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Breast Feeding and its

associated complications

Dr. Pushpa Singh


Sr. Gynaecologist & H.O.D
Dept of OBGYN
PGIMER & Dr. RML Hospital
New Delhi

Why Breastfeed?
Literature is replete with scientific evidence on the benefit of
the most natural process of a motherbreast feeding her baby
Exclusive breast feeding in the first six months of life can cut
down under-five child mortality by

13-15%
There could not be more compelling reasons for
breastfeeding the baby.

Advantages

Baby

Mother

Family

Advantages to the baby


Decreased incidence of infections- diarrhea,
RTI, otitis media, NE, late onset sepsis in pre
term
Reduction of both Type I and II diabetes,
leukemias, lymphomas, asthma and obesity.
Enhances performance on cognitive
development

Advantages to the mother


Involution of uterus and haemorrhage
Postnatal amenorrhoea
Decrease risk of breast and ovarian
malignancy
Decreased risk of hip fracture after
menopause

Advantages to the family


Readily available
Hygienic
Economical
Keeps children healthy

How is milk produced?


Preparation of breast for milk production
Production of milk
Let down Reflex

The first few steps..


Proper antenatal counseling
A well informed, supportive husband
Relative or nurse in the labour room

How Soon?

At The Earliest
In the healthy neonate suckling reflex is at its
peak- 30 to 40 mins after birth
Early feeds stimulate production of prolactin and
increases the mean duration of breast feeding

The first few steps..


Placed prone on the mothers abdomen
Feed in the 1st hr of delivery
on the labour table itself

Breast Feeding In Operative


Delivery
Maintain skin to skin contact
Breast feeding within 1 hr when LSCS under
spinal anesthesia; otherwise when the effect
of GA weans off.
Women should not have pain, as it decreases
production of milk
Position of baby is important

CARDLE
HOLD

SIDE LYING

POSITIONS
OF
BABY

FOOTBALL
(CLUTCH HOLD)

CROSS
CRADLE HOLD

Latching The Right Technique


Latching on is the creation of a tight seal around nipple
and most of the areola through babys mouth.
Ideally, babys lower lip should be covering more of the
areola than the upper lip and nipple should not hurt after
few min

Frequency And Length Of Breast


Feeding
Exclusive breast feeding for 6 months
On an average 650 to 850 ml milk is produced
per day.
2 to 3 hourly or 8 feeds per day or feed on
demand
Duration time is 25 to 30 min- both breasts
should be fed each time

The Right Technique


Babys head should be always at a higher
level
Correct latching on
Proper sucking and swallowing
Post feed care of baby is important

Indicators Of Adequate Feed


No. of feeds each day (8 or on demand)
If baby sleeps well for 2 to 3 hours after feed
Urine output- 6 to 8 diapers per day
No. of stools- 4 to 5 times per day
Weight gain- 30 gm per day

Care Of Mother
Calorie intake- 300 to 500 extra calories
( 2200 to 3000 kcal per day)
Balance diet and no weight reduction
Fluid intake : 22% from well balanced diet;
increase fluid intake is essential but excessive
consumption can result in reduction of
production of milk( Dusdiekor in 1994)
Iron and Calcium Supplementation

Contra Indications For Breast


Feeding
Maternal:
Acute febrile conditions and critically ill patients
Breast abscess
HIV +ve mother
Open cases of pulmonary TB
Anti thyroid drugs
Anti cancer drugs
Hepatitis A
Following radio pharmaceuticals

Contra Indications For Breast


Feeding (Contd.)
For baby:
Breast milk jaundice
Cleft lip or palate
Oromotor dysfunction
Pre-maturity
Under weight

GALACTOGOGUES
There is no ideal galactogogue
Chlorpromazine and metoclopromide- 10 mg 3 times
daily for 7 days
Garlic, ginger, coconut, jaggery, ghee, panjeeri,
saunth, khas-khas, bajra, pepper etc
Self confidence, freedom from anxiety, soothing
environment with vigorously sucking by an active
baby are the most effective pre-requisites for
successful establishment of lactation.

SUPPRESSION
Estrogen
Bromocriptin
Cabgolin
Thiazide
Pyridoxine
OCP
Testosterone

Lactation Complaints
Insufficient Milk Syndrome
Retracted nipples
Sore nipples
Breast engorgement
Mastitis
Breast abscess
Choice of contraception
Problem of working women

RETRACTED NIPPLE
Antenatal examination and counseling for cleaning
of nipples and their aversion is important
20 cc syringe may also be used for correcting
retraction
Nipple shield
Use of breast pump

SORE NIPPLE
Commonest
Cause improper latching
Symptoms: pain
Signs: nipple is red, cracked, bruised, blistered
and tender
Treatment: linolin/ emolient cream; air drying and
applying own milk, nipple shield for time being,
EBM

ENGORGEMENT
Swollen breast due to increased
milk production
Maybe early or late
Early engorgement resolves with baby sucking
Painful, swollen, warm, hard or rigid breasts needs
treatment
Treatment: gentle massages, warm compresses,
milk expression, breast support, oxytocics, NSAID

Mastitis And Breast Abscess


Pain, fullness, fever with or without chills,
swollen, red, tender breasts
Treatment: broad spectrum antibiotics,
anti-inflammatory drugs, breast support,
feeding to continue,
Untreated or under-treated neglected cases
may lead to antibioma / abscess formation

Mastitis And Breast Abscess (cont.)


Breast Abscess
High fever with chills
Localized, swollen, red, warm, tender,
indurated mass with fluctuation
Treatment is I&D and supportive therapy
same as mastitis
Breast feeding to be resumed as early as
possible

Milk Expression
Manual or hand expression
Via pump: hand held pumps, mechanical, cylindrical,
battery operated and semi operated pumps
Mechanical, cylindrical pump is safe and easy to use
and can be sterilized, cost effective
Suction generated by battery operated pump can be
regulated to suit the user
EBM stays in good condition in room temp for 8 hrs;
refrigerator 24 hrs or in the freezer at -20 degree
cent for 3 months.

CYLINDER BREAST PUMP

ELECTRICAL BREAST
PUMP

Electrical Breast Pump


Electrical pumping is more effective in raising
maternal prolactin levels and volumes of milk
8 times expression in 24 hrs ( twice at night
and 1 in early morning) is required to keep up
the milk production
Pumping both breasts simultaneously
produces more milk

Pacifier/ Dummies/ Soothers


These should not be used within 4 weeks of age
or until breastfeeding technique is fully
established.
It should not used to delay feeding

WEANING
Aim is to introduce- iron, calcium, vitamins and
calories to baby in adequate quantity through
liquid and semisolid diet from 4 to 6 months of age
It should be done gradually

The nature has designed the provision that


infants be fed upon their mothers milk. They
find their food and mother at the same time.
Its a complete nourishment for them both for
their body and soul
- Rabindranath Tagore

Breast Feeding and its


associated complications
Dr. Pushpa Singh
Sr. Gynaecologist & H.O.D
Dept of OBGYN
PGIMER & Dr. RML Hospital
New Delhi

The nature has designed the provision that


infants be fed upon their mothers milk. They
find their food and mother at the same time.
Its a complete nourishment for them both for
their body and soul- Rabindranath Tagore