Breastfeeding is part nutrition and part nurturing. The American Academy of Pediatrics, the American Academy of Family Practice and many other professional organizations recommend breastfeeding for first 12 months, but any amount of breastfeeding is beneficial to your baby.
Breastfeeding has been associated with reduced rates of allergies to cow’s milk and other allergies, asthma, diabetes, high cholesterol, obesity, ear infections, dental caries, infections, constipation, vomiting, diarrhea, deaths from respiratory infections, sudden infant death syndrome (SIDS), and cancer (leukemia and lymphoma). Infants also benefit from appropriate jaw, teeth and speech development as well as overall facial development. Breast milk contains all the nutrients baby needs, regardless of whether your baby was premature or full term.
There are other advantages than the ones listed here. Baby’s suckling releases prolactin, the milk-making hormone, which appears to produce a special calmness in mothers. Breastfeeding offers protection against urinary tract infections. Breastfeeding helps you relax and enjoy special time with your baby while you provide something that no one else can. Breastfeeding saves between $1,200 and $2,100 (civilian prices) a year in formula and supplies. No bottles, formulas, nipples needed. Breastfeeding is less work: your milk is always available, at the right temperature and ready to use. Night feedings can be accomplished much more easily.
The breast is formed by skin, chest muscles, blood vessels, nerves, fatty tissue and milk-producing tissue. Areola: the dark, circular area surrounding the nipple Montgomery glands – Located under the areola secrete a protective lubricant which prepares the breast for breastfeeding
Milk production begins at birth. Prolactin levels increase. Prolactin stimulates milk cells in the alveoli to produce & secrete milk. Milk reservoirs store your milk Special nerves in the nipple are stimulated as baby sucks Message sent to the brain Once you deliver, hormones stimulate the alveoli to produce milk. Your breasts become engorged
Lactogenesis: 1. Nipple stimulation and sucking stimulates nerve endings in areola and sends messages to the brain 2. The pituitary gland then secretes hormone prolactin, which stimulates milk production, and oxytocin which ***causes the release of milk***
33 32 32 Natural changes in your breast prepare you for breastfeeding. Here are some general suggestions that may help prepare the nipple and breast for proper positioning & good latch-on. However, research has not shown that prenatal breast and nipple preparation prevents or reduces nipple soreness.
34 33 33 Flat or Inverted Nipples may cause challenges with breastfeeding To check for flat or inverted nipples: -Place your thumb above and forefinger below your breast on the edge of your areola and gently compress your areola. This simulates the action of your baby’s mouth on your areola during feeding -The nipple should protrude or stick out. If it flattens or indents, you may have a flat or inverted nipple. This may make breastfeeding difficult because your baby cannot grasp enough of your areola in her mouth to suckle well. Caution: Stimulation of nipples sometimes causes uterine contractions and could cause premature labor for woman at risk. Discuss this treatment with your obstetrician. Discontinue nipple stimulation if it causes contractions unless you are at 37+ weeks. Breast Shells -These 2 piece plastic dome shaped shells are placed over the areola to draw out the nipple. They work by exerting a continuous, gentle pressure on the areola causing the nipple to protrude through the opening in the inner plastic ring. -Wear these shells in the last trimester of your pregnancy . -Keep area beneath shells dry. You may choose shells that have air holes for increased ventilation. -Continue wearing shells after your baby is born if the nipple problem persists -For a short time after removing the shells, your nipple will protrude more than usual-perhaps enough to help your baby latch on more successfully.
Breastfeeding is also called “nursing.”
Watch for signs that your infant is hungry. When crying occurs, earlier feeding cues have been missed and it is much difficult to feed an infant who is crying.
