BREAST FEEDING

Ordered to Meet English Task

Academic Year 2009/2010

Supervising lecturer
Andiwati, S.Pd

Semester 1 A

By:

Anis Rakhmawati (0902200001)

MINISTERY OF HEALTH OF THE REPUBLIC INDONESIA

HEALTH POLITEKNIK DEPKES MALANG
MIDWIFERY SUBJECT
PROGRAM OF STUDY MIDWIFERY KEDIRI
2009/2010
 PREFACE

Praise the presence of God Almighty, who has given His mercy and His
guidance so that the paper entitled "Breast feeding" can be resolved properly. The
author is fully aware that the preparation of this paper can be solved with help of
various parties, either directly or indirectly. For this, writer humbly thanking :
 God Almighty, who has given His mercy
 My English lecture, Mrs. Andiwati, S.Pd
 All friends who had helped, and
 All participants who have assisted the completeness of this paper.
The author is fully aware that the preparation of this paper still has many
shortcomings that suggestions and constructive criticism is expected. Finally, the
author hopes that what is presented in this paper can povide benefits to all of us,
amen.

Kediri, November 2009

the author
 TABLE OF CONTENTS

TITLE PAGE
PREFACE
TABLE OF CONTENTS
CHAPTER 1 INTRODUCTION
1.1 Background
1.2 Purpose
CHAPTER 2 REVIEW
2.1 Anatomy physiology of the breast
2.2 Properties and components of breast milk
2.3 The advantages of breast feeding
2.3.1 Neonatal Advantages
2.3.2 Maternal Advantages
2.4 The techniques of breast feeding
2.4.1 The Commencement of Breast breeding
2.4.2 Positioning The Mother
2.4.3 Positioning The Baby’s Body
2.4.4 Positioning (or attaching or lacthing) The Baby’s Mouth onto
the Breast
2.5 Care of breasts
CHAPTER 3 CLOSING
3.1 Conclusion
3.2 Suggestions
REFERENCES
ENCLOSURE
 CHAPTER 1
INTRODUCTION

1.1 Background

Many hours of the mother's time, day and night for many months will be
spent feeding the baby. She should be supported in the feeding method of her
choice and enable to accomplish it with skill, knowledge, confidence, and
pleasure. A firm mother-baby attachment can be forged during these frequent
encounters, provided that they proceed without anxiety. When the breast feeding
goes well, there is the added advantages of mother's sense of achivement and
satisfaction. For these reason alone, breast feeding must be the ideal way to feed a
baby. Unfortunately there is currently high failure rate which must in part be
attributed to lack of knowledge and loss of skills of mothers. It is the most
important knowledge to understand for mother about breast feeding so they can
do it as maximum as they can for their babies. So, this paper will share about
breast feeding.

1.2 Purpose

 Learning about anatomy physiology of the breast

 Knowing about properties and components of breast milk
 Knowing the advantages of breast feeding
 Learning the techniques of breast feeding
 Learning about care of breasts
 CHAPTER 2
REVIEW

