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How breastfeeding works

After completing this session participants will be
able to:

• name the main parts of the breast and
describe their function
• describe the hormonal control of breast milk
production and ejection
• describe the difference between good and poor
attachment of a baby at the breast
• describe the difference between effective and
ineffective suckling
Anatomy of the breast

Oxytocin makes
Muscle cells them contract
Prolactin makes
Milk-secreting cells
them secrete milk

Ducts

Larger ducts

Nipple

Areola
Montgomery’s glands
Alveoli
Supporting
tissue and fat
Is there a difference between a
small breast and a large breast ?
Is there a difference between a small breast and a large breast ?

The FAT and other
tissue gives the
breast the shape

Both contains the
same amount of
gland tissue
3/3

Prolactin

• Secreted during and after feed to produce next feed

Sensory impulses
from nipples

Prolactin in blood

Baby suckling
• More prolactin
secreted at night
• Suppresses
ovulation
What can we suggest to help a
mother INCREASE her milk supply ?
What can we suggest to a mother so she could INCREASE her milk supply ?

The more the baby suckles the more milk
is produced

Mother to eat and drink enough

More prolactin is produced at night

Hormones related to prolactin suppresses
ovulation so breastfeeding can help delay a new
pregnancy
Oxytocin reflex

• Works before or during feed to make milk flow

Sensory impulses
Oxytocin in from nipples
blood

Baby
suckling • Makes uterus
contract
Oxytocin is

• produced more quickly than
prolactin.

• makes the milk in the breast
flow for this feed

• can start working when mother
expects a feed, even
before a baby suckles

• If oxytocin reflex does not work
well, breast produce milk
BUT not flowing out
Oxytocin

• makes uterus contracts after
delivery
• helps reduce bleeding
• sometimes causes uterine pain
and a rush of blood during a feed
for the first few days
……..
3/5

Helping and hindering of oxytocin reflex

These help reflex These hinder reflex

• Thinks lovingly of baby • Worry
• Sounds of baby •Stress
• Sight of baby • Pain
• Touches baby
• Doubt
• Confidence (temporary)
Why is it important to understand
the oxytocin reflex in the way we
care for mothers after delivery ?
Why is it important to understand the oxytocin reflex in the way we care
for mothers after delivery ?

Mother needs her baby NEAR her all the
time

You must remember a mother’s feelings
whenever you talk to her… make her feel
good and built her confidence

Mothers are often aware of their oxytocin
reflex ….several signs….

Open manual to page 18 and read out
Signs & sensations of an active Oxytocin reflex

Mother may notice:
• Squeezing or tingling sensation in her breast
• Milk flow from breast
• Milk dripping from other breast when baby is
suckling
• Pain from uterine contraction, sometimes
with rush of blood
• Slow deep sucks and swallowing by the
baby which shows that milk is flowing into
the mouth
3/6

Inhibitor in breast milk

If breast remains
Inhibitor
full of milk,
secretion stops

Function of the inhibitor ?
Inhibitor
• Controls production of milk from
within the breast…

If one breast stops production, the
other continues

• Protects breast from harmful
effects of being too full

• If BM is removed, inhibitor also
removed… breast makes more
milk
The inhibitor helps us understand why…

If baby : • For breast to continue
• stops suckling making milk,
breast stops making milk must be removed
milk

• suckles more from • If baby cannot suckle,
one breast - breast EXPRESS milk to
becomes more larger, enable production to
more milk continue
3/7

Attachment to the breast

What do you see ? come n explain
3/7
Attachment to the breast
• More areola &
underlying tissue inside
mouth
• Large ducts inside
mouth
• Formed long teat
• Nipple forms only 1/3
of the “teat”
• Baby suckling from
breast and NOT nipple
3/7
Attachment to the breast

Baby’s tongue …
• forward over his lower
gum and beneath the
larger ducts
• cupped round the
“teat”
• presses milk out of
larger ducts into baby’s
mouth
When a baby suckles effectively…

the mouth and tongue do not rub the
skin of the breast and nipple
3/8

Good and poor attachment

What differences do you see?

1 2
Good and poor attachment

1 2

Nipple ?
Larger duct – where ?
Tongue can reach larger duct ?
Tongue pressing duct ?
3/9

Attachment (outside appearance)

What differences do you see?

1 2
Attachment – outside appearance

1 2

• more areola above upper lip
– reaching the larger ducts with his tongue
• mouth widely open
(nipple to nose technique)
• lower lip turned outwards
• chin touches the breast
What do you think might be the
result of poor attachment ?
3/10

Results of poor attachment

 Painful nipples
 Damaged nipples
 Engorgement
 Baby unsatisfied and cries a lot
 Baby feeds frequently and for a long time
 Decreased milk production
 Baby fails to gain weight
 Mother may loose self confidence
To prevent complications of poor
attachment…

• Teach the skill of proper
positioning and attachment

• Do not give feeding bottles
3/11

Reflexes in the baby
Rooting Reflex
Sucking Reflex
When something touches
lips, baby opens mouth, puts When something
tongue down and forward touches palate, baby
sucks

Skill
Mother learns
to position
baby
Baby learns to
take breast Swallowing
Reflex
When mouth fills
with milk, baby
swallows
Summary of session 3 is found on
pages 15 to 21 of the participants’ manual

IYCF : An Integrated Course (October 2005)