Introductio

n
▶ Breastfeeding is the optimal source of nutrition.
The Human Milk is species specific and it
provides all the essential nutrients
necessary for the growth and development of
the newborn infant.
Breast Anatomy -
Structure

fat
Prolactin
Reflex
Secretion continues
AFTER feed to
produce NEXT
feed

To increase milk productions

 Pituitary releases
prolactin and oxytocin.

Stimulation of Hormones travel

nerve via
endings in bloodstream
mother’s to mammary gland
nipple/areola to stimulate milk
sends signal production and
to mother’s milk ejection
hypothalamus/ reflex (let-down).
pituitary.

Infant suckles
at the breast.
Oxytocin
Reflex

For milk
Helping and Hindering
Oxytocin
the
Reflex

For milk
Inhibitor in
Breastmilk
Attachment at
Breast
Mechanism of
‘Suckling
Cycle’
What Differences Do You
See?
Picture Picture 2
1

GOOD
POOR
ATTACHMENT
ATTACHMENT
What Differences Do You
See?
Picture Picture 2
1

ATTACHMENT,
OUTSIDE
Consequences of
Poor Attachment
 Pain and damage to nipples Sore nipples
Fissures

 Breast milk not removed effectively Engorgement

Baby unsatisfied,
wants to feed a lot
Apparent poor milk supply
Baby frustrated,
refuses to suckle
Breasts make less milk
Baby fails to gain
weight
Causes of Poor
Attachment
Use of feeding  before breastfeeding established
bottle  for later supplements
 first baby
Inexperienced  previous bottle feeder
 small or weak baby
mother  nipple poorly protractile
 engorgement
Functional  late start
Lack of skilled  less traditional help and
support
difficulty community support
 doctors, midwives, nurses not
trained to help
 Feeding
Reflexes Rooting reflex
When
something
touches lips,
Sucking reflex
baby opens mouth
puts tongue down When something
and forward touches palate baby
sucks
Skill
Mother learns to position baby
Baby learns to take breast

Swallowing reflex
Gag reflex When mouth fills with milk,
When something touches baby swallows
anterior part of the tongue,
baby pushes it out.
 Types and
Composition of Human
▶ Breast
Types ofMilk
Breast Milk:
▶ Colostrum or
Early Milk
▶ Transitional Milk
▶ Mature Milk
▶ Colostrum or Early Milk is produced in the late stage of
pregnancy till 4 days after delivery; and is rich in antibodies.

▶ Transitional Milk produced from day 4 – 10 is lower in protein

in comparison to Colostrum.

▶ Mature milk is produced from approximately ten days after

delivery up until
the termination of the breastfeeding.
Nutrients in Human & Animal 1/4
Milk
What are the differences between
these milks?
Differences in the Quality of 1/5
the Proteins in Different
Milks
 Differences in the Fats
of Different Milks
HUMAN COW`
S

Contains
Contains
Essential Fatty Acids,
No Essential Fatty Acids
Enzyme
No Enzyme Lipase
Vitamins in Different 1/7
Milks
 1/8
Iron in
Milk
Types and Composition of Human
Breast Milk (Cont’d)
▶ Fat - The main lipids found in human milk are the
triglycerides phospholipids and essential fatty acids.

▶ Protein – Whey ; lactoferrin, lysozymes,

immunoglobulin A , lactalbumin, Casein; lower
concentration in human milk.

▶ Carbohydrate – Include lactose and

oligosaccharides.

▶ Leukocytes - Include neutrophils, marcrophages ,

lymphocytes.

▶ Non protein nitrogen – urea, uric acid

▶ Other constituents : steroid hormones, peptides,

insulins, growth factors, minerals, vitamins, lipase.
 Mechanism of Protection 1/9
Against Infection

When White cells in

Mothe mother’s body
r make
infecte antibodies to
d protect her
Some white
These cells go
antibodies are to her breast
secreted in and make
breastmilk to antibodies there
 Storage of Breast
▶ Milk
Human milk can be stored at room
temperature for 4
hours.

▶ Expressed milk can be stored in

refrigerator for 24hours.

