Breast feeding

Dr Nishi Sood

• Anatomy of breast• Colostrum and milk• Endocrinology of lactation• Benefits of breast feeding• Techniques of breastfeeding• Drugs which are contraindicated• Care of nipples• Breast fever,cracked nipples,mastitis,abcess• Contraception during breast feeding

Breast anatomy

• Breasts composed of glandular, fibrous, and adipose tissue

• Lobes are made up of lobules and lined with cuboidal epithelium

• Ducts combine to form lactiferous sinuses which serve as reservoirs for milk collection

• Prolactin plays a role in milk production

Endocrinology of lactation

• Mammogenesis –progesterone,estrogen,HPL,prolactin ,cortisol, insulin

• Secreation-inhibitory effect of progesterone is removed

• Lactation depends on stimulous

• Milk ejection/letting down reflex

Human Milk Facts

• Isotonic Solution– milk and plasma are of similar ion concentration

– Suspension of fat& protein in carbohydrate mineral solution

• Designed to protect infants chronic childhood diseases. – T-lymphocytes, B-lymphocytes, neutrophils, macrophages and

epithelial cells aid in protection,igA Immunoglobulins

• Two forms of breast milk are colostrum and mature milk.

• Usually about 600ml/day

Colostrum in Human Milk

• Thick, yellow fluid

• Produced during lactogenesis II (2-3 days after birth)

• Provides 58-70 cal/100 ml

• High in protein, electrolytes, sodium, potassium, chloride and vitamin A

• Low in fat and carbohydrate

• Lactobacillus bifidus factor

Mature Human Milk

• Thin and watery texture

• Provides 2,730-2,940 cal/L

• High in linoleic acid and cholesterol content for brain development

• High in fat content and lactose

• Docosahexaenoic acids (DHA)

– Long chain omega-3 fatty acids.

– Used for synthesis of brain tissues, central nervous system and eyes

• DHA and cholesterol not found in human milk substitutes

Mature Human Milk- PRO

• Protein

– Low content

• Dependent on infant’s age

– Antiviral and antimicrobial effects

– Alpha lactalbumin,beta lactoglobulin

– Casein

• Major protein in mature milk

• Casein, calcium phosphate, and other ions such as magnesium and citrate is what makes milk appear white.

Mature Human Milk- CHO

• Lactose– Disaccharide of galactose and glucose.– Dominant carbohydrate in human milk.– Enhances calcium absorption.

• Other carbohydrates– Monosaccharides

• Glucose– Polysaccharides

• Contribute calories• Stimulate the growth of bifidus bacteria in the gut• Inhibit the growth of E. coli and other bacteria

Change in Milk Composition During Feeding

• Foremilk

– Released first

– Higher in carbohydrate

– Lower in fat

• Hindmilk

– Resembles cream

– Higher in fat

– Lower in carbohydrate

– Released 10-20 minutes into the feeding

Effects on breast milk composition

• Alcohol

• Nicotine

• Caffeine

• Marijuana and other drug abuse

• Cytotoxicdrugs,ergotamine,lithium,phenobarbitone,atenolol,acebutolol,radioactive isotopes

• Environmental Exposures

• Genes

Benefits For Mother If Breastfeeding:

•Reduces the risk of breast cancer.

•Reduces the risk of uterine and ovarian cancer.

•Lessens osteoporosis.

•Benefits child spacing.

•Promotes emotional health.

•Promotes postpartum weight loss.

•Costs less to breastfeed.

•Maternal-infant interaction and closeness.

Benefits For Baby When Breastfed

• Immunologic properties of breast milk.• Increases your baby's intelligence level. • Better pain relief and less stress. • Build stronger bones. • Gets plenty of cholesterol. • Reduces risk of asthma. • Stronger immune systems. • Reduces risk of allergies.

Benefits For Baby Breastfed (con’t)

• Reduces the risk of becoming obese later in life.- Kids fed mainly on breast milk for the first 6 months of life were 22% less likely to be overweight by age 14. - Those who were breast-fed for at least 7 months were 20% less likely to be overweight than those babies who were given breast milk for 3 months.- Research shows how high levels of the protein hormone leptin abundant in mother's milk which influences a baby's growth and body composition development.

Possible Disadvantages For Baby If Breastfed:

• HIV transmission.

• Inadequate milk supply.

• Baby’s inability to suck.

POSITIONING

Principles:Mother needs to be comfortable and relaxed.support mother/infant

with pillows ;bring infant to level of breast.

Cradle hold – natural

position for mother/infant. Can be difficult for mother tosee infant’s face and control head position. Belly to belly position of mother/baby.

Football Hold – appropriate for small infant or C/S

delivery. Mother can control infant’s head, allows for better visibility of infant’s mouth. Good for infants who prefer to feed in upright position.

Across the lap – similar to

cradle except mother has better control of infant’s head. Belly to belly

Side lying – used mostly for early feedings, C/S deliveries, and nighttime feedings. Need pillows for support of mother’s leg and back.

LATCHING

• When mouth is open, bring baby to the breast, not breast to the baby

• Baby should take in as much of the areola as possible-”fish lips”

• Nose is almost touching

• See and hear baby swallowing

• Feels like a tug

• Sucking will increase as flow increases

COMMON PROBLEMS; HOW TO OVERCOME THEM

Sore nipples: is the most common problem during the early days of breast feeding.This can result from:

1. Improper positioning of the infant’s mouth on the nipple.2. Using only one position for all feedings.3. Feedings are too far apart so that when the baby begins nursing he/she

sucks very eagerly.4. Breast care that contributes to dry, irritated nipples.5. Trauma to the nipple because of improper removal from the breast.

Engorgement: is an overfullness that is a result of incomplete or inadequate empty-ing of the breasts.

All mothers are encouraged to observe the Four A’s of breastfeeding to minimize Breastfeeding problems.

• Mastitis /Parenchymatous/ Infection of Mammary Glands : Not until 3-4 wks

Unilateral

Marked engorgement precedes inflammation

10% progress to Abscess

• Breast Abscess

Care of Nipples

How Long Do You Breast-feed...

• The World Health Organization recommends

that infants start breastfeeding within one

hour of life, are exclusively breastfed for six

months, with timely initiation of adequate,

safe and properly fed complementary foods

while continuing breastfeeding for up to two

years of age or beyond.