Breast milk and breast feeding are very important steps in newborn babies life.

2. Lecture-6
Prof. Dr. Sunil Natha Mhaske
Dean
Dr. Vithalrao Vikhe Patil Foundation’s Medical College
and Hospital,
Ahmednagar (M.S.) India-414111
Mo- 7588024773
Mail-sunilmhaske1970@gmail.com
Breast feeding

3. Embryology of breast
Mammary Gland-
 Modified apocrine sweat gland.
 Present in both males and females.
 Female =>serves for lactation; secondary sexual character.
 About 4% women have amazia.
 Develops from the integument.
 Arises from the ventral surface of the embryo.
 milk line‐> thickened line of ectoderm
 Ducts and acinifrom ectoderm
 Supporting tissue from mesenchyme
 From nipple ectoderm grows inward 15‐20 solid rods (rudimentary
gland) and bulbous dilation at ends called as alveoli.
 At 5thmonth IU life cords develop.
 At 7/8thmonth hollowing of ducts; differentiated as milk ducts;
depression at site of nipple.
 At 9thmonth alveoli become canalized.

4.  At birth mesenchymal proliferation
causes nipple evertion and areola
becomes pigmented.
 At puberty 15‐20 lactiferous ducts have
15‐20 lobules each.
 Milk line or mammary ridge develops
from base of fore limb i.e. Axilla to hind
limb i.e. groin. Except at the level of
nipple, rest of it gets atrophied.
 Mammary ridge develop at 6thweek of
intrauterine life.

5. Anatomy of the Breast
 Breast is an organ which whose structure reflects its special function:
the production of milk for lactation.
 The epithelial component of the tissue consists of lobules, where milk
is made, which connect to ducts that lead out to the nipple.
 These lobules and ducts are located spread throughout the background
fibrous tissue and adipose tissue (fat) that make up the main mass of
the breast.

6. Physiology of Breastfeeding
 Physiologically, the breast is an organ specialized for milk formation
(lactation).
 Many additional changes are seen in the breast tissue during pregnancy and
lactation due to the changes in hormones during those times.
 A woman’s breasts start getting ready to make milk when she becomes
pregnant.
 Breast changes are caused by four main hormones.
 These hormones cause the ducts and glandular tissue (alveoli) to grow and
increase in size
 The breasts start to make the first milk, colostrum, in the second trimester.
 Milk is produced as a result of interaction between hormones and reflexes.
 During pregnancy and lactation the glandular tissue is stimulated to produce
milk due to various hormonal influences.

7. Two hormones come into play during lactation:
1. Prolactin Reflex (milk secretion reflex):
 Prolactin produced by pituitary gland is responsible for milk
secretion by alveolar epithelial cells.
 When the baby sucks, the nerve ending in nipple carry message to
the anterior pituitary which in turn releases prolactin and that acts on
the alveolar glands in the breast to stimulate milk secretion.
 This cycle from stimulation to secretion is known as Prolactin reflex
or the milk secretion reflex.

8. 2. Oxytocin Reflex (milk ejection reflex):
 Oxytocin is produced by the posterior pituitary.
 It is responsible for contraction of milk glands from the glands into
the lactiferous sinuses and the lactiferous ducts.
 The hormone is produced in response to stimulation to nerve
endings in the nipple by suckling as well as by the thought, sight, or
sound of the baby.

9. Signs of good attachment are-
•Baby mouth wide open
•Lower lip turned outwards
•Baby’s chin touches mother’s
breast
Poor attachment results in-
- Pain or damage to nipple leading
to sore nipple
- Breast milk not removed
effectively thus causing breast
engorgement
- Poor milk supply hence baby is
unsatisfied after feeding
- Breast produces less milk
resulting in frustrated baby and
refusal to suck. This leading to
poor weight gain.

10. Types of Breast Feeding-
1. Exclusive breast feeding-
 Exclusive breastfeeding means that the infant receives only breast
milk.
 No other liquids or solids are given, not even water.
2. Mixed feeding- feeding breast milk along with infant formula, baby
food and even water, depending on the child's age.
3. Expressed breast feeding-Expressing is a way of taking breastmilk
from mothers breast without baby needing to suckle.
4. wet nursing- method of breast feeding in which more than one
woman breastfeed a child women other than the mother of a child is
called wet nurse.
5. Tandem nursing- Feeding two children at the same time who are
not twins or multiples is called tandem nursing.

