BREASTFEEDING

BY:
Dinabandhu Barad
Msc Tutor
Dept. of child health nursing
SNC, SOA, DTU
 INTRODUCTION
 Breastfeeding is the feeding of an infant or young child with
breast milk directly from female human breast via lactation
rather then using infant formula from a baby bottle or
container

 Babies have sucking reflex that enables them to suck and

swallow milk

 Experts recommend that children be breastfed within one

hour of birth, exclusively breastfed for the first 6 months,
and the breast until age two.
WHERE AND HOW
WHERE AND HOW
 PHYSIOLOGY
The physiological basis of lactation is divided into four
phases :

1. Preparation of breasts (mammogenesis).

2. Synthesis and secretion from the breast alveoli (lacto
genesis).
3. Ejection of milk (galactokinesis).
4. Maintenance of lactation (galactopoiesis).
 MAMMOGENESIS
Mammogenesis is the process of growth and
development of the mammary gland in preparation for
milk production. This process begins when the
mammary gland is exposed to estrogen at puberty and
is completed during the third trimester of pregnancy.
 LACTOGENESIS
1. Begins when estrogen and progesterone are withdrawn
following delivery,

2. Prolactin begins its milk secretary activity

3. The secretary activity is enhanced growth hormone,

thyroxine, glucocorticoids and insulin.

4. Milk secretion actually starts on 3rd or 4th postpartum day

 GALACTOKINESIS
MILK LET DOWN REFLEX

Discharge of milk from the mammary glands depends

not only on the suction exerted by the baby during
sucking but also on the contractive mechanism which
expresses the milk from the alveoli into the ducts.
HOW IT HAPPENS
 GALACTOPOEISIS

Prolactin appears to be the single most important

galactopoietics hormone. For maintenance of effective and
continuous lactation, suckling is essential.
 MILK PRODUCTION

A healthy mother may produce about 500-800 ml of milk a day

to feed her infant with about 500 kcal /day
REFLEXES IN THE BABY

1. The rooting reflex

2. The suckling reflex
3. The swallowing reflex
 FACTORS WHICH LESSEN
MILK PRODUCTION
 Dummies, pacifiers, bottles-even one or two feeds.
 Making the baby wait for feeds.
 Giving feeds like sugar water gripe water, honey, breast milk
substitutes or formula, either as pre-lacteal feeds or at
anytime.
 Certain medications for mothers like oral contraceptives or
methergine.
 Painful breast conditions like sore or cracked nipples &
congested breast.
 DRUGS TO IMPROVE
MILK PRODUCTION

Metclopramide (10 mg thrice daily)

Increases the blood volume by increasing prolactin level.
Intranasal oxytocin contracts myoepithelial cells and
causes milk let down
COMPOSITION OF
BREASTFEEDING
 COMPOSITION
COLOSTRUM :
 Is the secretion of breast during the later part of pregnancy
& for 2-4 days after delivery
 It has deep lemon yellow colour as it contain several times
the protein of mature breast milk but less fat & more
minerals.
 It has important immunological factors (antibodies -
IgA)
 It’s alkaline in nature
 COMPOSITION
TRANSITIONAL MILK
During the next two weeks, the milk increases in quantity
and changes in appearance and composition and this is
called transitional milk.
The immunoglobin and protein content decreases while the
fat and sugar content increases.

MATURE MILK
The milk which replaces the transitional milk after 2 weeks
of lactation
 DIFFERENCES
DIFFERENCES BETWEEN COW'S MILK AND BREAST MILK

1. Both contain equal amounts of water.

2. The energy contents are equal approximately 20Kcal/kg/oz ,as 1oz=30
ml of milk
3. Protein : Cow milk contains higher protein approximately 3 folds, its
contents of casein is about 6 folds , while the human milk protein is
mainly whey protein (lactalbumin & lactglobulin ) but 30% casein .
4. Carbohydrates: Human milk 7% which is lactose while cow milk is 4.5%
.
5. Fat: Contents are almost equal but there is qualitative differences ,as
both containing triglycerides (olein ,palmitin & stearin ) but human milk
contain twice of the more absorbable olein .
 DIFFERENCES
DIFFERENCES BETWEEN COW'S MILK AND BREAST MILK

6. Minerals: Cow milk contains much more of all the minerals except
iron &copper &although breast milk iron is low but better absorbed
(bioavailable) and the infant will depend on the iron stores in the
first 4-6 months .

