BREASTFEEDING

1. BREASTFEEDING

2. 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 breastuntil
age two.

3. INTRODUCTION
"The more we know
about human
breast milk the
more we discover
about its value in
human nutrition
and development”.

4. WHERE AND HOW

5. WHERE AND HOW

6. 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).

7. MAMMOGENESIS

8. 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are withdrawn following delivery,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

9. 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.

10. HOW IT HAPPENS

11. HORMONES INVOLVED

12. GALACTOPOEISIS
Prolactin appears to be the single most
important galactopoietics hormone. For
maintenance of effective and continuous
lactation, suckling is essential.

13. MILK PRODUCTION
A healthy mother may produce about
500-800 ml of milk a day to feed her
infant with about 500 kcal /day

14. REFLEXES IN THE BABY
1. The rooting reflex
2. The suckling reflex
3. The swallowing reflex

15. 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.

16. 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

17. COMPOSITION OF
BREASTFEEDING

18. 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

19. 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

20. 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 .

21. 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 .

22. 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
digest
Too much difficult to
digest
Partially corrected
CARBOHYDRATE Lactose – plenty
oligosaccharides
Lactose – less
oligosaccharides
Lactose + Sucrose
Lacks lipase
FAT EFAs present
Lipase to digest
No EFAs
No lipase
Some EFAs added
No lipase
VITAMINS Adequate depending on
mom’s nutritional
adequacy
Low vitamin A, C and
Iron
Vitamin / mineral
added – usually
enough
ANTI-INFECTIVE
FACTORS
IgA, Lactoferrin,
Lysozeme, etc
None None
GROWTH FACTORS Present None none

23. DIFFERENCES
DIFFERENCES BETWEEN COW'S MILK AND BREAST MILK

24. TECHNIQUE OF
BREASTFEEDING

25. 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.
Rooming in and bedding should be done
with mother and baby to prevent separation
and promote breast feeding.

26. TECHNIQUE

27. TECHNIQUE

28. 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.
Gravity will help keep her in position. It’s best if your baby is awake but not
crying – if she’s crying, calm her first, perhaps by letting her suck your
finger.
1. When calm, your baby will begin to follow his instincts. He’ll start to move
towards one breast. Support your baby behind his shoulders and under his
bottom (hold his head only if he needs it). Let him move to where he’s
trying to go – towards your nipple. He knows where to go. Your job is to
keep him calm. You can help him by moving his whole body a little if
necessary.

29. TECHNIQUE
Here are the basic steps for breast feeding:
4. Your baby will most likely position herself on an angle, with her mouth near
your nipple and her feet supported by your thigh or lap.
4. When your baby is just below your nipple, he’ll dig his chin into your breast,
reach up with an open mouth, attach to the breast and start sucking

30. 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.

31. 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 mouth close to your
breast.
 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. Do not lean over your baby; keep
your back straight, and pull your baby up to your breast.

32. 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.
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.
- 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

33. 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

34. POSITIONS

35. ADVANTAGES OF
BREASTFEEDING

36. MATERNAL AND FETAL
MATERNAL FETAL
Reduces the risk of breast cancer,
ovarian cancer, diabetes, hypertension
and heart disease
Meets the full nutritional requirement of
infant
Promotes post partum weight loss and
emotional health
Reduces the risk of infectious disease
and illness
Emotional support and bonding Lowers the risk of developing allergic
Prevents post partum hemorrhage and
delays ovulation
Lowers the rate od sudden infant death
syndrome (SIDS), cancer,
gastrointestinal disrupt

37. 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.

38. 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.

39. 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

40. 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.

41. 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.

42. 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.

43. CONTRAINDICATION
OF BREASTFEEDING

44. CONTRAINDICATIONS
IN MOTHER
1. Chronic disease such as active TB, leprosy, AIDS etc.
2. Mothers addicted to alcohol or heavy doses of some
drugs.
3. Mothers taking any of the following medications:
radioactive isotopes, cancer chemotherapy agents,
such as antimetabolites, and thyrotoxic agents.
4. Psychosis
5. Local condition like breast abscess, cracked nipples
The mother should give adequate attention to her diet,
personal hygiene and health and should have sufficient rest.

45. 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

46. CONTRAINDICATIONS
Commonly mistaken as contraindication are the
following:
Women who have cesarean deliveries: Initiate
breastfeeding immediately, using a semi-recumbent
position on the side or sitting up.
Women received vaccinations or live with vaccinated
children: Neither inactivated nor live vaccines
administered to a lactating woman or other family
members affect the safety of breastfeeding for the mother
or infant.
Women who take medications: Most medications can be
taken while breastfeeding.

47. CONTRAINDICATIONS
Commonly mistaken as contraindication are the
following:
Women who had breast surgery: breastfeed frequently to
maintain milk supply. If the surgical wound is painful, the other breast can
be used but monitor infant growth because milk supply could be
insufficient.
Women who have hepatitis A: Initiate breastfeeding after infantreceives
immune serum globulin, and then vaccinate at 1 year of age.
Women who have hepatitis B: Initiate breastfeeding after infant receives
hepatitis B immune globulin and first dose of the 3-dose
hepatitis B vaccine series.
Women who have hepatitis C: Hepatitis C is not a contraindicationfor
breastfeeding, but reconsider if nipples are cracked or bleeding.
Women who have pierced nipples: Remove nipple accessories before
feeding to avoid the risk of infant choking.

48. PROBLEMS IN
BREASTFEEDING

49. 1. Blood stained nipple discharge
2. Painful nipple
3. Breast engorgement
4. Plugged duct
5. Mastitis
PROBLEMS

50. 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.

51. BLOOD STAINED NIPPLE DISCHARGE

52. 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.

53. BREAST ENGORGEMENT
If you baby does not adequately remove the
milk from your breasts, it may lead to breast
engorgement.
Begins at the 2nd and 3rd postpartumday

54. 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.

55. 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.

56. 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

57. MASTITIS
Breast inflammation

58. 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

59. THANK YOU