• is the normal way of providing young infants with the
nutrients they need for healthy growth and
• ... Virtually all mothers can breastfeed
• Exclusive breastfeeding is recommended up to 6 months
of age, with continued breastfeeding along with
appropriate complementary foods up to two years of age
Anatomy and Physiology
– During pregnancy and lactation indicates the
mammary glands are becoming functional
– Breast size before pregnancy does not determine
the amount of milk a woman will produce
Hormones during pregnancy
–Estrogen stimulates the ductile systems to
grow, then estrogen levels drop after birth
–Progesterone increases the size of alveoli
–Prolactin contributes to increasing the
breast tissue during pregnancy
• Alveoli secrete milk and contract when
• Oxytocin stimulates milk secretion and is
released during the ‘let down’ or milk ejection
• After let down, milk travels into the ductules,
then to the larger – lactiferous or mammary
• Hormones during breastfeeding
–Prolactin levels rise with nipple stimulation
–Alveolar cells make milk in response to
prolactin when the baby sucks
–Oxytocin causes the alveoli to squeeze the
newly produced milk into the duct system
Latch On and sucking
Infant Empties Breast
Milk Production Occurs
• the yellowish, sticky breast milk produced at the end
• recommended by WHO as the perfect food for the
• and feeding should be initiated within the first hour
– Small amount for the immature digestive system
– ‘paints’ the digestive tract
– Low fat for easy digestion
– Contains mothers antibodies which boost infants’
– Acts as a laxative to ease passage of meconium
• The milk comes in
– Transitional milk for up to 2 weeks
• May still have yellow appearance
• Amounts increase quickly as infant hungers and
digestive system matures
– Mother's" milk making” changes from endocrine
to autocrine system
– Mature milk
• Supply/demand system engorgement decreases
• Properties of fore milk and hind milk present
• Provides immunologic protection while the infant’s
immune system is maturing
– Antimicrobial agents
– Anti-inflammatory agents
– Immunomodulating agents
– Decreased necrotizing enterocolitis
– Decreased infection rates
– Better able to tolerate feedings
– Increased IQ rates
• Contains long chain polyunsaturated fatty acids that help
the infant’s brain develop – these are normally provided
by the mother in late pregnancy, therefore preterm
infants miss this
Mother Health Benefits
• Less postpartum bleeding
• More rapid uterine involution
• Weight loss
• Decreased premenopausal breast cancer rates
• Decreased ovarian cancer rates
• Lactational amenorrhea
– Should still use progesterone only contraceptives
– Combined contraceptives dry up milk
• Saves money
• Saves time
• Babies love it
Management of breast feeding
• 1) Preparation of prospective mother:
a- emotional support.
b- education on benefits of B.F. and Technique.
c- good maternal health and nutrition.
d- avoidance of drugs that interfere with breast feeding
i.e. ergometrine ; sedatives ; analgesics
2) Early initiating of breast feeding
Within first 30-60 minutes after delivery :
a- Psychological bonding by skin contact is maximal.
b- Rooting and suckling reflexes are maximal.
c- Suckling stimulates milk secretion or let down reflex.
d- Colostrum has nutritious anti-infective characters.
Criteria of good position
1- infant body is close to the mother.
2- infant body is turned to the mother.
3- infant whole body is supported (not only head or
4- infant neck is straight or bent slightly back.
5- how to carry and protect (as above).
6- Rooting reflex : by touching the baby cheek or lower lip with
7- when mouth is open the nipple or lower part of the areola
are pushed well back in the infant's mouth against it's
palate ; so that hard palate compress and massage the milk
senuses which lie beneath the areola.
8- mother should be shown how to attach her baby to the breast
9- Baby's face must not be buried in the breast (interfere with
10- Continue feeding till baby releases nipple.
11- Mouth especially corners are wiped.
12- Baby is held vertically and tapped gently 2-3 times on the
back to drive any swallowed air.
13- Baby placed in bed either lying on its right side or prone.
The 4 criteria of good
The 4 criteria of good attachment:
1)) infant chin is touching the breast.
2)) infant mouth is widely open.
3)) lower lip is turned outwards.
4)) more aleady tissue above than below the mouth.
Adequate Breast feeding
Baby feeds at least 8 times 24 hrs.
Baby is calm satisfied after feeds.
Baby sleeps well 2-4 hours after nuring.
Normal motion no constipation.