7. Vitamins: Both has large amount of vitamin A, cow milk has low
vitamin C & D ,also human milk has low vitamin D and depends
largely on the maternal nutrition and sun exposure .both milk
contains adequate amount of vitamin B complex so breast fed
infants should receive the daily requirements of vitamin D which is
400 I.U / day .
 DIFFERENCES
DIFFERENCES BETWEEN COW MILK, FORUMULA MILKAND BREAST MILK

BREAST MILK COW MILK FORMULA MILK

WATER Enough Extra needed May need extra

ENERGY Equal Equal Equal

PROTEIN Correct amount easy to Too much difficult to Partially corrected

digest digest
CARBOHYDRATE Lactose – plenty Lactose – less Lactose + Sucrose
oligosaccharides oligosaccharides Lacks lipase
FAT EFAs present No EFAs No Some EFAs added No
Lipase to digest lipase lipase
VITAMINS Adequate depending on Low vitamin A, C and Vitamin / mineral
mom’s nutritional Iron added – usually
adequacy enough

ANTI-INFECTIVE IgA, Lactoferrin, None None

FACTORS Lysozeme, etc
GROWTH FACTORS Present None none
DIFFERENCES
DIFFERENCES BETWEEN COW'S MILK AND BREAST MILK
 TECHNIQUE OF
BREASTFEEDING
 INITIATION
Breast feeding should be started within half an hour of
birth as soon as possible after normal delivery where as in
case of caesarian section delivery, within 4 hours.
TECHNIQUE
 TECHNIQUE
Here are the basic steps for breast feeding:

1.Make sure you’re comfortable and well supported with

pillows. Lean back rather than sit upright

2.Place your baby on your bare chest between your breasts,

facing you.
3.Support your baby behind his shoulders and under his
bottom (hold his head only if he needs it).
SIGNS OF GOOD ATTACHMENT
 POSITIONS
 Baby’s head & body straight.
 Baby’s body turned towards the mother, nose opposite the
nipple.
 Baby’s body touching mother’s abdomen.
 Baby’s whole body well supported not just neck or
shoulders.
 Mother should than support her breast with her finger flat
against her chest wall under her breast.
 POSITIONS
1.Cradle Hold (Tummy to Tummy)

 Sit as straight as possible with a pillow behind you, or sit

on the edge of the bed.
 Cradle your baby in your arm, her tummy against yours
and her head resting in the bend of your elbow. Her ear,
shoulders and hip should be in a straight line.
 Tuck your baby's lower arm out of the way, with her
 POSITIONS
1.Cradle Hold (Tummy to Tummy)
 Support your breast with your free hand; place all of
your fingers underneath it, well away from the
areola.
 Rest your thumb lightly on top of your breast above your
areola.
 Lift your breast upward and lightly stroke your nipple on
your baby's lower lip. As part of the rooting reflex, her
mouth will open wide.
 Pull her quickly onto the breast to latch-on when her
mouth is opened wide, like a big yawn, and her tongue is
down.
 POSITIONS
2.Football hold
 Position your baby so her legs and body are under your
arm, with your hand holding her head (as if you were
holding a football).
 Place your fingers below your breast. Allow your baby to
latch-on while pulling her in close, holding her head
tightly against your breast.
 Keep your baby's body flexed at the hip with her legs
tucked under your arm.
 POSITIONS
The football hold is a good position when:

-You have had a caesarean birth and want to avoid placing

your baby against your abdominal incision.
-You need more visibility in getting your baby to latch-on.
-Your breasts are large.
-You are nursing a small baby, especially if premature.
 POSITIONS
The football hold is a good position when:

-Your baby tends to slide down your areola onto your nipple.
-Your baby is fussy, restless and hard to latch-on.
-Your baby is sleepy. Sitting upright may encourage her to
remain alert for a longer period.
-You have inverted nipples.
 POSITIONS
3 Side lying position
 First, position yourself and your baby on your sides tummy-
to- tummy.
 Bend your top leg and position with pillows
 Place your fingers beneath your breast and lift upward, then
pull your baby in close as she latches-on.
 The side-lying position is an especially good choice for
breastfeeding when:
You must be flat after a caesarean birth with
spinal anesthesia.
POSITIONS
ADVANTAGES OF
BREASTFEEDING
 MATERNAL AND FETAL
MATERNAL FETAL
Reduces the risk of breast cancer, Meets the full nutritional requirement of
ovarian cancer, diabetes, hypertension infant
and heart disease

Promotes post partum weight loss and Reduces the risk of infectious disease
emotional health and illness

Emotional support and bonding Lowers the risk of developing allergic

Prevents post partum hemorrhage and Lowers the rate od sudden infant death
delays ovulation syndrome (SIDS), cancer,
gastrointestinal disrupt
 IMMUNITY
 During breast feeding approximately 0.25-0.5grams per
day of secretory IgA antibodies is passed to the baby via
the milk.This is one of the most important feature of
breast feeding.

 The main target of these antibodies is the

microorganism in the fetal intestine.

 Breast milk also contains several substances such as bile

salt stimulated lipase which protects against amoebic
infection, lactoferrin which binds to iron and inhibits
growth of intestinal bacteria.
 SUDDEN INFANT
DEATH SYNDROME
 Non breast fed babies have worst arousal from sleep at 2-3
months

 This coincides with the peak of incidence of sudden

infant death syndrome.