2.1 Anatomy Physiology of The Breast

The breast are compound secreting glands, composed mainly of glandular

tissues which is arranged in lobes, approxiamately 20 in number. Each lobe is
divide into lubues that consist of alveoli and ducts. The alveoli contain acini cells
which produce milk and are surrounded by myo-epithelial cells which contact and
propel the milk out. The breast are richly supplied with blood. Small lactiferous
ducts, carrying milk from alveoli, unite to form langer ductus: one large duct
leaves each lobe and widens to form a lactiferous sinus or ampulla which acts as a
temporary reservoir for milk. A lactiferous tubule from each sinus emerges on the
surface of the nipple. Each of breast functions independently of the other.
The nipple, composed of erectile tissues, is covered with epitellium and
contains plain muscle fibres which have a sphincter-like action in controlling the
flow milk. Surrounding the nipple is an area of pigmented skin called the aerola
which contains Montgomery's glands. These produce a sebum-like substance
which acts as a lubricant during pregnancy and throughtout breast feeding.
Breasts, nipples and aerolae vary considerably in size from one woman to another.
The breast is supplied with blood from internal and external mammay and
branches from the intercostal arteries. The veins are arranged in a circular fashion
around the nipple.
Lymph drains freely between two breast and into lymph nodes in the
axillae and the mediastrum.
During pregnancy, oesterogens and progesterone induce alveolar and
ductal growth as well as stimulating the secreting of colustrum. Other hormones
are also involved and they govern a complex sequence f events which prepare the
breast for lactation. The production of milk is held in abeyance until after delivery,
when the levels of prolaction to rise and milk production of prolactin is caused by
the baby feeding at the breast, with concentrations highest during night feeds.
(prolactin supresses anovulatory untill lactation ceases, although for others this
effect is not so prolonged). If breast feeding (or expressing) has to be delayed for
a few days, lactation can still be initiated.
Milk release is under neuro-endocrine control. Tactile stimulation of the
breast stimulates the poduction of oxytoxin causing contaction of the myopithelial
cells. This process is known as 'let-down' or 'milk-ejection' reflex and makes the
milk available to the baby. In the early days of lactaion this reflex is
unconditioned and is therefore unlikely ti be inhibited by anxiety. Later it becomes
a conditioned reflex responding to the baby's cry (or other circumstances
associated with the baby or feeding). At this stage it could be inhibited to some
extent by anxiety. Milk is transferred to he baby by a combination of the milk
ejection reflex and active removal of milk by the action of baby's tongue and jaw.
Removal of milk is the most important factor in the maintenance of milk
production, because without it prolactin will not be release and the supply will
diminish.

