BREASTFEEDING
INTRODUCTION
• Breastfeeding is the best natural feeding and breast milk . The basic
food of infant is mother’s milk. Breastfeeding is the most effective way
to provide a baby with a caring environment and complete food . It
meets the nutritional as well as emotional and psychological needs of
the infant. But recently there is tendency to replace the natural means
of infant feeding and introduction of breast milk substitutes . So,
breastfeeding deserves encourage from all concerned in the welfare of
children
DEFINITION
• According to WHO-
“ Breastfeeding is the normal way of providing young infant with
the nutrients they need for healthy growth and development”.
“Breastfeeding is the process of feeding a mother’s breast milk to her
infant , either directly from the breast or pumping out the milk from
the breast and bottle- feeding it to the infant”.
ADVANTAGE OF BREASTFEEDING
• For child –
• Prevents from hypothermia .
• Enhance brain and visual development.
• Help in adequate growth and development.
• Breastfeeding is the safest, cheapest and best protective food for infants.
• Breastmilk is the natural food readily available worm and free from contamination.
• It helps bonding and development.
For mother-
• Protect breast and ovarian cancer.
• Protect obesity and shapes body.
• Reduces post delivery bleeding and anemia.
• Delays next pregnancy.
PREPARATION OF MOTHER FOR BREASTFEEDING
Preparation for breastfeeding must begin in the antenatal period .
Mother craft training should be provided and includes benefits of breastfeeding
which should be given in the prepregnant stage.
In the antenatal period , examination of breast and identification of problems,
like retracted nipple should be done with necessary advice for intervention.
Adequate diet in prenatal period should be consumed in terms of energy and
nutrients.
Antenatal counseling , family support , mother support group also should be
emphasized as the preparation of mother for breastfeeding.
INITIATION OF BREASTFEEDING
Breastfeeding should be initiated within first half an hour to one hour of birth or as soon as
possible.
It should also be initiated within one hour even after cesarean section delivery, if the mother and
baby , both are having no problem.
Early suckling provides warmth, security and ‘colostrum’, the baby’s first immunization.
Although little in amount , the first milk , colostrum , is most suitable and other nutrients , the
baby needs.
It is rich in anti- infective factors and protect the baby from respiratory infection and diarrheal
disease.
Mothers should be demontrated about the techniques of breastfeeding .
Mother should be advised for exclusive breastfeeding up to 6 month and as demand feeding.
No food or drink other then breast milk should be given to neonates. No bottle and pacifier are
allowed.
INDICATORS OF ADEQUACY OF BREAST FEEDING
• Adequacy of breastfeeding is indicated and established by the following:-
Audible swallowing sound during the feed.
Let down sensation in mother’s breast.
Breast is full before feed and softer afterward.
Wet nappies 6 or more in 24 hours.
Frequent soft bowel movement, 3 to 8 times in 24 hours.
Average weight gain of 18 to 30 gm /day .
Baby sleeps well and does not cry frequently.
Baby has good muscles tone and healthy skin .
NOTE:- Passage of urine 6 to 8 times per day and average weight gain are considered as
most important criteria.
PHYSIOLOGY OF LACTATION
• Lactation can be divided into 5 stages:-
• 1- Mammogenesis- Development of breast to a functional state.
• 2- Lactogenesis- Synthesis and secretion of milk from the breast alveoli.
• 3-Galactokinesis- Ejection of milk outside the breast.
• 4-Galactopoiesis- Maintenance of lactation
• 5- Involution- Regression and atrophy post lactation.
•
• (1) Mammogenesis-
Growth of ducts and lobuloalveolar system.
This starts from birth to puberty and continues in pregnancy.
Ductal sproutong predominates in 1st trimester and 2nd trimester hence the breast will contain more
glandular epithelial cells than stroma.
Just before the during parturition there is a new wave of mitotic activity causing growth and maturation.
HORMONAL INFLUENCE DURING MAMMOGENESIS
• Progesterone - cause increased growth pf alveoli size and lobes.
• Estrogen- Stimulates milk duct system to grow and differentiate, deposition of fat .
• Prolactin- Contributes to increased growth and differentiation of the alveoli and ductal structures.
•
• (2) Lactogenesis-
• (Stage 1st) : Occurs in mid pregnancy
There is initiation of milk synthesis.
Alveoli differentiates into secretory cells and prolactin stimulates mammary secratory cells to
produce milk.
Insulin and serum growth factors induced cell division of stem cells of the gland and presence of
cortisol for formation of alveoli is required for induction of milk synthesis .
• Stage -2)from late pregnancy to day 8.
This is triggered by rapid drop in progesterone levels after placental delivery .