11. Prelacteal feed is any kind of food except mothers milk provided
to newborn before initiating breast feeding
Feed used:
- Water And Jiggery
- Honey
- Ajwani And Khand
- Sugar Water
- Milk And Jiggery
Hazards of Prelacteal feed:
- Infection
- Contamination
- Allergy, Breast engorgement
- Suckling problems
Prelacteal feed-

12. Expression of Breast Milk
Indications for expression of breast milk .
 Used for relieving breast engorgement .
 Means of feeding working mother’s baby in their absence
 For feeding babies who cannot suckle well.
 To maintain milk production
 For feeding of premature, low birth weight or sick baby.

13. Technique of expression
 Wash hands with soap & water before expression.
 Sit or stand comfortably, and hold the clean container near her breast.
 Put the thumb on her breast above the nipple and areola with first finger on the
breast below the nipple and areola, opposite the thumb
 Press the thumb and first finger slightly inwards towards chest wall.
 Press the breast behind the nipple and areola between her finger and thumb.
 press the lactiferous sinuses beneath the areola.
 Press the areola in the same way from the side, to make sure the milk is expressed
from all segments of the breast.
 Avoid squeezing the nipple as it may hamper the expression.
 Express one breast for at least 3-5 min until the flows slow down and then express
the other side.

14. Storing expressed breast milk -
Place of storage Temperature storage time
In a room 25 °C 77 °F Six to eight hours
Insulated thermal
bag with ice packs
Up to 24 hours
In a refrigerator 4 °C 39 °F Up to five days
Freezer compartmen
t in a refrigerator
−15 °C 5 °F Two weeks
A
combined refrigerat
or and freezer with
separate doors
−18 °C 0 °F Three to six months
Chest or upright
manual defrost
deep freezer
−20 °C −4 °F
Six to twelve
months

15. Breastfeeding positions
1.Side-lying hold
2. Cradle hold position (same arm)
3. Cradle hold (opposite arm)
4. Rugby ball hold-

16. Benefits of breast feeding
To baby:
1. A healthier baby- The incidences of pneumonia and diarrhea is less,
which can be devastating, especially in developing countries.
2. Long-term protection- from type I diabetes, celiac disease and
Crohn’s disease.
3. Lower risk of Sudden infant death syndrome by about half.
4. Weight -no risk of obesity.
5. Breastfed babies have a better antibody response to vaccines than
formula-fed babies.
6. Primary immunization of baby-those babies who gets colostrums they
gets protection against many diseases The antibodies in colostrum
provide passive immunity, while growth factors stimulate the
development of the gut. They provide the first protection against
pathogens.

17. 7. A custom-made supply-
- Formula isn’t able to change its constitution, but breast milk morphs to meet the
baby’s changing needs.
- Colostrum—the “premilk” that comes in after delivery—is chock-full of
antibodies to protect the baby. It’s also higher in protein and lower in sugar than
‘full’ milk, so even a small amount can hold off the baby’s hunger.
- When full milk comes in (usually three to four days after delivery), it is higher in
both sugar and volume than colostrums. The baby needs a lot of calories and
frequent feedings to fuel his rapid growth.
- Mature milk is designed to be digested quickly.
8. Immunity- breastfeeding strengthens the immune system and help improve the
normal immune response to certain vaccines.
9. Breast milk is always available and always at the right temperature.
10. Psychological benefits- breast-fed children are more mature, assertive and
secure with themselves.
11. Breast fed babies have more IQ than other non-breast fed babies.

18. To mother:
1. Breast feeding burns up to 500 calories a day.
2. oxytocin released when baby nurses helps the uterus contract,
reducing post delivery blood loss.
3. breastfeeding will help uterus return to its normal size more
quickly at about six weeks postpartum, compared with 10 weeks if
you don’t breastfeed.
4. breastfeed mothers have a lower risk of postmenopausal
osteoporosis.
5. Breastfeeding mothers have lower risk of premenopausal breast
cancer and ovarian cancer.
1) Breastfeeding baby around the clock no bottles or formula will

19. 6. Breast feed baby will be less often sick , so fewer sick days for
working mother.
7. Bonding with baby.
8. Feeling of important member in family.
9. Ready to feed at any place at proper temperature, no need of
preparation or boiling.
10. Birth control because no menstruation due to exclusive breast
feeding.

20. To family:
1) Better health, nutrition, and well-being.
2) Breastfeeding costs less than artificial feeding.
3) Breastfeeding results in less illness of baby and ultimately lower
medical care costs.
4) Less budget on health.