2.2 Properties and Components of Breast Milk

Human milk varies in its composition with the time of day, with the
stage of lactation, in response to maternal nutrition and because of individual
variations. Fore-milk, at the begininng of the feed, differs from hind-milk, towards
the end of the feed. Samples obtained for research may not represent the milk
obtained by the baby because of the methodes used for collection. Comparison
with the milks of other animals shows human milk to be unique. It meets all
nutritional requirements of the new baby and has many other important properties
as well.
Fat provides the baby with more than 50% of his calorific requirements
(Helsing and Savage King 1982). The fat content in human milk has diurnal
variations, being lowest in he morning and highest in the afternoon. The
proportion of fat in the milk increase during the course of the feed, sometimes
increasing five times the initial value. It is utilised very rapidly because of the
action of the enzyme lipase which is present in the milk in a form which only
becomes active i the infant’s prestine. Pancreatic lipase is not plentiful in the
newborn baby.
Lactose. There is more lactose in human milk than in any other
mammalian milk. It is converted into galactose and glucose by action of the
enzyme lactase angd these sugars provide energy to the rapidly growing brain.
Lactose enhances the absorption of calcium and also promotes the growth of
lactobacilli which increase intestinal acidity, thus stemming the growth of
pathogenic organisms.
Protein. Human milk contains less than half the amount of protein
contained in cow’s milk but because of its easy digestibility it provides the baby
with the ideal quantity. Human milk f orms soft, flocculent curds when acidified
in the stomatch. The predominant protein is lactabumin (when protein) and
caseinogen is present in lower quantities. This provides a continuous flow of
nutrients to the baby. Two amino acids, cystine and taurine, are found in human
milk but not in cow’s milk. The first is important for growth and the second for
the development of the brain. Colostrum contains nearly there times the amount of
protein that is present in imature milk and contains all the ten essential amino
acids. It also contains secretory IgA and lactoferrin (see below).
Vitamins, minerals, and trace element
There are four fat soluble vitamins, A, D, E, and K :
Vitamin A. Mature human milk contains 280 international units
(IU) of vitamin A and colostrum contains twice that amount. Cow’s milk contains
only 180 IU.
Vitamin D. It is now believed that both water-soluble and fat-
soluble vitamin D are present in human milk. Provided that the mother’s diet is
adequate and that the baby can be exposed to the sun, supplementation with
vitamin D is not necessary. Dark-skinned babies ae he exceptions.
Vitamin E. Human colostrum is rich in vitamin E and the levels in
mature human milk are higher than in cow’s milk. It’s main function is to prevent
haemolytic anaemia but it also helps to protect the lungs and retina from oxidant
induced injury.
Vitamin K. This vitamin is essential for the synthesis of blood-
clotting factors. It is present in human milk and absorbeb efficiently. Recent
research suggests that the breast-fed baby may receive more vitamin K than has
previously been demonstrated because it has been discovered that levels are
higher in colostrum and, in the early days. In the high fat hind-milk(Kries et al
1987). Later, levels depend on maternal dietary intake. Babies who are at risk of
haemorrhage, such as the preterm and those delivered precipatately or
instrumentaly, usually receive a prophlactic dose, usually by intramuscular
injection. May paediatricians consider that all other babies should receive an oral
dose soon after birth. After a few days the baby’s gut flora will synthesise vitamin
K. Colonisation of the gut may be aided by encouraging the mother not to wash
her breasts, or otherwise clean them before a feed.
Vitamin B complex. All of the B vitamins are present at levels
which are believed to provide the baby with his necessary daily requirements.
Vitamin C. Human milk contains 43 mg/100 ml in fresh cow milk.
The amount in the mother in the mother’s milk reflects the dietary intake and it is
advisable for her to increase her intake during lactation. Vitamin C is essential for
collagen synthesis.
Iron. Normal full-term babies are usually born with ahigh
haemoglobin breakdown is utisilied again. They also have ample iron stores
which last from 4-6 months. Human milk and cow’s milk contain small quatities
of iron (0.5-1 mg/1). 49 % of the amount available in human milk is utilisied,
whereas only 4% is absorbeb from cow’s milk (Saarinen and Siimes 1977). The
difference is due to the high levels of vitamin C and lactose in human milk which
facilities absorption. Babies who are fed cow’s milk may become anaemic
because of microhaemorrhages of the bowel. Preterm babies do not have good
iron stores and may need supplementation with oral iron.
Zinc. This trace mineral is esssential to humans. A deficiency may
result in failure to thrive and typical skin lesions. Althought there is more zinc
present in cow’s milk than a human milk, the bio-availability is greater in human
milk.
Other minerals. Human milk has significantly lower levels of
calcium, phosphorus, sodium and potassium than cow’s milk. Breast milk threfore
impose a lower solute load on the neonatal kidney than does unmodified cow’s
milk. If a baby is fed on ‘doorstep’ milk, he will become dehydrated due to
hypernatremia (excess sodium). The breast-fed baby does not ingest an overload
of salts and is therefore unlikely to need additionaly water under most conditions
(Almroth 1978, golderg and Adams 1983, Sachdev et al 1991).
Other important properties
Anti-infective factors. During the first 10 days there are more white
cells per ml than there are in blood.
Macrophages and neurotrophills are amongst the most common
leucocytes in human milk and they surround and destroy harmful bacteria by
lymphocytes in human milk.
Immunoglobulins IgA, IgG, IgM, and IgD are all found in human
milk. Of these the most important is IgA, which appears to be both synthesised
and stored in the breast. It ‘paints’ the intestinal epithelium and protects the
mucosal surfaces against entry of pathogenic bacteria and entero viruses. It
affords protection against Eschericia coli, salmonellae, shigellae, streptococci,
staphylococci, pneumococci, poloivirus and rotaviruses.
Lysozyme is present in breast milk in concentration 5000 times
greater than in cow’s milk. It is a well known general anti-infectifve agent and its
actifity appears to increase during lactation.
Lactoferin is abudant inhuman milk but is not present in cow’s milk.
It effects the absorption of enteric iron, thus epreveting pathogenic E. coli from
obtaining the iron they need for survival.
The bifidus factor in human milk promotes the growth of Gram-
positive bacilli in the gut flora, particulary Lactobacillus bifidus, which
discourages the multipliction of pathogens. Babies who are fed on cow’s milk
formula have Gram-negative (potentially pathogenic) bacilli in thier gut flora.
Anti-allergic factors. Allergic problems occur lessfrequanly in
breast fed babies than in bottle-fed babies. This may be because the infant’s
intestinal mucosa is permeable to proteins before the age of 6-9 months and
roteins in cow’s milk can act as allergens.
Occasionally a baby may become allergic to substance in his
mother’s milk which come from her diet. This is rare and can be circumvented by
the mother avoiding the foods which cause the trouble so that she may continue to
breast feed.