Be comfortable! -It’s easiest to try breastfeeding first sitting up -Sit in a bed, armchair, or rocking chair. -Place pillows behind your back, under your elbow, and in your lap to support your baby. -You may find that a footstool brings your knees up and makes you more comfortable. - Hold baby at breast level. Support your breasts if they are large and support baby’s head. Support keeps the your nipple from pulling away from baby, making the nipple sore. You should not feel tugging. Use your elbow & forearm on the side the baby will breastfeed from to will support baby’s head, neck & back. Use that same hand to hold baby’s bottom or thigh. Correct Holds: Cradle Hold, Cross Cradle Hold, Football Hold, Side Lying Improper positioning: Can cause of nipple soreness Restricts milk flow Presses back on the areola & breast Incorrect Breast Support “V-hold” or “Cigarette hold” Holding the bottom thigh will help mom to roll baby inward to wrap around her trunk in a C shape Baby’s ear, shoulder & hips will be aligned with his legs Baby’s chin & the tip of his nose should be touching breast Incorrect Body Positioning: Baby lies on his back Baby head turned to the side Baby’s head tipped back away from breast These positions cause pulling & tugging on the nipple which can lead to nipple soreness and injury
21 20 20 Good position for c-section Moms or to doze while breastfeeding
20 19 19 Good position for mothers who had c-section
19 18 18
Your milk “comes in” on average 3-4 days postpartum. Prior to this, the infant is suckling antibody-rich colostrum. Your milk will come in faster by nursing as soon as possible postpartum and nursing frequently. When the milk comes in, breasts can become hard and painful (known as engorgement). This is relieved by breastfeeding. The let-down reflex is stimulated by infant suckling. Let down can be inhibited by fear, embarrassment, and anxiety. “Let down” releases calorie-rich milk essential for infant weight gain. Foremilk is produced between feedings and is high in protein. Calorie-rich hindmilk is released with “let down” and as breastfeeding continues. Using both breasts at every feeding allows for maximum nutrition and continued milk production. During let down, milk may drip from second breast and uterine cramping may occur. If you feel your “let down” between feedings, press inward on the areola to stop the release of milk. Breast pads worn in your nursing bra are helpful to catch milk that leaks out between feedings.
22 21 21 -Always alternate the breast you start with. Babies usually nurse more vigorously at the first breast. This will make sure that both breasts get an equal amount of stimulation. You may use a safety pin on your bra strap to remind you which side to begin with, or palpate your breasts and begin with the side that feels more full. -Cup your breasts with your free hand, supporting it with your fingers underneath and thumb on top.
Babies are born with a reflex that causes them to open their mouths wide when properly stimulated. To stimulate the rooting reflex, brush the baby’s lips gently. If your baby does not open her mouth wide, be patient and keep brushing her lips. Some babies respond more quickly if just their bottom lip is lightly brushed or tickled. Be patient. The baby is learning about breastfeeding just like you are. Wait until baby’s mouth is WIDE open, center you nipple in her mouth and quickly pull her to breast. It is very important that your baby opens her mouth wide and takes in as much of the nipple as possible. This will prevent pain and nipple soreness. Latch-on occurs when the baby compresses the areola and draws nipple into mouth. The infant needs to compress milk sinuses under areola to release milk. If baby grasps the nipple only, the milk sinuses will not be compressed to release milk. Swallowing occurs in response to the presence of milk. Why do nipples get sore? Try the following finger demonstration: Place your index finger in your mouth to the first knuckle and then suck on it. Your tongue rubs the end of your finger. This is what happens to your nipple when your baby does not get enough of your breast in your mouth. Now, put your finger in your mouth back to the second joint and suck as before. This time there is no rubbing. The tongue comes up under the finger, compressing it against the roof of the mouth, and does not touch the end at all. This clearly demonstrates why getting the breast farther back into the baby’s mouth can make the difference between sore nipples and comfortable breastfeeding.
25 24 24 When your baby opens his mouth WIDE (like a yawn) quickly center your nipple in his mouth and pull him toward you with the arm that is holding him. -With a good latch-on, your baby’s lower jaw (which does most of the work of nursing) should be as far back from the nipple as possible. -The baby should be pulled in so close that his chin is pressed into the mother’s breast. -his nose may be on the breast as well. -Some mothers are afraid to pull their babies this close, because they worry that the baby won’t be able to breathe. But a baby’s nostrils are flared so that he can breathe even when his nose rests against the breast. .
27 26 26 -Babies usually nurse for a total of twenty to thirty minutes at a feeding – 10 to 15 minutes on each breast. But all babies are different -- some nurse for shorter periods, others for longer periods. -The same baby may nurse longer at one feeding than at another -Watery foremilk contains protein while hindmilk contains fat and calories. Only the baby knows if he’s had the right amount of both and is satisfied. -If you need to take you baby off the breast before he is finished, break the suction to avoid damage to sensitive breast tissue.
