Basic breast feeding rules and contraindications

1. RENNU PRIAKSHAN VIVEGANANDARAJAH
GROUP14 (ONMU)
Breast Feeding

2. Introduction
• According to the WHO Breastfeeding is the normal way of providing young infants
with the nutrients they need for healthy growth and development. Virtually all
mothers can breastfeed, provided they have accurate information, and the support
of their family, the health care system and society at large.
• Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is
recommended by WHO as the perfect food for the newborn, and feeding should be
initiated within the first hour after birth.
• Exclusive breastfeeding is recommended up to 6 months of age, with continued
breastfeeding along with appropriate complementary foods up to two years of age
or beyond.

3. • Breast feeding is provided by mammary gland of the mothers at their natural
states. And mammary glands start to develop in adolescence age and attain
complete development during pregnancy, Below are the various phases of
the development of the mammary gland and lactation.
I. Mammogenesis (lengthening and branching milk ducts)
II. Lactogenesis (formation of milk by cells of alveols )
III. Galactopoiesis (production of milk )
IV. Phases of automatism

4. Types of breast milk
• Colostrum or foremilk – during the first days of life, dense liquid of yellowish
color, (relative density 1.040- 1.060)
• Transitive milk -4th 5th days of life,
• Mature milk – in 2nd -3rd week
Milk which outpoured in one feeding can be classified as
• Early milk – At the beginning of the feeding, got more lactose, proteins and water.
• Late milk – At the end of the feeding, more enriched in fats

5. Amount of the ingredients in mother’s
milk
Kind
(In 100 ml)
Protein
(g)
Fat
(g)
Carbohydrate
(g)
Calorie
(Kcal)
Colostrum 7.5 2 4-5 150
Transitive 2.5 3.2 5.5 – 6.6 60-80
Mature 1.1-1.5 3.5-4.5 7 65-70
Also contains necessary Vitamins, Minerals and Salts like calcium, phosphorus, Iron,
copper, Zinc. It also contains Active enzymes(protease, lipase etc.), hormones,
Immunoglobulins like IgA, IgM, IgG, Specific antibodies for some diseases plus non
specific protectors like lysozyme.

6. • Infants with galactosemia, phenylketoneurea
• Mothers who use illegal drugs.
• Mothers infected with HIV, human T-cell lymphotropic virus type I or type
II, or who have an active herpes lesion on the breast.
• Mothers taking any of the following medications: radioactive isotopes,
cancer chemotherapy agents, such as antimetabolites, and thyrotoxic agents.
• Breastfeeding mothers should avoid alcohol. An occasional drink is
acceptable, but breastfeeding should be avoided for 2 hours after the drink.
Mothers with untreated varicella should not feed from the breast, but in
most cases pumped milk can be fed to the infant.
Contraindications of breast feeding

7. • 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 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 infant receives 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 contraindication for 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
Commonly Mistaken as contraindication
are the following

8. 1.The first placing of the child to the mother’s
breast in the delivery room should be within the 1st hour of his/her life
(in the absence of contraindications).
2. Before each feeding it is necessary to wash the breast. According
to the modern rules, when feeding is often (as indicated, at free
feeding), it’s not necessary to do it every time.
3. If the condition of the mother is satisfactory on the second day after
the delivery, feeding is carried out under a quiet, confident condition, in
a quiet convenient, comfortable sitting (possible lying) position.
The body of the child should be pressed to the body of the mother;
the face should be directed towards the mother’s breast. The head
and the body of the infant should be supported in the same position.
The mother at this time should look tenderly at her child, admire him
and love him/her.
Rules of breast feeding

9. 4.At every feeding the infant is placed only on one breast and then
during the next feeding on the other one, thus alternating them. In some
cases (at lack of milk) it is possible to put the child to one breast and
after emptying it , to feed the baby with the milk from the other breast
if he/she is still hungry. Next feeding should be with the mentioned
second/other breast.
5.At first it is necessary to discard the first flow of milk and then place the
infant mouth on the breast. The infant should grasp well with the mouth
not only the nipple, but a large part of the areola, so that the chin
of the infant touches the breast firmly. At this moment the mouth
should be well open, and the lower lip turned out
Breaking of such rules of placing the infant to the breast causes pain,
the integrity of the nipple is damaged, and cracks are formed on it.
As a result of this, feeding becomes very painful, and not sufficient in
quantity. Due to the accumulation of the milk in the breast lactostasis
is formed which leads to the future reduction of the secretion and
promotes the development of hypogalactosis.

10. 6. After feeding during the 1st -2nd months of life, it is necessary to out
pour the accumulated milk from the breast (the accumulation of milk
in the breast reduces the process of lactation). Further formation of the
necessary amount of the breast milk, as a rule, is stabilized, and thepouring is not
carried out.
7.In order to prevent cracks forming on the nipple, it is necessary after each feeding
to wipe the breast with a clean, dry towel. Norwegian pediatricians recommend at
frequent feeding to moisten the nipple and areola with
some drops of breast milk and let it dry up.

11. 8.The duration of feeding is about 20-30 minutes. However, it is said that
there is no exact time of every feeding of the infant. Every infant sucks the
breast with different frequency and different duration of feedings with a day.
are those who quickly swallow milk. One must not take away the infant
from the breast if he/she is still sucking. First of all he/she should
satisfy his/her ‘appetite, and, secondly, the milk considerably differs
in its contents from what it was at the beginning and what it is at the
end of the feeding.
9. If for any reason the infant does not suck the breast, it is necessary to
outpour some milk in order to promote continuation of the secretion
process for the next feeding.

12. • Within 2-3 months the child usually receives the portion of food every
3hours, i.e. 7 times a day: 6 a.m., 9 a.m., 12.00 noon, 3 p.m., 6 p.m., 9 p.m.
and 12.00 midnight.
After that the night interval comes which lasts for 6 hours. Some children wake
up at night and cry and the mother thus individually decides
whether it is necessary to feed the newborn at night. Most children regularly
suck mother’s breast throughout the day. Gradually, they cease disturbing at
night and in 2-3 month they do not wake up at all.
Regime of feeding of the child

13. Approximately by the end of the second and the third months the child
begins to receive breast milk every 3.5 hours, i.e. 6 times a day: 6 a.m., 930a.m.,
1p.m., 4.30p.m., 8 p.m. and 11.30p.m. The night interval lasts for 6.5 hours.
From 6 months of age( when the child receives some weaning food) till the end
of the 1st year the interval between feedings increases to
4 hours and the child eats 5 times a day: 6 a.m., 10 a.m., 2 p.m., 6 p.m. and
10 p.m. The night break lasts for 8 hours.
So till 6 months, the ideal type of baby food (excluding medical prescriptions) is
exclusively breast milk, and he/she should not be given any other food or liquid.

14. Advantages of Human Milk
• Low renal solute load
• Immunologic, growth and trophic factors
Decrease illness, infection, allergy
• Improved digestion and absorption
• Nutrient Composition: CHO, Protein, Fatty Acid,
etc
• Cost
• Other

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