Breastfeeding & Lactation

Benefits – Infant Health

COLOSTRUM
✓ Small amount for the immature digestive
system
✓ ‘paints’ the digestive tract
✓ Low fat for easy digestion
The milk comes in
✓ Transitional milk for up to 2 weeks
➢ May still have yellow appearance
➢ Amounts increase quickly as infant hungers and
digestive system matures

✓ Contains mothers antibodies which boost
infants’ immune system
✓ Acts as a laxative to ease passage of
meconium
✓ Mother's" milk making” changes from endocrine
to autocrine system
✓ Mature milk
➢ Supply/demand system engorgement decreases
➢ Properties of fore milk and hind milk present

Lower risk of
✓ Diarrhea, constipation, infection (Ear,
respiratory, meningitis, urinary tract)
✓ SIDS, allergic diseases, chronic digestive
diseases, juvenile onset diabetes
✓ Acute Leukemia, adult obesity
Benefits – Infant Health

Provides immunologic protection while the infant’s Preterm Infants

immune system is maturing ✓ Decreased necrotizing enterocolitis
✓ Antimicrobial agents ✓ Decreased ROP
✓ Anti-inflammatory agents ✓ Decreased infection rates
✓ Immunomodulating agents ✓ Better able to tolerate feedings
✓ Increased IQ rates

Contains long chain polyunsaturated fatty acids that

help the infant’s brain develop – these are normally
provided by the mother in late pregnancy, therefore
preterm infants miss this
Benefits – Mother Health

✓ Less postpartum bleeding

✓ More rapid uterine involution
✓ Weight loss
✓ Decreased premenopausal breast cancer rates
✓ Decreased ovarian cancer rates
✓ Lactational amenorrhea
➢ Should still use progesterone only
contraceptives
➢ Combined contraceptives dry up milk
Lactation Physiology
Breast enlargement
✓ During pregnancy and lactation indicates the mammary glands are
becoming functional
✓ Breast size before pregnancy does not determine the amount of
milk a woman will produce

Hormones during pregnancy

✓ Estrogen stimulates the ductile systems to grow, then estrogen
levels drop after birth
✓ Progesterone increases the size of alveoli and lobes
✓ Prolactin contributes to increasing the breast tissue during
pregnancy
Hormones during breastfeeding
✓ Prolactin levels rise with nipple stimulation
✓ Alveolar cells make milk in response to prolactin when the baby
sucks
✓ Oxytocin causes the alveoli to squeeze the newly produced milk
into the duct system
Lactation Physiology

✓ Alveoli secrete milk and contract when stimulated

✓ Oxytocin stimulates milk secretion and is released
during the ‘let down’ or milk ejection reflex
✓ After let down, milk travels into the ductules,
then to the larger – lactiferous or mammary
ducts
Breastfeeding - Barriers
✓ Early breastfeeding failures deprive infants of the benefits, and leave many mothers disappointed
✓ It is a natural process, but many mothers need a lot of help

Must educate mothers regarding: Breast Pathology

✓ Positioning the baby
✓ Latching on
✓ Normal nipple soreness
✓ Cramping with breastfeeding
✓ How often to feed the baby
✓ Need to wake the baby
✓ Alerting techniques
✓ Rooting & Sucking
✓ Listening for swallows
✓ Preventing engorgement
✓ Nutrition
✓ Supply and demand
✓ Infant cues
✓ Flat/inverted nipples, breast reduction surgery that severed
milk ducts, previous breast abscess, extremely sore nipples
(cracked, bleeding, blisters, abrasions)
Hormonal pathology
✓ Failure of lactogenesis, hypothyroidism
Overall health
✓ Smoking, anemia, poor nutrition, depression
Psychosocial
✓ Restrictive feeding schedules, mother without support system,
not rooming in with baby, bottle supplementing when not
medically required
Others
✓ Previous breastfed infant who failed to gain weight well,
perinatal complication (hemorrhage, htn, infection
Breastfeeding Teaching Methods

✓ With infant in mother’s arms

✓ Consistent information
✓ Repeat information in a variety of ways
✓ Watch the mother feed the baby and help
✓ Let the mother know she may have difficulties at first
✓ Remind mom that baby is learning with her
✓ Praise the mother’s progress, help build confidence
✓ Provide discharge support
Breastfeeding – The Results

✓ Baby gains weight

➢ No more than 7% weight loss
➢ Back to birth weight in 2 weeks
➢ 1oz per day weight gain for the first three months
✓ Mother is comfortable and satisfied
✓ If baby is still loosing weight on the 4th day of life:
➢ Get feeding evaluation
➢ Remember to:
• Fed the baby
• Maintain the milk supply
• Continue breastfeeding
Breastfeeding – Complications

Infants at risk for poor weight gain

✓ Premature (less than 38 weeks)
✓ Difficulty latching on
✓ Ineffective or unsustained sucking
✓ Oral anatomic abnormalities (cleft lip/palate, short frenulum, receding
chin)
✓ Multiples
✓ Jaundice
✓ Cystic fibrosis
✓ Infection
✓ Cardiac disorders
✓ Neurologic problems – downs, hypo or hypertonia
✓ Poor apgars
✓ Long labor
✓ Sleepy, nondemanding, passive temperament
✓ Separation from mother early after delivery
✓ Infants less than 5 lbs
Breastfeeding – Hospital Discharge Support

Mother breastfeed longer if they:

✓ Are confident at hospital discharge
✓ Have a good support system after discharge
✓ Receive follow up after discharge

Upon discharge:
✓ Give written information
✓ Recommend mom to keep breastfeeding record
✓ Give mom phone number for a telephone helpline
✓ Lactation consultant follow-up