Breast feeding is one of the most important gift, support, bond, attachment provided between the Mother and the baby even after the delivery of the baby to maintain the normal physiology of the mother, baby, family, society and the nation. some of the aspects of breast feeding especially the importance of proper feeding techniques to initiate, sustain and make the breast feeding successful is mentioned here.

1. Dr. Shivu. P
MBBS, DCH.
Consultant Pediatrician.
No. 757, Vinayamarga,
11th cross, Siddarthanagar,
Mysore 11. PIN: 570011.
Mobile number: 9448477380,
Land phone: 0821 2561277,
0821 4000778
Mail: shivup.183@gmail.com
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3. Breast feeding - Key words in Anatomy.
 Breast: It is the milk
producing organ in
mammals.
Note: All the mammals
feed their off springs
till they are able to
eat other naturally
available food as they
don’t have artificial
feeds.
We don’t leave any one,
some times for good.

4. Breast feeding - Key words in Anatomy.
 Nipple: the anterior most
projection of the breast
which contains the ducts to
let down the milk.
Note: Baby sucking only at the nipple will not get the milk as the ducts does
not contain milk in it, but it only participates in the process of flow of milk
as the baby creates strong negative suction force from below and
compression pressure over the milk containing pockets called lactiferous
sinuses which are present beneath the areola. Sucking only at the nipple
will cause physical trauma to the nipple, which leads to cracked nipple,
bleeding from the nipple skin and severe pain to the mother

5. Breast feeding - Key words in Anatomy.
 Areola: the brownish black skin
surrounding the nipple and contains oil
secreting glands called Montgomery's
gland which maintains the appropriate
lubrication during the process of sucking.
Note: Do not advice to wash the breast frequently or after each feed as it will remove
the lubricating oil and it make the skin dry and prone for injury and infection as
sucking will cause friction and physical trauma to the nipple and areola in the
absence of lubrication. Feeding mothers can wash their breast during their regular
bath.
Areolar glands or Glands of Montgomery are sebaceous glands in the areola
surrounding the nipple. The glands make oily secretions (lipoid fluid) to keep the
areola and the nipple lubricated and protected. Volatile compounds in these
secretions may also serve as an olfactory stimulus for newborn appetite.

6. Breast feeding - Key words in Anatomy.
 Milk pockets – Lactiferous sinuses: It is the
dilated spindle shaped space which stores small
volume of milk which is received from the
lactiferous duct proximally and discharges the
milk out through the ducts in the nipple by
suction from below and by the circumferential
compression pressure all around.
Note: baby gets the milk well, only when
1. the upper jaw and lower jaw circumscribes the areola to create the
circumferential pressure,
2. when the baby latch the breast with air tight grip , with no air gap between the
breast and the mouth of the baby,
3. with good suction pressure,
All these together makes good sucking with good shift of milk from the breast to
the mouth of the baby.

7. Breast feeding - Key words in Anatomy.
Note: When excess milk is collected in the gland space / duct /
sinus that leads to engorgement of the breast. Since the ducts
and the glands extends up to the base of the breast and also
in to the axilla, the manual expression of the milk by keeping
the flat of the hands should start from the base of the breast
and the hands are slided over the breast towards the nipple
as one hand gives counter pressure to the other hand.
Lactiferous ducts: they make the milk to flow which is secreted
from the lactiferous gland towards the milk pockets (lactiferous
sinuses).
This is repeated in all the quadrants of the breast by keeping the hands in diagonally
opposite side over the breast (that is above and below, inside and outside, upper outer side
and lower inner side, upper inner side and lower outer side). Do not squeeze the front of the
breast with single hand, it can cause severe pain with reverse flow pressure.

8. Breast feeding - Key words in Anatomy.
 Lactiferous glands (Milk secreting
glands); the exocrine gland which
secretes the milk by extracting the
nutrients from the interstitial space and
from the blood. The muscle cells which
surrounds the gland helps the gland to
contract and make the milk to flow
towards the ducts.
Note: the secretion of milk from the gland
and its contents depends on the
nutrition of the mother. Good nutrition
is vital in secreting good quality and
quantity of milk.

9. Breast feeding - Key words in Anatomy.
Good nutrition is vital
both in pregnancy and
lactation as the body
gains about 12 kgs in
pregnancy in which the
breast is going to gain
1 to 2 kgs of weight.