2.3 The advantages of breast feeding

2.3.1 Neonatal Advantages

In addition to the flexibility of the composition of breast milk to suit the
needs of the growing child (Department of Health and Social Security 1988), it
has other benefits. Breast-fed babies are less liely to be overweight than bottle-fed
infants in the days of unmodified milks (Hall 1975). It thought, however, that
breast feeding has a protective effect against the occurrence of obesity in
adolensence (Kramer and Moroz 1981). Also, unlike artifical feeds, breast milk
cannot be too concentrated, nor can anything be added to it.
Infections, especially of the gastrointestinal tract, are less common in
breast-fed infants (victoria et al. 1987). They are protected from these in many
ways. White cells in the milk, such as neutrophils and macrophages, destroy
harmful bacteria in the gut; growth of pathogens is inhibited by the acid
environtment of the gut and by the growth of gram-positive organisms, such as
lactobacilli (Lucas 1983).
Lactoferrin binds to enteric iron, making it unavailable for the growth of
E. coli, and breast milk contains immunoglobulins (mainly immunoalglobulin
(IgA) which prevent passage of enteroviruses and pathogens through the gastric
mucosa (Bullen et al. 1972); goldman and Smith 1973).
Delaying the introduction into the diet of foreign proteins by breast
feeding has been shown to reduce, rather than totally protect against, the incidence
of allergies in infancy.

2.3.2 Maternal Advantages

Breast feeding helps the mother to use the fat stores laid down in pregnacy
in preparation for feeding, altought lacation women become more energy-efficient
and do not need to increase their dietary intake as much as was previously thought
(illingworth et al. 1986) . Prolonged and reular feeding (especilly during the
night) delays the return of ovulation (Howie et al 1982). In the developig world,
this is an important aid to birth spacing. Breast feeding requires no preparation or
the purchase of any equiptment. It can cause less disruption during the night or
when travelling. Society’a attidutes to breast feeding, especially in public, may
create some difficulties (Newson and newson 1965) although, in practice, discrete
feeding can usually be accomplished. If nursing mothers continue to be isolated
from the rest of society, there will be little chance of breast feeding becoming an
acceptable public activity (Melthosh 1985). Many women find breast feeding to
be a very pleasurable activity, which promotes a feeling of closenes and intimacy
between the mother and child (Messenger 1982). Some mothers also experience
an increase in libido (and may on occasion even reach orgasm) during feeding,
which may give rise to embarrasement especially if unexpected (master and
johnson 1966).

2.4 The techniques of breast feeding

2.4.1 Positioning The Mother

There are two main positions for the mother to adopt while she is breast
feeding. The first is lying on her side and this may be approciate at different times
during her lactation (Fig. 33.3). if she has had a caesarean section, or if her
perineum is very painful, this may be the only position she can tolerate in the first
few days sfter birth. She will need assistance in placing the baby at the breast
because it will be difficult for her to manipulate him skilfully. When feeding from
the lower breast it may be helpful to raise her body slightly by tucking the end of
a pillow under her ribs. Later she and her baby have learned how to breast feed,
either during the day because she finds it more comfortable and restful or at night
because it is more convinient.
The second position is sitting up in early days it is particulary important
that the mother’s back is upright and at a right angle to her lap bed with her legs
streched out in front of her (though she might be able to achive it sitting cross-
legged) or if she is sitting in a chair with a deep backward-sloping seat and
sloping back.
Both lying on her side and sitting correctly on a chair (with her back and
feet supported) enhance the shape of the breast and also allow ample room in
which to manoeuvre the baby.