32 31 31 Andrea – see if you can clean this comic up some – it is hard to see
31 30 30 Before your milk comes in, your baby will get colostrum which provides all the nourishment the baby needs, plus important antibodies to protect him against infections. Your baby is getting enough to eat if: She eats 8-12 times in 24 hours During each feeding, she actively sucks on each breast for 10-15 minutes Adequate wet diapers 2-3 per day by day 3; 6 or more/day by day 6 after birth Stools Baby’s stools will be meconium first day or two After 3 rd or 4 th day, should have about 3 bowel movements per day for the first few months Appearance is generally loose, yellow, and seedy with mild smell As baby gets older stools may decrease in frequency Weight gain Initially, all babies a bit of birth weight (5-7%) but should regain it by 2 weeks Baby should gain about 1 pound a month Ask pediatrician about Vitamin D supplementation. The size of a women’s breast have nothing to do with how much milk her body can make. To maintain your milk supply, empty your breast at regular intervals. To maintain milk supply, you must have repeated stimulation of the nipple and areola to produce prolactin and oxytocin. The more you breastfeed, the more milk you will produce.
Your baby may need fluoride drops. Consult your pediatrician for advice. Your breast milk may be deficient in vital nutrients that your baby needs if you are not eating a healthy diet. Also, breastfeeding can deplete your body of calcium and iron if not consuming enough in your diet.
It is important to take care of your breasts, especially the nipple area. If you experience tenderness or soreness, contact your obstetrician, lactation consultant or the baby’s pediatrician for advice.
26 25 25 Can occur with improper positioning or latch Make sure infant has breast deeply in his mouth throughout feeding Use pillows to support infant Breast Shells: These 2 piece plastic dome shaped shells allow air to circulate around the nipple and may help if sore nipples are a problem. Consult La Leche League or the hospital’s lactation consultant if you need help.
36 35 35 Engorgement: This is caused by additional blood that has rushed to the breasts in order to assure adequate nourishment for the new baby, and some swelling of tissues. Breasts may feel like they will burst. Treatment: Nurse baby frequently -- emptying the breasts will relieve the congestion Use warm showers. May alternate between heat packs and ice packs Gentle breast massage -- with the palm of your hand, gently stroke the breast downward toward the nipple. This is most effective when done under a shower or while leaning over a bowl of warm water If engorgement causes the nipples to flatten and you are having difficulty latching your baby on, you may try pumping or hand expressing some milk first to relieve the fullness Breast shells can also be used between feedings to draw out flat nipples Sometimes placing a cold washcloth or ice pack on your nipple will help bring it out.
39 38 38 May be caused by improper positioning, infrequent nursings, supplementary bottles, overuse of pacifier, bras that are too tight or other restrictive clothing. Treatment: Change positions at each nursing: Lie down, sit up, switch from rocking chair to the sofa to a lounge chair. A variety of positions will give your baby a better chance to reach all of the milk ducts and keep them emptied Lean over to Nurse: Get up on your hands and knees and lean over to nurse, with your breasts hanging freely from the rib cage. This allows a plugged duct to be opened more easily. While this position may not be the most comfortable for you, it can allow a plugged duct to be opened and keep the inflammation from progressing to mastitis.
42 41 41 Nurse frequently- Mastitis will not harm baby and the infection will clear up more quickly when the breast is kept empty. Also, antibiotics in your milk will protect your baby from the bacteria that may be causing the infection Antibiotic Therapy Take all medication as prescribed Be sure your physician prescribes an antibiotic that is safe for nursing mothers Other treatment strategies: Rest! Apply wet or dry heat to area Remove any dried milk secretions on nipple by soaking with plain warm water Take warm showers Nurse on affected side frequently Loosen constrictive clothing, especially your bra After using warm packs or massage, nurse the baby or hand express some milk immediately.
You may need to temporarily suspend breast feeding if you have to take medication that could cause harm to your baby. Ask your doctor about medication effects. Some maintenance shops, paint shops, weapons cleaning areas have organic solvents Some studies show that toxins transfer into breastmilk and cause damage to the infant’s nervous system, liver, or cause cancer. For more information, see Breast Feeding in the Military: part II. Resource and Policy Considerations, Military Medicine, 168, 10:813, 2003, MAJ Michael Bell
When you begin to wean your baby from the breast, do so gradually. This will decrease discomfort for you and be easier for your baby. Substitute a bottle for the breast if your baby enjoys that substitution. If your baby is not interested in a bottle, serve drinks in a sippy cup. As breastfeedings decrease, make sure your baby is getting nutrition from other foods. If you are unsure what foods to introduce, call your pediatrician. Once you’ve decided to wean, be firm. Decide which feeding will be the easiest for your baby to let go of. Keep your baby busy during skipped feeding. Wear clothing that are very difficult to nurse in.