10. Breast feeding - Key words in Anatomy.
 Ligament of cooper:(also known as
the suspensory ligaments of Cooper)
and the fibrocollagenous septa are
connective tissue in the breast that help
maintain structural integrity and bears
the weight of the partially mobile breast
over the chest wall deep pectoral fascia.
Note: the weight of the breast of the non pregnant women varies and these
ligaments has to support about one kilogram of extra weight during
pregnancy and lactation, and they may become lax later. So supporting the
breast with appropriate inner were which neither compresses the breast
and make the impairment in milk flow nor very loose and thus does not
support the breast should be worn.

11. Breast feeding Physiology.
Receptors in the nipple and areola will be
stimulated as the baby starts sucking at the breast
and the impulses will reach the brain /
hypothalamus.
Hypothalamus will release the ‘Prolactin releasing
hormone’ in to the anterior pituitary and the
pituitary gland will produce the ‘Prolactin’ which
acts on the alveolus of the breast to secrete the
milk.
Hormone oxytocin will be released from the
posterior pituitary and it makes the myoepithelial
cells which surrounds the milk containing alveolus
to contract and thus makes the milk to flow down.

12. Breast feeding Physiology.
 Love and affection, is the
physiological process through
which the blood vessels relax
and maintain the normal
pressure under physiological
condition, make the blood
supply to the breast optimum
and facilitates the milk
secretion, not only in the
feeding breast, but even from
the opposite breast.

13. Breast feeding Physiology.
 Vision: Mother
looking at the baby
and enjoying the
process of breast
feeding enhances the
flow of breast milk.

14. Breast feeding Physiology.
 Hearing; The cry of the child, the sounds produced by the
baby make the mother to secrete more milk.

15. Breast feeding Physiology.
 Olfaction; child will have its own odor, which usually stimulates
the mother.
 The milk and the secretions from the nipple and areola will have
its own odor which attracts the baby for feeding.

16. Breast feeding Physiology.
 Touch of the baby: every one
on this earth enjoys holding
the babies with close contact
and more by the mother.
Touch of the baby by the
mother induces positive
feeding reflex. Sucking and
rooting reflexes are all well
established which involves
the touch.

17. Breast feeding and Physics - Pressure.

18. Breast feeding and Physics-
Circumferential pressure.

19. Breast feeding and
Physics-
Suction Pressure.

20. Breast feeding and physics.
Circumferential pressure and suction pressure.

21. How Breasts Make Milk:
The Physiology of Breastfeeding
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 .
Breasts start to make the first milk, colostrum, in the second trimester. Colostrum
is thick and clear to yellow in colour. Once the baby and the placenta are delivered,
breast starts to make more milk.
Over the next few days, the amount of milk from the breasts increase and the
colour will change to appear more watery and white.

22. Breast feeding Physiology.

23. Breast feeding Physiology.

24. Breast feeding Physiology.
Hormones of Lactation.
 The complex physiology of breastfeeding includes a delicate
balance of hormones.
 There are four hormones that help breasts make milk are
estrogen, progesterone, prolactin and oxytocin.
 The body naturally knows how to adjust the level of these
hormones to help the breasts to make milk.

25. Breast feeding Chemistry.
Estrogen and progesterone:
 They prepare the breasts to make milk.
 These hormones are released by the
placenta during pregnancy.
 They increase the size and number of
milk ducts in the breasts.
 Once the baby is born and the placenta is
delivered, these hormones decrease. This
decrease signals the body that it is time
to make milk.

26. Breast feeding Chemistry.
Progesterone :
 It plays an important role in mammary
gland development in females.
 In conjunction with prolactin, it
mediates lobuloalveolar maturation of
the breasts during pregnancy to allow
for milk production, and
thus lactation and breastfeeding after
childbirth.
 Estrogen is required for progesterone
to mediate lobuloalveolar maturation.

27. Breast feeding Chemistry.
 Prolactin is a hormone named
originally after its function to
promote milk production
(lactation) in mammals in
response to the suckling of
young after birth. It has since
been shown to have more
than 300 functions in the
body.