5) Normal amount of urine :- 6 or more / 24
6) Normal weight gain (20-30 gm/ day or 150-
210 gm / week Can be assessed by :-
a) Wt. charls.
b) Test weighing
•The advantages of bottle feeding.
•You can see exactly how much milk your
baby is getting at each feed.
•Your partner can share in the pleasure of
feeding his baby
•Formula milk is harder to digest than breast
milk and stays in a baby’s stomach longer so
babies tend to go longer between feeds.
•You have more freedom ,allowing you to get
a good night’s sleep!
How much ?
• as frequently as every one or two hours and
will drink about 50ml
Is it safe to continue breast-feeding if
I'm pregnant with another child?
Generally, it's safe to continue breast-feeding while pregnant — as long as you're careful
about eating a healthy diet and diligently drinking plenty of fluids. There's an important
caveat, however. Breast-feeding can trigger mild uterine contractions. Although these
contractions aren't a concern during an uncomplicated pregnancy, your health care
provider might discourage breast-feeding while pregnant if you have a history of preterm
labor or you're experiencing uterine pain or bleeding.
If you're considering breast-feeding while pregnant, be prepared for changes your nursing
child might notice. Although breast milk continues to be nutritionally sound throughout
pregnancy, the content of your breast milk will change — which might change the way your
milk tastes. In addition, your milk production is quite likely to decrease as your pregnancy
progresses. These factors could lead your nursing child to wean on his or her own before
the baby is born.
Your comfort might also be a concern. During pregnancy, nipple tenderness and breast
soreness are common. The discomfort might intensify while breast-feeding. Pregnancy-
related fatigue might pose challenges as well. If you want to continue breast-feeding while
pregnant — or breast-feed both the baby and the older child after delivery — you might
need additional support from loved ones or other close contacts. Also check with your
health care provider about taking supplemental prenatal vitamins.
Breast-feeding and medications: What's safe?
If you're breast-feeding, you know you're giving your baby a
healthy start. However, if you need to take medication while you're
breast-feeding, you might have questions about the possible
impact on your breast milk.
Here's what you need to know about medications and breast-
Do all medications pass into breast milk?
Almost any drug that's present in your blood will transfer into your
breast milk to some extent, although the level of medication in
your breast milk is likely to be low. There are exceptions, though, in
which drugs can become concentrated in breast milk. As a result,
every medication must be considered separately.
Does my baby's health and age influence how he or she might
be affected by exposure to medication in my breast milk?
Exposure to medication in breast milk poses the greatest risk to
premature babies, newborns, and babies who are medically
unstable or have poorly functioning kidneys. The risk is lowest
for healthy babies 6 months and older.
Should I stop breast-feeding while taking medication?
Most medications are safe to take while breast-feeding. Also, the
benefit of continuing to take a medication for a chronic condition
while breast-feeding often outweighs any potential risks.
Still, some medications aren't safe to take while breast-feeding.
If you currently take a medication that could be harmful to your
baby, your health care provider might be able to recommend a safe
alternative medication. If not, he or she might recommend that you
stop breast-feeding temporarily or permanently — depending on
how long you need to take the medication.
If you need to stop breast-feeding only temporarily, use a breast
pump to keep up your milk supply until you're able to breast-feed
again. Simply discard the milk you pump while you're taking the
If you need to stop breast-feeding permanently — which is unusual
— ask your health care provider to help you choose an infant
formula that will meet your baby's needs.
What medications are safe to take while breast-feeding?
With your health care provider's input, consider this list of
medications found to be safe during breast-feeding. Keep in mind
that this isn't a comprehensive list of safe medications.
Acetaminophen (Tylenol, others)
Ibuprofen (Advil, Motrin IB, others)
Naproxen (Aleve, Naprosyn, others) — short-term use only
Miconazole (Monistat 3, Micaderm, others)
Clotrimazole (Mycelex, Lotrimin, others)
Penicillins (amoxicillin, ampicillin, others)
Cephalosporins (Keflex, Duricef, others)
Loratadine (Claritin, Alavert, others)
Saline nasal drops
Medications containing pseudoephedrine (Sudafed, Zyrtec D,
others) — use with caution because pseudoephedrine can decrease
Birth control pills
Progestin-only contraceptives, such as the minipill
New research suggests that combination birth control pills, oral
contraceptives that contain estrogen and a progestin, don't affect
milk production. Still, consider waiting until breast-feeding is firmly
established — about six to eight weeks — before using this type of
birth control pill.