Breastfeeding getting started
Breastfeeding Getting Started [insert presenter info]
Advantages for the Baby <ul><li>Less illnesses, diseases & disorders </li></ul><ul><li>Antibodies in breast milk </li></ul><ul><li>Always the right temperature </li></ul><ul><li>Nurturing benefits from skin to skin contact </li></ul><ul><li>Aids in development of baby’s brain and nervous system </li></ul>
Advantages for Mother <ul><li>Decreased postpartum bleeding </li></ul><ul><li>Earlier return to pre-pregnancy weight </li></ul><ul><li>Delayed resumption of ovulation </li></ul><ul><li>Reduced risk of ovarian cancer </li></ul><ul><li>Reduced premenopausal breast cancer </li></ul>
Anatomy & Physiology During Pregnancy <ul><li>Breast, areola, & nipple increase in size </li></ul><ul><li>Veins may be more noticeable </li></ul><ul><li>Milk glands & ducts increase </li></ul><ul><li>Colostrum is produced in the second trimester </li></ul><ul><li>Montgomery glands become numerous and prominent </li></ul>
How Does a Breast Produce Milk? <ul><li>Milk is made in grapelike structures deep in the breast </li></ul><ul><li>When milk “let’s down” it travels out of the “grapes” down the stems “ducts” and collects in the pools (sinuses) under the dark area (areola) behind the nipple </li></ul><ul><li>Baby’s gums press areola to release milk </li></ul>
Lactogenesis Illustration by Joyce Kopatch, USACHPPM
Before Delivery: Preparing for Breastfeeding <ul><li>Massage breasts and rub nipples gently </li></ul><ul><li>Avoid using soap on nipples </li></ul><ul><li>Expose nipples to air and briefly to sunlight </li></ul><ul><li>Let nipples rub against clothing </li></ul>
Flat or Inverted Nipples <ul><li>Begin treatment late in pregnancy </li></ul><ul><ul><li>Stop if causes uterine contractions </li></ul></ul><ul><li>Breast shells </li></ul><ul><ul><li>Wear 1 hour a day and gradually increase to several hours </li></ul></ul><ul><ul><li>Dry area under nipple often </li></ul></ul>
Is Your Baby Hungry? Infant Feeding Cues <ul><li>Bringing hands to mouth or cheek and trying to suck on them </li></ul><ul><li>Rooting </li></ul><ul><li>Lip smacking, mouthing, tongue protrusion </li></ul><ul><li>Crying is a late feeding cue </li></ul>
Breastfeeding Your Infant <ul><li>Wash your hands </li></ul><ul><li>Position yourself comfortably and correctly </li></ul><ul><li>Use pillows or towels for support </li></ul><ul><li>Uncover the breast you wish to offer first </li></ul>
The Side-lying Position <ul><li>Lie on your side </li></ul><ul><li>Use pillows </li></ul><ul><li>Tummy-to-tummy </li></ul><ul><li>Baby’s mouth in line with nipple </li></ul>Illustration by Joyce Kopatch, USACHPPM
The Football Position <ul><li>Baby’s legs are under your arm </li></ul><ul><li>Use pillows </li></ul><ul><li>Helpful for baby’s who are having trouble latching on </li></ul>Illustration by Joyce Kopatch, USACHPPM
The Cradle Position <ul><li>Tummy-to-tummy </li></ul><ul><li>Baby’s head in crook of your elbow </li></ul><ul><li>Shoulders, hips, in straight line </li></ul><ul><li>Level with breast </li></ul><ul><li>Pillow in lap will help </li></ul>Illustration by Joyce Kopatch, USACHPPM
Milk Ejection Reflex “Let Down” <ul><li>Tingling sensation in breast </li></ul><ul><li>Relaxed feeling occurs </li></ul><ul><li>“Let down” can occur between feedings </li></ul>
Offering Your Breast to Baby <ul><li>Fingers underneath, thumb on top of breast </li></ul><ul><li>Fingers well behind areola </li></ul>Illustration by Joyce Kopatch, USACHPPM