▶ Breast milk can be stored in the freezer at

-200C for about 3 months
 Achieving Optimal
Breastfeeding
▶ Activities, attitudes and procedures during the
delivery and post partum period have an
impact on breastfeeding

▶ There is well documented evidence soon

after
delivery starting breast feeding provides skin
to skin
contact between infant and mother, helps to
maintain the body temperatures, reduce risk
of
hypoglycemia, enhance oxytocin
release and beneficial
nutrition with intake of colostrum

▶ Skin to skin contact should occur for

 Achieving Optimal Breastfeeding
(Cont’d)
▶ Breastfeeding should be started
and fully established before
discharge from the hospital

▶Physicians and health care

professionals should
observe at least one feeding and ensure
this is done properly and breast milk
is produced

▶Lactation specialist should also work

with
parents that are having difficulty with
breast feeding.
 Signs of Effective
Breastfeeding
▶ Frequent feedings 8-12 times daily.

▶ Intermittent episodes of rhythmic sucking with audible

swallows should be heard while the infant is nursing.

▶ Infant should have about 6-8 wet diapers in a 24 hour

period once breast feeding is established.

▶ Infant should have minimum of 3-4 bowel movements

every 24 hours.

▶ Stools should be about one tablespoon or larger and

should be soft and yellow after day 3.

▶ Average daily weight gain of 15 -30g.

 Good Breastfeeding

Techniques
The baby should be properly positioned to achieve effective
latching
▶ The mother should wear comfortable apparel, with the breast
well exposed for the infant to be able to latch.

▶ The infant’s mouth, chin and umbilicus should be lined up

with the head in a neutral position.

▶ The infant is brought to the breast, with the nose touching or

close to the
breast.

▶ The gum line should overlap the areola, and the nipple
straight back into
the mouth.

▶ The tongue moves forward beyond the lower gum, cupped

and forming a reservoir.
Breastfeeding
Positions
Cradle Hold

▶ This is the most

common position
used by mothers.

▶ Infant’s head is
supported in the
elbow, the back
and buttock is
supported by the
arm and lifted to
the breast.
Breastfeeding
Positions
Football Hold Position
▶ The infant’s is placed
under
the arm, like
holding a football

▶ Baby’s body is
supported
with the forearm and
the
head is supported
with the hand.

▶ Many mothers are

not
comfortable with
this position
 Breastfeeding
Positions
Side Lying Position

▶ The mother lies on her side

propping up her
head and shoulder
with pillows.

▶ The infant is also lying

down facing the
mother.

▶ Good position after

Caesarean section.

▶ Allows the new mother

some rest.
 Breastfeeding
Positions
Cross Cradle Hold
Position

▶ Ideal for early

breastfeeding.

▶ Mother holds the baby

crosswise in the crook of
the
arm opposite the
breast the infant is to
be fed.

▶ The baby's trunk and

head are
supported with the
forearm and palm.
Breastfeeding
Positions
Australian Hold
Position

▶ This is also called

the saddle hold

▶ Usually used for

older infants

▶ Not commonly
used by mothers.

▶ Best used in older

infants with runny
Can You Identify the
positions??
 Benefits of
Infant
Breastfeeding to
▶ Helps in Gastrointestinal development and function
s
▶ Helps in development of the immune system

▶ Helps in cognitive development of the infant

▶ Infants who are breastfed have reduced risk of infection
compared to
formula fed infants.
 Benefits of
Breastfeeding to Infants
▶ Breastfed infants have reduced risk of
obesity later in life compared to
formula fed infants.

▶ Reduced risk of sudden infant

death syndrome, Hodgkin's
lymphoma, Leukemia and non
insulin dependent Diabetes.

▶ Lower risk of infections e.g.

otitis media, Lower respiratory
tract infection, Diarrheal diseases,
 Benefits of
Breastfeeding to Mothers
▶ Enhance early maternal – infant bond.
▶ Aids involution of the uterus.
▶ Long term breastfeeding helps in loss of the excess
weight acquired during pregnancy.
▶ Prolonged Breastfeeding prolongs anovulation.
▶ Documented long term effect of breastfeeding include
reduced risk of breast, ovarian and endometrial cancers.
Socio-economic
Benefits of
Breastfeeding
▶ Income savings
▶ Reduced risk of infections and diseases
hence reduced hospital visits and
attendant medical cost.
▶ Mothers are more economically productive
since they will spend less time caring
for a sick child.
Advantages of
Breastfeeding (contd.)
Mother Society
Family
 Reduces post  Eco-
delivery  Low cost friendly
bleeding and
anemia involved  Human
 Delays resource
 Less
next developm
pregnanc illnesses en t
y
 Family  Economy
 Protects
developm
breast
and
bonding en t
ovarian
cancer
Barriers To
Effective
Breastfeeding
▶
▶ Lack
Beliefofthat breast milk is not sufficient
confidence in
mother
▶ Lack of adequate support system