2.4.2 Positioning The Baby’s Body

The baby’s body should be turned towards the mother’s body (Fig. 33.5).
the baby’s mouth should be opposite the nipple and the neck should be slightly
extended (Fig. 33.6).

2.4.3 Positioning (or attaching or lacthing) The Baby’s Mouth onto the
Breast
The baby should be supported acros his shoulders, so that the slight
extension of the neck can be maintained. The head may be supported by the
extended fingers of the supporting hand (Fig. 33.7) or on the mother’s forearm
(Fig 33.8). it may be helpful to wrap the baby firmly in a small sheet so that his
hands are by his sides (Fig. 33.9). if the baby’s mouth is moved gently but
persistently against his mouth wide (Fig 33.10). this is termed the rooting reflex.
Mothers may find the suggestion that they should try to stroke the top lip against
the nipple helpful (Prechtl 1985). As his mouth gapes, he is moved quickly to the
breast. The aim is to osition the bottom lip at least 0,5 inchi (1,5 cm) away from
the base of the nipple. This allows the baby to draw some of the breast tissue into
his mouth with his tongue and lower jaw. If correctly positioned, the baby will
have formed a teat from the breast and the nipple. The lactiferous sinuses will now
be within the baby’s mouth (Fig. 33.11) (woolridge 1986). The nipple will extend
back as far as the soft palte and make contact with it. It is this contact which
triggers the sucking reflex. the baby’s lower jaw closes on the breast tissues,
suction is exterted so that the nipple is held well within the mouth and the tongue
applies rhythmical cycles of compression so that milk is stripped from the ducts.
Although the mother may be startled by the physical sensation, she should not
experience pain. Some women experience feelings of sexual arousal or even
orgasm due to the stimulation of the nipple, though this is probably rare.
2.5 Care of breasts

The breast should be washed daily with clean water or mild soap. A well-
fitting brassiere provide needed support. During the early postpartum period a
tight binder, ice pack, and mild analgesic may be necessary to relieve discomfort
caused by pressure if the milk comes in. Nipple and breast stimulation should be
avoided. When showering, women should stand so that the shower sprays their
back and not their breast. Medication to suppress lactation may be prescibred.
Note, as of August 1994, bromocriptine (parlodel) was voluntarily withdrawn by
the manufacturer as an indication for lactation suppression due to reports f serious
advers effects.
 CHAPTER 3
CLOSING

3.1 Conclusion

 Anatomy physiology of the breast

Breast has consisted of :
 Lobes :
• Alveoli  contain acini cells which surrounded by myo-epithilial
cells
 Lactiferous ducts :
• Lactiferus sinus
• Lactiferus tubule
 Nipple
• Erectile tissues  covered with epithelium, contain plain muscle
fibres (have a sphincter)
• Aerola  conatins montgomery’s glands
 Internal and external mammary arteries and branches from the
intercostal arteries
 During pregnancy, oestrogens and progesterone induce alveolar and
ductal growth as well as stimulating the secretion of colostrum

 Properties and components of breast milk :

 Fat
 Lactose
 Protein
 Vitamins, minerals and trace elements :
• Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K
• Vitamin B complex
 • Vitamin C
• Iron
• Zinc
• Other minerals  lower levels of calcium, phosphorus, sodium
and potassium than cow’s milk
• Other important properties :
 Anti-infective factors
 Macrophages and neutrophils
 Secretory IgA and interferon
 Immunoglobulins  IgA, IgG, IgM, and IgD
 Lysozyme  concentrations 5000 times geater tahn cow’s milk
 Lactoferrin  only in human milk
 The bifidus factor (gram-positive bacilli lactobacillus
bifidus)
 Anti-allergenic factors

