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MANAGEMEN LAKTASI

Roesli Indonesian Breast feeding Center

. Utami

dr. Utami Roesli SpA IBCLC FABM

Anatomy of the Lactating Breast

Sir Astley Cooper

Wax cast of the ductal network of a lactating breast (1840)

dr. Utami Roesli SpA IBCLC FABM

New View: what has changed?


New Old
No branching of ducts until deep in the breast Branching of ducts close to the nipple

Ducts branch closer to the nipple

dr. Utami Roesli SpA IBCLC FABM

New View: what has changed?


Old
Lactiferous Sinuses

New
No Lactiferous Sinuses

Conventionally described dr. Utami Roeslilactiferous SpA IBCLC FABM sinuses do not exist 4

New View: what has changed?


Old
Even distribution of glandular tissue

New
65% of glandular tissue within 30 mm of nipple

Glandular tissuedr. is found closer to the nipple Utami Roesli SpA IBCLC FABM

New View: what has changed?


New Old
Substantial subcutaneous fat near the nipple Minimal subcutaneous fat near the nipple

Roesli SpA IBCLC FABM Subcutaneous fat dr. isUtami minimal at the base of the nipple

New View: what has changed?


Old
Even ratio (1 : 1) of glandular to fatty tissue

New
Ratio of glandular to fatty tissue is 2:1

The ratio of glandular to fatty tissue is not equal, but dr. Utami Roesli SpA IBCLC FABM rather 2 : 1

New View: what has changed?


Old
Ductal network depicted as radial and symmetrical

New
Ductal network not always radial or symmetrical

dr. Utami Roesli SpA IBCLC FABM The ductal network is not always radial or symmetrical

New View: what has changed?


Old
15 20 ducts exiting at the nipple

New
4 -18 ducts exiting the nipple (average of 9)

Fewer ducts exiting the nipple than previously thought

dr. Utami Roesli SpA IBCLC FABM

Alveoli Berbentuk anggur Bila dirangsang Prolaktin Sel dinding Alveoli akan mebuat ASI Ductus Lactiferous Menyalurkan ASIke ujung puting Otot polos Myoepithel Otot mengelilingi Alveoli Bila dirangsang Hormon Oksitosin , otot akan mengkerut menyemprotkan ASI didalam alveoli kedalam Saluran Payudara keluar pada ujung putting
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STAGE OF LACTATION

With the arrival of transitional milk

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Reflek PROLACTIN

Rangsangan putting saat menyusu menghambat Dopamine (Prolactin Inhibiting Factor ); Hipophise Anterior mengeluarkan Prolaktin dr. Utami Roesli SpA IBCLC FABM Prolaktine merangsang sel sel dinding alveoli untuk membuat ASI

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dr. Utami Roesli SpA IBCLC FABM

PROLACTIN 13

Reflek Oksitosin - Pengaliran ASI- Reflek Kasih Sayang Reflek Let Down Milk EjectionRefleks

Isapan bayi merangsang serabut syaraf menjalar melalui syaraf mammary afferent ke hyphothalamus; merangsang Hyphopise Posterior mengeluarkan Hormon Oxytocin Oksitosin merangsang myoepithelial cells yang mengeliling alveoli untuk dr. Utami Roesli SpA IBCLC FABM 14 berkontraksi mengalirkan ASI keluar alveoli ke ductus lactiferous ( let-down or

HAL YANG MENGURANGI OKSITOSIN


1. Takut payudara berubah dan gemuk 2. Ibu bekerja 3. Takut ASI tidak cukup 4. Ibu kesakitan 5. Ibu sedih, cemas, marah, kesal, bingung 6. Malu menyusui 7. Suami, keluarga kurang mendukung
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Melihat, memikir Bayi