▶ History of previous breast surgery

▶ Breast engorgement, cracked and

sore nipples

▶ Retractile nipples
Barriers To Effective
Breastfeeding

▶Embarrassment by
mother
▶Jealousy by siblings

▶Chronic illness in
mother; psychosis,
Cancer.
Contraindication to
Breastfeeding
▶ Neonatal conditions-Inborn error of
metabolism; galactosemia,
phenylketonuria.
▶ Maternal conditions-
 Mothers on certain medications ;
anticancer therapy, radioactive
isotope, antithyroid drugs, MAO
inhibitors, lithium, gold
salt,ergotamine etc.
 Psychosis(untreated)
Role of the
Nurse
▶ Provide education about
breastfeeding at first prenatal visit

▶Physical exam should include breast

exam

▶ Ensure rooming-in after delivery

▶ Ensure breastfeeding is started and

established before discharge after
delivery.

▶ Observe at least a session of

RECOMMENDATI
ONS
▶ Exclusive breast feeding
until 6 months of age

▶ Introduce complimentary
foods with continued
breastfeeding

▶ Optimum to breastfeed
for 2 years or longer
HARMFUL EFFECTS
OF
FORMULA MILK
Why some mothers
choose formula vs.
breast milk
▶ Distressed by physical discomfort of early
breastfeeding problems.
▶ Convenience issues

▶ Pressures of employment/school

▶ Worries that breast shape will change

▶ Formula manufacturers manipulate through

people their
through ads
▶ Doctors and nurses need more lactation
training
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 Why some mothers
choose formula vs.
▶ Moms given very little time to adjust to
breast
changes of milk
postpartum

▶ Family demands

▶ Non-supportive family/health
professionals

▶ Embarrassment

▶ Lack of confidence in self

▶ Feeling that one cannot produce enough

www.dreamstime.com/
Mother’s milk vs. formula
milk
▶ Formula milk for 3
days old babies is no
different than
formula milk for 3
months old infants.

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▶ Breast milk is
ingeniously different
every single day;
adapted to the
changing needs of
the baby.

breastfeeding.8k.com/
Mother’s milk vs. formula
milk

▶ Human milk is designed

to support the
development of large
brains, capable of
processing and storing
lots of information.
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w
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.
b
a
▶ Cows milk is b
y
designed to m
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Illness Relative
risk
▶ Allergies, eczema 2 to 7 times
▶ Urinary tract infections 2.6 to
5.5 times
▶ Inflammatory bowel disease
1.5 to 1.9 times
▶ Diabetes2.4 times
▶ Gastroenteritis 14 times
▶ Hodgkin's lymphoma 1.8 to 6.7
times
▶ Otitis media 2.4 times
▶ Haemophilus influenzae
meningitis 3.8 times
▶ Necrotizing enterocolitis 6 to
10 times
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Illness Relative
risk
▶ Pneumonia/
lower
respiratory
tract
infection 4
times
▶ Respiratory
syncytial virus
infection 3.9 times
▶ Sepsis 2.1 times
▶ Sudden infant
death
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syndrome 2.0 lungs1.gif
Barriers to
Bonding
* A Bottle places a
physical barrier
between mom and
baby

*Less skin to skin

contact

*Less eye contact

* The hormonal
connection between
the breastfeeding
mother and baby
cannot be
experienced by the
 Other Options If
Breastfeeding is Not
Possible
Mom can still use her milk,
even if she decides not to
▶ breastfeed:
Use a breast pump
(electric/manual)
▶ Cup or bowl feeding
▶ Spoon feeding
▶ Get milk from donation bank

graphics.iparenting.com/.
../womanpumping.jpg
There is no freedom of choice for
humans if it has been taken
away from them
at the beginning.