 The advantages of breast feeding

 Neonatal Advantages :
• The flexibility of the composition of breast milk to suit the needs
of the growing child
• Breast-fed babies are less liely to be overweight than bottle-fed
infants in the days of unmodified milks
• Infections, especially of the gastrointestinal tract, are less common
in breast-fed infants
• Lactoferrin binds to enteric iron, making it unavailable for the
growth of E. coli
• Breast milk contains immunoglobulins (mainly immunoalglobulin
(IgA) which prevent passage of enteroviruses and pathogens
through the gastric mucosa
 Maternal Advantages
• Breast feeding helps the mother to use the fat stores laid down in
pregnacy in preparation for feeding
 • Prolonged and reular feeding (especilly during the night) delays the
return of ovulation
• Breast feeding requires no preparation or the purchase of any
equiptment
• Many women find breast feeding to be a very pleasurable activity,
which promotes a feeling of closenes and intimacy between the
mother and child
• Some mothers also experience an increase in libido (and may on
occasion even reach orgasm) during feeding, which may give rise
to embarrasement especially if unexpected

 The techniques of breast feeding

 Positioning The Mother
There are two main positions for the mother to adopt while she is
breast feeding :
• The first is lying on her side and this may be approciate at different
times during her lactation  if mother has had a caesarean
section, or if her perineum is very painful
• The second position is sitting up in early days it is particulary
important that the mother’s back is upright and at a right angle to
her lap bed with her legs streched out in front of her (though she
might be able to achive it sitting cross-legged) or if she is sitting in
a chair with a deep backward-sloping seat and sloping back.
 Positioning The Baby’s Body
The baby’s body should be turned towards the mother’s. The baby’s
mouth should be opposite the nipple and the neck should be slightly
extended
 Positioning (or attaching or lacthing) The Baby’s Mouth onto the
Breast
The baby should be supported acros his shoulders, so that the slight
extension of the neck can be maintained. The head may be supported by
the extended fingers of the supporting hand ) or on the mother’s forearm.
 If correctly positioned, the baby will have formed a teat from the breast
and the nipple. The lactiferous sinuses will now be within the baby’s
mouth

 Care of breasts
The breast should be washed daily with clean water or mild soap. A
well-fitting brassiere provide needed support. During the early postpartum
period a tight binder, ice pack, and mild analgesic may be necessary to
relieve discomfort caused by pressure if the milk comes in. Nipple and breast
stimulation should be avoided. When showering, women should stand so that
the shower sprays their back and not their breast. Medication to suppress
lactation may be prescibred.

3.2 Suggestions

Knowledge and skills of breast feeding have been retained within society,
women consider it the normal thing to do. Midwives should encourage mothers to
breast feed because of the potection against infection conferred on the baby and
breast feeding will have a excellent chance of being succesful. On the other hand,
in the so-cailed development world, the midwives should recognise that the
majority of women who choose to the breast feed do so because they regard it as
the fulfilment of motherhood and are less conscious of the benefits of human
milk for the babies. But mothers also must be had an encouragement from
theirselves to find out the knowledge and skills of breast feeding.
 REFERENCES

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livingstone
Bobak. Maternity Nursing. 1995. Missouri : Mosby-year book
Johnson, martin H. Essential Reproduction. 2000. Australia: Blackwell science
Ruth, johnson. Skills For Midwifery Practice. 2000. British : Britishchurchill
livingstone
Silvertone, Louise. The Art and Science of Midwifery. 1993. British : Redwood
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_________. Healthy Mother and Healthy Newborn Care. 1998. _____ : ______
www.babyfriendlyusa.org