Required the presence of elevated levels of prolactin and cortisole , insulin , growth hormone and
parathroid hormone to facilitate mobalization of nutrients and minerals.
There is a switch from endocrine to autocrine control.
(3)Galactokinesis-
Depends on the suckling mechnism of the baby and the contractile action which will express milk from
the alveoli into the ducts .
This contraction is brought about by the action of Oxytocin.
Milk let down reflex/milk ejection reflex .
Inhibited by psychic condition / pain / breast engorgement.
4)Galactopoiesis-
Prolactin is the hormone for maintenance od lactation .
And suckling is essential for maintenance of milk secretion .
Periodic breast feeding relieves pressure in the ducts and promotes more secretion .
Controlled by autocrine system .
(5)Involution-
Apoptotic cell death and tissue remodelling post lactation .
Requires a combination of lactogenic hormone deprivation and local signals to
undergo regression and atrophy.
TECHNIQUES OF BREASTFEEDING
Mother should be comfortable and relaxed physically and mentally before giving breast feeding.
She should wash her hands.
She can have a glass of water or milk.
Mother should have no due work in her hands.
Baby should be clean and dry before feeding.
Correct positioning of mother and baby is an important.
(1) Cradle Position- Your baby’s will be on his or her side , facing your chest. His or her head will
rest on your arm , and your forearm will gently support your baby’s back. A pillow is helpful ,
especially with smaller babies , but not a necessary.
(2) Cross cradle position- Same of cradle position but just the opposite hand was used to support
the infant and the same side hand was used to hold the breast.
INDICATIONS
• To learn latching .
• To maintain comfortness of mother.
(3) Side lying position- Mother and baby lie down together , facing each other.
This is a very restful position and can even allow mom to sleep while nursing her
child, so it is a particularly useful position at neight.
Indications-
• Cesarean birth.
• Uncomfortable siting.
(4) Football holding position- Baby is tucked under one arm , off to the side
( like a football). Hold baby with one arm while the hand supports your breast.
Indications-
• Cesarean birth
• To see the latch on position
• Large breast
• Small baby
• Infant is sleepy
(5) Laid back position- The laid back breast feeding position is also
referred to as biological Nurturing . The mother lays back against
pillowa so she is slightly inclined . Her baby will lay against her chest.
Gravity holds the baby in place so mother and baby can relax
CONTRAINDICATIONS OF
BREASTFEEDING
• For child-
• If the infant has been diagnosed with galactosemia.
• Phenylketonuria- may have partially breastfeed.
For mother-
• Mother addicted to drugs.
• Mother drinks more than minimum.
• Mother infected with HIV.
• Mother have active untreated tuberculosis , T- cell lymphotrophic virus type 1 or 2.
• Mother is receiving diagnostic or therapeutic radio active isotopes or has had exposure to
radioactive materials.
• Mother is taking certain medications , anticancer therapy etc.
• Mother is Hepatitis B surface antigen positive.
• Mother is abusing drugs
COMPLICATIONS OF BREASTFEEDING
Breast Engorgement
Cracked and sore nipple
Plugged Duct
Mastitis
Breast abscess
Breast cancer
Breast pain
LATCH ON TECHNIQUE
L- Latch
A- Audiable
T- Types
C- Comfort
H- Hold
Mother hold the baby in upright position on her lap.
Mother is wide open and the chin touches the breast.
Mother guide the nipple and areola into the baby’s mouth for effective milk
transfer.
Persistaltic action from the tip of the tongue to the base.
• Signs of a good latch -
Every time you breastfeeding your baby check that-
His chin is touching your breast and he can breath through his nose.
His mouth is open wide and he has a mouthful of you areola .
He starts with short sucks brfore sucking more slowly and deeply.
The latch is comfortable and pain free .
Your baby’s lips turn out.
Your baby’s chest and stomach rest against .
Your body , so that baby’s head is straight , not turned to the side.
BREASTFEEDING PATTERNS ON
DURATION
Depends mainly on-
• Baby’s needs
• Baby’s size
• Baby’s sucking strength
• Mother’s milk supply
First feed- Normal delivery- 1/2 - 1 hours
Cesarean section- 4- 6 hours
Demand feeding - The baby is put to the breast as soon as the baby becomes hungry.
There is no restriction of the no. of feed and duration of suckling time.
Duration of feed- The initial feeding should last for 5-10 min at each breast.
• Thereafter, the time spent is gradually increased. Baby is feed from one breast
completely so that baby gets both the fore milk and hide milk .
•
• Amount of feed-
• First day 60 ml/kg/24 hours.
• Third day 100 ml/kg/ 24 hours.
• Tenth day 150 ml /kg/24 hours .
However the baby can take as much as he wants.
Feeding at frequent intervals about 6-8 times a day.