21. 1) Breastfeeding offers society improved health of children
2) Breast feeding is friendly, does not waste scarce resources or creates pollution.
3) It does not requires no packaging, shipping, or disposal
4) Prolonged lactation helps to promote the spacing of children.
5) Breastfed infants showed a better serum and secretory responses to peroral and
parenteral vaccines than the formula-fed.
6) Breastfeeding reduces the cost of healthcare and the need for costly health services
that must be paid for by insurers, government agencies, or families.
7) Breast-fed babies are less likely to need excessive medical attention as they grow.
8) Food Expense of baby is low leading to Reduced tax burden on communities and
government
9) More Ecological- less use of natural resources (glass, plastic, metal, paper) and also
less waste for landfills.
10) Less Child Abuse because of breastfeeding bonding.
To society

22. Contraindications of breast feeding
Absolute contra indications-
 Active, untreated tuberculosis.
 Human t-cell leukemia virus type 1
 Maternal lead levels greater than 40 micrograms/deciliter.
 Antithyroid drug therapy
 Radioactive compounds therapy
 Chemotherapy drug treatment
 Use of cocaine, heroin, marijuana, amphetamines,
phencyclidine
 AIDS- women should know their HIV status before deciding
to breastfeed
 Baby having galactosemia

23. Relative Contraindications-
 Infected lesions on breasts, such as superficial boils,
impetigo, and herpes simplex.
 Mother having Hepatitis B infection
 Cracked nipple

24. Drugs contraindicated during breast feeding mothers-
Estrogens Iodides Ergotamine
Lithium Cytostatics Amphetamine
Gold Bromocryptine cocaine
heroin marijuna, LSD
Alcohol Nicotine Azathioprine
Amiodarone, codeine Phencyclidine
Morphine meperidine methadone
Aspirin in large doses Ethosuximide primidone
Phenobarbital cyclophosphamide methotrexate
Chloramphenicol Metformin

25. Composition of
breast milk
Fat (g/100 ml)
total 4.2
fatty acids – length
8C
trace
polyunsaturated fatty
acids
0.6
cholesterol 0.016
Carbohydrate (g/100 ml)
lactose 7
oligosaccharides 0.5
Minerals (g/100 ml)
calcium 0.03
phosphorus 0.014
sodium 0.015
potassium 0.055
chlorine 0.043

26. Protein (g/100 ml)
total 1.1
casein 0.4
a-lactalbumin 0.3
lactoferrin (apo-
lactoferrin)
0.2
IgA 0.1
IgG 0.001
lysozyme 0.05
serum albumin 0.05
β-lactoglobulin –

27. Comparison of human milk and cows milk
Nutrient Human Milk Cow's Milk Goat's Milk
Calories (Kcal) 172 146 168
Water (g) 215 215 212
Protein (g) 2.5 7.9 8.7
Fat (g) 10.8 7.9 10.1
Saturated fat (g) 4.9 4.6 6.5
Monounsaturated fat (g) 4.1 2.0 2.7
Polyunsaturated fat (g) 1.2 0.5 0.4
Omega-3 fatty acids (mg) 128 183 97.6
Omega-6 fatty acids (mg) 920 293 266
Cholesterol (mg) 34.4 24.4 26.8
Carbohydrate (g) 17.0 11.0 10.9
Sugars (g) 17.0 11.0 10.9
Vitamin A (IU) 522 249 483
Vitamin C (mg) 12.3 0 3.2
Vitamin D (IU) * 9.8 97.6 29.3
Vitamin E (mg) 0.2 0.1 0.2
Vitamin K (mcg) 0.7 0.5 0.7

28. Nutrient Human Milk Cow's Milk Goat's Milk
Thiamin (mg) 0.0 0.1 0.1
Riboflavin (mg) 0.1 0.4 0.3
Niacin (mg) 0.4 0.3 0.7
Vitamin B6 (mg) 0.0 0.1 0.1
Folate (mcg) 12 12 2
Vitamin B12 (mcg) 0.1 1.1 0.2
Pantothenic acid (mg) 0.5 0.9 0.8
Choline (mg) 39.4 34.9 39.0
Calcium (mg) 79 276 327
Iron (mg) 0.07 0.07 0.12
Magnesium (mg) 7.4 24.4 34.2
Phosphorus (mg) 34.4 222 271
Potassium (mg) 125 349 498
Sodium (mg) 42 98 122
Zinc (mg) 0.4 1.0 0.7
Copper (mg) 0.1 0.0 0.1
Manganese (mg) 0.1 0.0 0.0
Selenium (mcg) 4.4 9.0 3.4

29. References-
1. https://www.horlicks.in/in/en/mothers/articles/breastfeedingguid
e.html?
2. https://www.webmd.com/parenting/baby/nursing-basics
3. https://www.whattoexpect.com/first-year/breastfeeding/basics/
4. https://www.parents.com/baby/breastfeeding/
5. https://en.wikipedia.org/wiki/Breastfeeding
6. https://www.womenshealth.gov/breastfeeding
7. https://www.healthychildren.org/English/ages-
stages/baby/breastfeeding/Pages/default.aspx

30. Thanks a lot