HAL YANG MENINGKATKAN OKSITOSIN


Ganti popok Pijat Bayi

Memandikan

Ibu Tenang Bergurau

Bermain

dr. Utami Roesli SpA IBCLC FABM

Sendawa

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REFLEXES IN NEWBORN

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POSISI MENYUSUI

CROSS dr.CRADLE Utami Roesli SpA IBCLC FABM

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HOLD THE BABY BEHIND THE BACK AND SHOULDER NOT ONLY TKE HEAD ALLOW BABYS HEAD TO FALL BACK ONTO YOUR WRIST & FOREARM SNUGGLE THE BABY FROM UNDERNEATH TURN BABYS BODY TO FACE YOU

CHIN TO BREAST CHEST TO CHEST


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POSISI MENYUSUI YANG BENAR : Kunci Keberhasilan Pelekatan


1. Letakkan kepala bayi di pertengahan lengan bawah 2. Posisikan bayi dari bawah , dagu bayi melekat pd payudara, hidung menjauhi payudara 3. Seluruh badan bayi menghadap ibu 4. Dada bayi melekat pada dasar payudara (dada) ibu 5. Bahu dan lengan ibu tidak tegang dan dalam posisi natural
dr. Utami Roesli SpA IBCLC FABM

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Dagu Bayi Menempel ke Payudara ibu CHIN TO BREAST


Perut/dada bayi menempel pasadadadan perut ibu CHEST TO CHEST SELURUH BADAN BAYI MENGHADAP KE BADAN IBU HINGGA TELINGA BAYI PADA GARIS LURUS DG LENGAN BAYI LEHER BAYI LURUS PEGANG BELAKANG BAHU JANGAN KEPALA BAYI

POSISI MENYUSUI yang BENAR: Kunci Keberhasilan PELEKATAN


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POSISI MENYUSUI YANG KURANG TEPAT

Kepala bayi terletak di siku hingga bayi menunduk

Badan bayi tidak menghadap badan ibu. Hanya bahu yang ditompang oleh tangan ibu. Leher bayi terputar Badan ibu condong kedepan
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ATTACHMENT : The Key to successful Breastfeeding


Position baby so the nipple is above babys top lip & opposite babys nose Tease babys bottom lip & chin with the breast & areola WAIT for baby to respond with wide open mouth, tongue down QUICKLY bring baby onto the Breast. Push behind babys chest & shoulder, never behind babys head

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PELEKATAN : Kunci Keberhasilan Menyusui


Bayi datang dari arah bawah Hidung bayi berhadapan dengan puting susu Dagu bayi merupakan bagian terdepan melekat pd payudara (contact point) Puting diarahkan ke atas ke langit-langit bayi Telusuri langit-langit bayi dg puting sampai ada diantara uvula dan pangkal lidah Puting susu hanya 1/3 atau dari bagian dot jaringan payudara yang terbentuk

dr. Utami Roesli SpA IBCLC FABM

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CARA BAYI MENGELUARKAN ASI

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GOOD ATTACHMENT / CORRECT LACH - ON Signs of Good Attachment :


Babys chin touching the breast His mouth wide open His lower lip turned outwards His cheeks round, or flattened against his mothers breast More areola above the babys mouth then below Breast look round during feeding
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TANDA PELEKATAN BENAR

Areola bagian atas terlihat lebih banyak dari bagian bawah Bibir atas terputar keluar keatas dan bibir bawah terputar keluar kebawah Mulut terbuka lebar Dagu melekat ke payudara dr. Utami Roesli IBCLC FABM 27 SpA Pipi menggelembung

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Signs of Attachment : He has taken much of the areola and the underlying tissue into his mouth The lactiferous ductus are included in these underlying tissue He has streched the breast tissue out to form a long teat The nipple forms only about 1/3 of the teat The baby is suckling from the breast not from the nipple

GOOD ATTACHMENT / CORRECT LACH - ON


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dr. Utami Roesli SpA IBCLC FABM