Breast-feeding is not a
choice, but an obligation
to the choice,

Give your child the freedom

of choice.
www.13.waisays.com/
image006.jpg
Kangaroo
Mother
Care
Kangaroo Mother
Care
▶ Kangaroo Mother Care (KMC) is a special way of
caring
of low birth weight babies
▶ It fosters their health and well being by
promoting effective thermal control,
breastfeeding, infection prevention and
bonding
▶ In KMC, the baby is continuously kept in skin-to-
skin contact by the mother and breastfed
exclusively to the utmost extent
▶ KMC is initiated in the hospital and continued at
home.
Components of
Kangaroo Mother
Care
▶ Skin to skin contact
▶ Exclusive breast
feeding
Pre-requisite for
KMC
▶ Support to the mother in hospital and at
home
▶ Post discharge follow up
Requirement for
KMC
implementation
▶ Training of nurses, physicians and other staff
• Educational material
•If possible, reclining chairs in the nursery and
postnatal wards
▶ Mother can provide KMC sitting on an ordinary
chair or in a semi-reclining posture on a bed
with the help of pillows
Preparing for
KMC
▶ Arrange a time
▶ Demonstrate her KMC procedure
▶ Encourage her to bring her family
members
KMC
procedure
▶ The baby should be placed between the mother's
breasts in
an upright position
▶ The head should be turned to one side and in a
slightly extended position
▶ This slightly extended head position keeps the airway
open and allows eye to eye contact between the
mother and her baby.
▶ The hips should be flexed and
abducted in a "frog" position; the arms
should also be flexed.
▶ Baby's abdomen should be at the level of the
mother's
epigastrium.
▶ Mother's breathing stimulates the baby, thus
reducing the occurrence of apnea.
▶ Support the baby’s bottom with a sling/binder.
KMC – positioning of the baby
Start kangaroo position as soon as possible after delivery!

01/06/ 20
1
7
▶ KMC can be provided using any front-open, light
dress as
per the local culture

▶ KMC works well with blouse and sari, gown or

shawl.
▶ A suitable apparel that can retain
the baby for extended period of time can
be adapted locally
▶ Baby is dressed with cap, socks, nappy, and
front-open sleeveless shirt or 'jhabala'.
Time of
initiation
▶ KMC can be started as soon as the baby is stable
▶ Babies with severe illnesses or requiring
special treatment should be managed
according to the unit protocol
▶ Short KMC sessions can be initiated during
recovery with ongoing medical treatment (IV
fluids, oxygen therapy)
▶ KMC can be provided while the baby is being
fed via oro-gastric tube or on oxygen therapy
Duration of
KMC
▶ Skin-to-skin contact should start gradually in
the nursery, with a smooth transition from
conventional care to continuous KMC
▶ Sessions that last less than one hour should be
avoided because frequent handling may be
stressful for the baby.
▶ The length of skin-to-skin contacts should be
gradually increased up to 24 hours a day,
interrupted only for changing diapers.
▶ When the baby does not require intensive care,
she should be transferred to the post-natal ward
where KMC should be continued.
Criteria to transfer the
baby from nursery to
the ward
 Stable baby
 Mother confident to look after the
baby
 Gaining weight
Discharge
criteria
▶ Baby's general health is good and no evidence of
infection
▶ Feeding well, and receiving
exclusively or predominantly breast
milk.
▶ Gaining weight (at least 15-20 gm/kg/day for at
least three consecutive days)
▶ Maintaining body temperature satisfactorily for at
least three consecutive days in room
temperature.
▶ The mother and family members are confident
to take care of the baby in KMC and should be
asked to come for follow-up visits regularly.
When should KMC
be discontinued ?
▶ When the mother and baby are comfortable,
KMC is continued for as long as possible, at
the institution & then at home
▶ Often this is desirable until the baby's
gestation reaches
term or the weight is around 2500 g
▶ She starts wriggling to show that she is
uncomfortable, pulls her limbs out, cries and
fusses every time the mother tries to put her
back skin to skin.
▶ This is the time to wean the baby from KMC
▶ Mothers can provide skin to skin
contact occasionally after giving the baby a
bath and during cold nights.
Post discharge follow
up
▶ In general, a baby is followed once or twice a
week till 37-40 weeks of gestation or till the bay
reaches 2.5-3 kg of weight
▶ Thereafter, a follow up once in 2-4 weeks may be
enough till 3 months of post-conceptional age
▶ Later the baby should be seen at an interval
of 1-2 months during first year of life
▶ The baby should gain adequate weight (15-20
gm/kg/day up to 40 weeks of post-conceptional
age and 10 gm/kg/ day subsequently)