deliveryEnsure rooming-in after delivery

Ensure breastfeeding is started and Ensure breastfeeding is started and established before discharge after delivery.established before discharge after delivery.

Observe at least a session of breastfeeding Observe at least a session of breastfeeding to ensure it is done correctlyto ensure it is done correctly

RECOMMENDATIONSRECOMMENDATIONS

Exclusive breast feeding until 6 months of age

Introduce complimentary foods with continued breastfeeding

Optimum to breastfeed for 2 years or longer

HARMFUL HARMFUL EFFECTS OF EFFECTS OF

FORMULA MILKFORMULA MILK

Why some mothers choose Why some mothers choose formula vs. breast milkformula vs. breast milk

Distressed by physical discomfort of early Distressed by physical discomfort of early breastfeeding problems.breastfeeding problems.

Convenience issuesConvenience issues

Pressures of employment/schoolPressures of employment/school

Worries that breast shape will changeWorries that breast shape will change

Formula manufacturers manipulate people Formula manufacturers manipulate people through their adsthrough their ads

Doctors and nurses need more lactation trainingDoctors and nurses need more lactation training

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Why some mothers choose Why some mothers choose formula vs. breast milkformula vs. breast milk

Moms given very little time to adjust to changes Moms given very little time to adjust to changes of postpartumof postpartum

Family demandsFamily demands

Non-supportive family/health professionalsNon-supportive family/health professionals

EmbarrassmentEmbarrassment

Lack of confidence in selfLack of confidence in self

Feeling that one cannot produce enough milkFeeling that one cannot produce enough milk

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Mother’s milk vs. Mother’s milk vs. formula milkformula milk

Formula milk for 3 days Formula milk for 3 days old babies is no old babies is no different than formula different than formula milk for 3 months old milk for 3 months old infants.infants.

Breast milk is Breast milk is ingeniously different ingeniously different every single day; every single day; adapted to the changing adapted to the changing needs of the baby.needs of the baby.

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Mother’s milk vs. Mother’s milk vs. formula milkformula milk

Human milk is designed Human milk is designed to support the to support the development of large development of large brains, capable of brains, capable of processing and storing processing and storing lots of information. lots of information.

Cows milk is designed Cows milk is designed to support functions, to support functions, like constant grazing.like constant grazing.

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Illness Relative riskIllness Relative risk Allergies, eczema 2 to 7 Allergies, eczema 2 to 7

timestimes Urinary tract infections Urinary tract infections

2.6 to 5.5 times2.6 to 5.5 times Inflammatory bowel Inflammatory bowel

disease 1.5 to 1.9 timesdisease 1.5 to 1.9 times Diabetes, type 1 2.4 timesDiabetes, type 1 2.4 times Gastroenteritis 3 timesGastroenteritis 3 times Hodgkin's lymphoma 1.8 Hodgkin's lymphoma 1.8

to 6.7 timesto 6.7 times Otitis media 2.4 timesOtitis media 2.4 times Haemophilus influenzae Haemophilus influenzae

meningitis 3.8 timesmeningitis 3.8 times Necrotizing enterocolitis Necrotizing enterocolitis

6 to 10 times6 to 10 times www.geocities.com/.../ Canopy/4116/stalk.gif

Illness Relative riskIllness Relative risk

Pneumonia/lower Pneumonia/lower respiratory tract respiratory tract infection 1.7 to 5 infection 1.7 to 5 timestimes

Respiratory syncytial Respiratory syncytial virus infection 3.9 virus infection 3.9 timestimes

Sepsis 2.1 timesSepsis 2.1 times Sudden infant death Sudden infant death

syndrome 2.0 timessyndrome 2.0 times Industrialized-world Industrialized-world

hospitalization 3 hospitalization 3 timestimes

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Barriers to Bonding Barriers to Bonding

* * A Bottle places a physical A Bottle places a physical barrier between mom barrier between mom and babyand baby

*Less skin to skin contact*Less skin to skin contact

*Less eye contact*Less eye contact

* The * The hormonal connection hormonal connection between the between the breastfeeding mother breastfeeding mother and baby cannot be and baby cannot be experienced by the experienced by the bottle feeding motherbottle feeding mother

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Other Options If Other Options If Breastfeeding is Not Breastfeeding is Not

PossiblePossibleMom can still use her milk, even if she Mom can still use her milk, even if she

decides not to breastfeed:decides not to breastfeed:

Use a breast pump (electric/manual)Use a breast pump (electric/manual) Cup or bowl feedingCup or bowl feeding Spoon feedingSpoon feeding Eyedropper or feeding syringeEyedropper or feeding syringe Nursing supplementerNursing supplementer Get milk from donation bankGet milk from donation bank

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THE ENDTHE END

There is no freedom of choice for humansThere is no freedom of choice for humansif it has been taken away from themif it has been taken away from themat the beginning.at the beginning.

Breast-feeding is not a choice,Breast-feeding is not a choice,but an obligation to the choice,but an obligation to the choice,

GiveGive your child the freedom of choice.your child the freedom of choice.

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Additional ResourcesAdditional Resources

La Leche LeagueLa Leche League World Health World Health

OrganizationOrganization Community Community

Health NursesHealth Nurses Lactation Lactation

ConsultantsConsultants Public Health Public Health

Agency of CanadaAgency of Canada

ReferencesReferences Mohrbacher, Nancy, and Stock, Julie. Mohrbacher, Nancy, and Stock, Julie. The Breastfeeding Answer The Breastfeeding Answer

Book, Book, 3rd Edition. Illinois: La Leche Leage International, 2003. The Breastfeeding Committee for Canada. The Baby-Friendly

Iniative in Community Health Services: a Canadian Implementation Guide. BCC, 2002.

World Health Organization. Evidence for the Ten Steps to Successful Breastfeeding. Geneva: WHO, 1998.

Class Notes Google Images http://www.fda.gov/FDAC/features/895_brstfeed.html http://medicalreporter.health.org/tmr0297/breastfeed0297.html http://www.mamadearest.ca/en/info/benefits_breastfeeding.htm http://www.lambtonhealth.on.ca/infant/benefits.asp http://www.babyfriendly.org.uk/health.asp http://www.phac-aspc.gc.ca/rhs-ssg/factshts/brstfd_e.html http://www.caaws.ca/mothersinmotion/baby/

feeding_benefits_e.html

Breast feeding

Health & Medicine

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