Rooting Reflex and Latch-On <ul><li>Position baby correctly at breast with mouth directly in front of nipple </li></ul><ul><li>Use nipple to tickle baby’s lips until mouth opens wide </li></ul><ul><li>Support baby’s head </li></ul><ul><li>Baby’s mouth is open wide enough to take in nipple and most of areola </li></ul>
Open wide… <ul><li>Quickly center your nipple in his mouth and pull him toward you </li></ul><ul><li>Baby’s lower jaw far back from the nipple </li></ul><ul><li>Baby’s chin on breast </li></ul><ul><li>Nose may be on breast </li></ul>
Coming off the breast <ul><li>Watch baby for cues that he is finished </li></ul><ul><ul><li>May spontaneously come off the breast </li></ul></ul><ul><ul><li>May fall asleep </li></ul></ul><ul><li>Allow baby to determine when he is done </li></ul><ul><ul><li>Foremilk and hindmilk </li></ul></ul><ul><li>If you need to stop the feeding early, break suction by inserting finger into corner of baby’s mouth </li></ul>
Is baby getting enough to eat? <ul><li>Baby feeds frequently </li></ul><ul><li>10-15 on each breast per feeding </li></ul><ul><li>Adequate wet diapers </li></ul><ul><li>Adequate stools </li></ul><ul><li>Baby is gaining weight </li></ul>
Nursing Mothers: Stay Well Nourished <ul><li>Follow same healthy diet you ate while pregnant </li></ul><ul><li>Breast feeding burns 300-400 additional calories per day </li></ul><ul><li>If you are not well nourished, your supply of breast milk may decrease </li></ul>
Breast Care <ul><li>Sore or cracked nipples </li></ul><ul><li>Engorgement </li></ul><ul><li>Plugged Ducts </li></ul><ul><li>Mastitis </li></ul>
Preventing Sore or Cracked Nipples <ul><li>Properly position infant </li></ul><ul><ul><li>Use pillows </li></ul></ul><ul><ul><li>Check for good latch on </li></ul></ul><ul><li>Do not use ointments or creams </li></ul><ul><li>Express a few drops of milk onto nipple after feeding (antibacterial properties) </li></ul><ul><li>Allow nipples to air dry </li></ul>
Engorgement <ul><li>May occur between 2nd and 6th day when your milk “comes in” </li></ul><ul><li>Occurs more frequently in first-time mothers </li></ul><ul><li>Hang in there! This will go away after a day or so. </li></ul>
Plugged Ducts <ul><li>Tender spot, redness, or sore lump in breast </li></ul><ul><li>Milk is unable to flow through duct leads to inflammation </li></ul><ul><li>Change feeding positions from time to time </li></ul>
Mastitis <ul><li>Occurs when plugged duct is not treated </li></ul><ul><li>Flu-like symptoms (tired, aches, fever) </li></ul><ul><li>Start treatment immediately </li></ul><ul><ul><li>Contact physician for antibiotics </li></ul></ul><ul><ul><li>Apply heat </li></ul></ul><ul><ul><li>Breastfeed frequently </li></ul></ul><ul><ul><li>Rest </li></ul></ul>
REMEMBER Getting breastfeeding correct from the start is crucial to long-term breastfeeding success!
Reasons to Suspend or Avoid Breastfeeding <ul><li>Treatment with a medication that transfers into the breast milk </li></ul><ul><li>Level of risk to environmental exposures at duty station or in the field </li></ul><ul><ul><li>Solvents </li></ul></ul><ul><ul><li>Chemicals </li></ul></ul><ul><ul><li>Fuels </li></ul></ul>
Weaning <ul><li>Wean gradually </li></ul><ul><li>Substitute a bottle or serve drinks in a sippy cup </li></ul><ul><li>Ensure adequate nutrition for baby </li></ul><ul><li>Be firm in your decision </li></ul>
Acknowledgements Ms. BethAnn Cameron, MS, CHES Health Educator Directorate of Health Promotion and Wellness US Army Center for Health Promotion and Preventive Medicine Ms. Cindy Plank Health Educator General Leonard Wood Army Community Hospital Fort Leonard Wood, Missouri Wellness Center Martin Army Community Hospital Fort Benning, Georgia