28. Breast feeding Physiology.
 Prolactin helps the breasts to make milk.
 After the birth of the baby, prolactin levels increase.
 At every time of breastfeed or pump, the body releases
Prolactin.
 With each release, the body makes and stores more milk
in the breast alveoli.
 If the level of this hormone gets too low, the milk supply
will decrease. This is why it is important to breastfeed or
pump right after delivery and then at regular time
frames.

29. Breast feeding Physiology.

30. Breast feeding Physiology.
 Oxytocin releases milk from the breasts.
 When the baby (or breast pump) begins to suck and draw the
nipple in to the mouth, this hormone is released. This release
causes milk to be squeezed out of the alveoli, into the ducts
and out of the nipple, into the baby’s mouth. This process is
called let down or milk ejection reflex (MER).

31. Breast feeding Chemistry.
 Oxytocin is released in to the
bloodstream as a hormone in
response to stretching of the cervix
and uterus during labour.
 It helps in the contraction of the
uterus during labour.
 It is also secreted with the
stimulation of the nipples
from breastfeeding and thus helps
the uterus to contract , minimises the
bleeding and makes the uterus to
attain pre pregnancy size.

32. Good position in breast feeding
Baby’s body is well supported.
Baby is held close to the mother.
The entire body of the baby is turned
towards the mother (But not only the
head).
Baby’s head is in close contact with
the mother with good attachment to
the nipple and areola.
Baby’s abdomen is in close contact
with the abdomen of the mother.
With this the baby ‘s mouth, chin and
the umbilicus will come in straight line
(i.e. the head, neck, and the body of the
baby are kept in the same plain).

33. Good position in breast feeding
Chin of the baby is in close contact with the breast , that is there is no gap
between the breast and the chin of the baby.
Most of the areola of the breast is inside the mouth of the baby.
Baby’s mouth is wide open.
Tongue of the baby latches the nipple and areola.
Lips are everted out (turned out) and grasping the areola well.
Lips and gums are fitted firmly and circumferentially like a purse string, over
the areola in air tight fashion.

34. Bad position in breast feeding

35. Poor attachment.

36. Poor attachment.

37. Good attachment.

38. Good attachment.

39. Good
attachment.
If the baby breast feeds with good
attachment then only the milk will be filled
inside the stomach and there is no
collection of air.
Even then it is better to burp for about 20
minutes after each feed because, even a
minute amount of air can also cause
problem.

40. Poor attachment.
If there is poor attachment then some amount of air will enter in to the mouth
through the gap between the mouth of the baby and the breast, that will enter in to
the stomach as the baby swallows the milk mixed with the bubbles of air.
Later they may enter in to the intestine where they form the air columns or the child
may vomit the milk as the air bubbles comes out through the esophagus and then
through the nose and mouth.

41. Burping after the feed.
As the air is lighter than fluid (that is the milk) all the air bubbles will fuse at
the top of the stomach (that is at the fundus of the stomach) when the baby is
kept in erect posture either over the shoulder or over the lap. This fused air
bubble (that is only the air) will come out through the mouth of the baby
leaving only the milk which is settled at the bottom (Body and the Pylorus)
of the stomach . Thus only milk will enter in the intestine.

42. Poor burping – Short burping – No burping.
 Will lead to vomiting, as the air tries to come out of
the stomach which is mixed with milk.
 Air mixed milk may come out both through the
mouth and nostrils.
 When the milk sticks to the nose, they may get
discomfort in the nose or blocked nose and the baby
does not know how to clear the nose and it will not
be able breath through the nose, so it will
continuously cry to breath himself through the
mouth.
 Baby may be hungry, but it will not be able to feed as
the mouth is going to be covered with breast during
the breast feeding and the nose is already blocked
and it gets suffocated if it tries to feed.

43. Poor burping – Short burping – No burping.
 The air which enters the small intestine makes the
intestine to bloat up and thus the baby gets the
pain in the abdomen, and the baby will cry with
this pain disturbing the entire family and the
neighbors, till the air gets out of the intestine
from the bottom as flatus.
The air columns which are formed between the milk in the lumen of the
intestine and the wall of the intestine will interfere with the digestion and
absorption of the milk and thus poor weight gain by the baby.
Lack of sleep by the baby make it irritable child with poor growth and poor
performance in the life.
Sleepless night by the members of the family may interfere with the earning by
the family members.

44. Burping after the feed
Any one in the family can involve in this lovely job of burping and enjoying with the baby.