POOR ATTACHMENT / LACH - ON


More areola below babys mouth than above it or the same amount His mouth not wide open His lower lip is turn in His lips is pointing forwards or his lower lip turned in Babys chin not touching the breast
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Signs of Poor Attachment : Only the nipple is in babys mouth, not the underlying breast tissue The lactiferous ducts are outside the babys mouth, his tongue can not reach The tongue is inside his mouth not pressing on the lactiferous sinuses
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NIPPLE CONFUSION Introducing artificial teats to a breastfed infant may begin a process of inadequate suckling at the breast , because the action of mouth, tongue, mandible different from breast to bottle It can lead to total refusal of the breast

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depan MAKANAN mereka di tangan kita EMAS ANAKHari DENGAN STANDAR


IMD ASI Eksklusif 6bln MPASI makanan keluarga ASI sampai 2 tahun

TERIMA KASIH LEBIH SEHAT


Juga dari IQ LEBIH TINGGI EQ LEBIH BAIK SQ LEBIH BAIK SOLEH,SOLEHA

anak-anak Mataram Lombaol

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DAFTAR PUSTAKA 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics.; 1997: 100: 1035-1039. Bhandari N et al. Effect of community-based promotion of exclusive Breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial Lancet 2003: 26; 361 (9367):1418-23 Birch E el al. Breastfeeding and Optimal Visual Development. J Pediatr Ophthalmol. Strabismus1993; 30 : 33-38 Black R F et al : The Support of Breastfeeding.Lactation Specialist Self- Study Series.Module 1. Jones and Bartlett Pub. Boston. Toronto London 1998 Black R F et al : The Science of Breastfeeding .Lactation Specialist Self- Study Series.Module 3. Jones and Bartlett Pub. Boston. Toronto London 1998 Black R F et al : The Management of Breastfeeding.Lactation Specialist Self- Study Series.Module 4. Jones and Bartlett Pub. Boston. Toronto London 1998 Bouwstra H et al . Exclusive breastfeeding of healthy term infants for at least 6 weeks improves neurological condition J Nutr 2003; 133 ( 12): 4243-3 Chantry CL : Colostrum :Liquid Gold ABM News and Views 2002: vol 8, no 4 Cohen R Comperation of Maternal Absenteeist and Infant Ilness Rates among Breastfeeding and Formula Feed Women in two Corporations. American Journal of Health Promotion 1995, 10 ( 2 ): 148-53 Honwood U, Fergusson DM, Breastfeeding and later cognitive and academic outcomes. Pediatrics : 101: p.e9; 1998 Howie PW. MBBS, MSc and Begum S. MBBS,MSc Protective effect of Breastfeeding against infection. BNJ, 1990 ,300: 11-16 Laurence R Breastfeeding. A Guide for Medical Profession. 5th ed. St.Louis, MO: CV Mosby: 1999 Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992 : 339 .261-264 Mortensen EL et al. The Association Between Duration of Breastfeeding and Adult Intelligence . JAMA, 2002, 287 (18): 23652371 Oddy WH . Breastfeeding protects againts illness and Infection in Infant and Children Breastfeeding Review 2001: 9(2):11-18 Rogan WJ, Gladen BC, Breastfeeding and cognitive development. Early Human Development 1993: 31: 181-193 Riva E, Agostoni C, Trojan S, Luoti D, Fiori L, Giovannini M; Early Breastfeeding is linked to higher IQ scores in dietary treated PKU children. Acta Paediatr1996, 83 : 56-58 Tobolic TJ: Fathers Day : Understanding and Supporting the Father in the Triad. Academic Breastfeeding Medicine News and Views 2003 vol 9 no 2 UNICEF Collaborative Group on Hormonal Factors in Breast Cancer : Breast Cancer and Breastfeeding : Collaborative

Reanalysis of Individual Data from 47 Epidemiological Studies in 30 Countries , including 50 302 Women with Breast Cancer and 96 973 Women without the Disease. Lancet 2002 ; 360: 187-95 Victora CG, Barros .WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of Breastfeeding on Infant and child mortality due to Infectious diseases in less developed countries: a pooled analysis.Lancet
2000: 355; 451-55

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