 The risk of SIDS is doubled among infants whom has been

not breastfeed.
 MENTAL HEALTH
 Breastfeeding for more than 6 months is an independent
predictor of better mental health through childhood and
adolescent.

 The more months the child has been breastfeed they less
likely suffer from depression, dequilent behavior, attention
issues and physiological issues

 Breastfeeding can also improve cognitive function

 HORMONE RELEASE
 Breastfeeding releases oxytocin and prolactin,
hormones that relax the mother and make her feel more
nurturing toward her baby.

 This hormone release can help to enable sleep even

where a mother may otherwise be having difficulty
sleeping.

 Breastfeeding soon after giving birth increases the

mother’s oxytocin levels, making her uterus contract
more quickly and reducing bleeding.

 Pitocin, a synthetic hormone used to make the uterus

contract during and after labor, is structurally modeled on
oxytocin.
 WEIGHT LOSS
 As the fat accumulated during pregnancy is used to produce
milk, extended breastfeeding as least 6 months can help
mothers lose weight.

 However, weight loss is highly variable among lactating

women monitoring the diet and increasing the amount of
intensity of exercise are more reliable ways of losing
weight.

 The 2007 review for the AHRQ found “The effect of weight
breastfeeding in mothers on return-to-pre- pregnancy
weight” was negligible, and the effect of breastfeeding on
postpartum weight loss was unclear.
 LONG-TERM HEALTH
For breastfeeding women, long-term health benefits
incudes:

 Less risk of breast cancer, ovarian cancer, and

endometrial cancer.
 Breastfeeding diabetic mothers requires less insulin.
 Reduced risk of metabolic syndrome.
 Reduce risk of post-partum bleeding.
 Women who breast fed for a longer duration have a lower
risk for contracting rheumatoid arthritis than women who
breast fed for a short duration or who had never breast
fed.
CONTRAINDICATION
OF BREASTFEEDING
 CONTRAINDICATIONS
The true contraindication of the breastfeeding are
galactosemia and phenylketonuria.
The maternal condition which are contraindicated for
breastfeeding can be remembered as ‘REAL’
R: Radiotherapy
E: Ergot therapy
A: Antimetabolites therapy
L: Lithium therapy
 CONTRAINDICATIONS
IN INFANT

1. Gross prematurity of baby or other conditions in which

the newborn cannot suckle.

1. Inborn errors such as phenylketonuria, lactose

intolerance, galactosemia
PROBLEMS IN
BREASTFEEDING
 PROBLEMS
1. Blood stained nipple discharge
2. Painful nipple
3. Breast engorgement
4. Plugged duct
5. Mastitis
 BLOOD STAINED NIPPLE DISCHARGE

 Typically bilateral
 Due to epithelial proliferation
 2nd and 3rd of pregnancy and < 3 months of postpartum
 Self limiting, no treatment needed.
BLOOD STAINED NIPPLE DISCHARGE
 PAINFUL NIPPLES
Causes:
– Improper latching and positioning
– Thrush (candidiasis)
– Symptoms: swollen, hard, warm and painful
Prevention :
– Early and frequent feeds
– Correct the positioning and attachment
– Express your milk when feedings are missed
Treatment:
– Resting the affected nipple
– Hand express some milk to allow for easier latching.
 BREAST ENGORGEMENT
If the baby does not adequately remove the milk from your
breasts, it may lead to breast engorgement.
Begins at the 2nd and 3rd postpartumday
 BREAST ENGORGEMENT
Causes:
– Delayed or infrequent feeding
– Improper latching and positioning
– Symptoms: swollen, hard, warm and painful
Prevention :
– Early and frequent feeds
– Correct the positioning and attachment
– Express your milk when feedings are missed
Treatment:
– Applying and ice bag, breast massage, analgesics
– Hand express some milk to allow for easier latching.
 PLUGGED DUCT
Plugged ducts are an occlusion or plug has occurred in the
milk passageways.
This plug prevents milk from passing through or slower
than usual.
 PLUGGED DUCT
Causes:
– Infrequent feeding and milk stasis
– Inadequate removal of milk from one area of the breast.
– Symptoms: swollen, hard, warm, painful and noticeable lump.
Prevention :
– Early and frequent feeds
– Correct the positioning and attachment
– Express your milk when feedings are missed
– Wear a comfortable, properly fitting bra.
Treatment:
– Warm water packs, breast massage
– Try to move the lump toward the affected nipple to assure drainage
MASTITIS
Breast inflammation
 MASTITIS
Causes:
– Bacteria enter the breast through the nipple.
– Blocked duct obstructs the flow of the milk & distends the alveoli
– cracked or sore nipple.
– Symptoms:
• Painful, red and swollen
• Flu like symptoms
• Tachycardia
• Pyrexia, rigors
• Intense, localized pain
• Red, hot and swollen breast
Treatment:
– Isolation of the mother and baby
– Ceasing the breastfeeding from the affected part
– Express the milk manually or electric pump
– Antibiotic such as flucloxacillin
THANK YOU