This document provides an overview of breastfeeding and breast milk. It begins with objectives for a classroom teaching session on breastfeeding. It then covers anatomy and physiology of the breast, the phases and hormones involved in lactation, and composition of breast milk and colostrum. Key points emphasized are that breast milk meets all nutritional needs for infants for the first 6 months, and that exclusive breastfeeding and feeding on demand are recommended. The document defines various terms used to describe breast milk at different stages.

2. Classroom teaching
on
Breastfeeding
Prepared by:
Kalpana Kawan
Roll no. 06
BNS 2nd year
Teaching and learning practicum

3. General objective
At the end of this session, Bsc 3rd year students will be able to
explain about Breastfeeding.

4. Specific objectives
At the end of this session, Bsc Nursing 3rd year students will
be able to:
review the anatomy of breast.
explain the physiology of lactation.
define breastfeeding.
introduce breastfeeding.
state the composition of breast milk.

5. Count.......
 define colostrum.
 introduce colostrum.
 state the compostion of colostrum.
 list the important of colostrum.
 state the term use for breast milk.

6. Anatomy of breast
• The human breast are modified sweat glands responsible for
lactation.
• Breast is extended from 2nd to 6th ribs vertically and margin of the
sternum to the mid axillary line horizontally.
• Breast or mammary gland composed of glandular tissue, fibrous
connective tissue, adipose tissue.

7. Count........
• Different hormones are responsible for the development of the breast
and changes that occur during pregnancy.
• The major hormones affecting breast development and enlargement
are estrogen, progesterone and prolactin.

8. Structure of the Human Breast
• Each breast contains about 20 lobes, each lobes contains several
lobules which at the end have alveoli.
• Alveoli contain acini cells which produce milk and surrounded by
myoepithelial cells which contracts and propel the milk out.
• Small lactiferous ducts, carrying milk from the alveoli unite to form
larger ducts, one large duct leaves each lobe and wider to form a
lactiferous sinus or ampulla which acts as a temprory reservoir for
milk

9. Count......
• A lactiferous tubles from each sinus emerges on the surface of the
nipple.
• The nipple, is made up of erectile tissue, is covered by pigmented skin.
• Surrounding the nipple, in an area of pigmented skin called the areola
which contain Montgomery's gland.
• These sebaceous glands secrete sebum like substance which act as a
lubricant during pregnancy and throughout breastfeeding.

10. Count......
• The areola extends for a distance of 2.5 cm around the nipple.
• The breast is supply with blood from the internal and external
mammary arteries and branches from the intercostals arteries.
• Venous blood supply by the branches of thoracic veins and
intercostals vein.

11. Physiology of lactation
The secretion or production of milk is known as lactation .The hormone
which initiates lactation is called prolactin . The physiological basis of
lactation is divided into 4 phases:
• Phase 1 - Preparation of breasts ( mammogenesis)
• Phase 2 - Synthesis and secretion from breasts alveoli (lactogenesis)
• Phase 3 - Ejection of milk ( Galactokinesis)
• Phase 4 - Maintenence of lactation ( Galactopoisis)

12. Physiology of lactation contd...........
Phase 1 - Preparation of breasts ( mammogenesis)
• Pregnancy is associated with remarkable growth of both ductal and
lobuloalveolar systems.
• An intact nerve supply is not essential for growth of the mammary
glands during pregnancy.

13. Physiology of lactation contd......
Phase 2 - Synthesis and secretion from breasts alveoli
(lactogenesis)
• Milk secretion actually starts on 3rd and 4th postpartum day.
• Around this time, the breast become engorged, tense, tender
and feel warmth.
• Inspite of a high prolactin level during pregnancy, milk
secretion is kept in abeyance.

14. Physiology of lactation contd.....
• . Probably, steroids estrogen and progesterone circulating during
pregnancy make the breast tissues unresponsive to prolactin.
• When the estrogen and progesterone are withdrawn following
delivery, prolactin begins its milk secretory activity in previously fully
developed mammary glands.
• The secretory activity is also enhanced directly or indirectly by
growth hormone, thyroxine and insulin.

15. Physiology of lactation contd........
Phase 3 - Ejection of milk (Galactokinesis):
• Oxytocin is the major galactokinetic hormone.
• Discharge of milk from the mammary glands depends not only on the
suction exerted by the baby during suckling but also on the contractile
mechanism which expresses the milk from the alveoli into the ducts.

16. Physiology of lactation contd.....

17. Physiology of lactation contd....
• Presence of the infant or infant’s cry can induce let down without
suckling.
• A sensation of rise of pressure in the breasts by milk experienced by
the mother at the beginning of sucking is called “draught”.

18. Physiology of lactation contd....
• This can also be produced by injection of oxytocin.The milk ejection
reflex is inhibited by factors such as pain, anxiety, breast engorgement
or adverse psychic condition (depression).
• The ejection reflex may be deficient for several days following
initiation of milk secretion and results in breast engorgement.

19. Physiology of lactation contd.....
Phase 4 - Maintenence of lactation (Galactopoiesis):
• Prolactin appears to be the single most important
galactopoietic hormone.
• For maintenance of effective and continuous lactation,
frequency of suckling (>8/24 hours) is essential.

20. Physiology of lactation contd.....

21. Milk production
• A healthy mother will produce about 500–800 mL of milk a day to
feed her infant.
• This requires about 700 Kcal/day for the mother, which must be made
up from diet or from her body store.
• For this purpose a store of about 5 kg of fat during pregnancy is
essential to make up any nutritional deficit during lactation.

22. Factor affacting Lactation (Review)
Following are the factors that enhance lactation
• Proper positioning of the infant at the breast.
• If mother is relaxed/comfortable and confident.
• Think lovingly of baby
• Frequent feeding.
• Precautions to avoid sore nipples
• Avoidance of formula feeding.

23. Contd........
Following can adversely affect the lactation.
Maternal factors
• Stress/ Anxiety ( may decrease production and milk ejection reflex)
• Separartion of mother and child (eg return to work, school)
• Hormonal imbalance( thyroid gland, Polycystic ovary syndrome)

24. Contd.......
• Surgery to the breast or nipple.
• Mother who does not wake up ( drug, alcohol,medication)
• Poor nutrition of mother.
• Incorrect position
• Painful breast

25. Contd.......
Infant factor
• Baby refusing the breastfeeding.( rapid flow, flat nipple,large nipple)
• Baby sleeping for a long period. ( e.g jaundice, certain medication)
• Long period between feeding( baby does not wake up at night)
• Weak suction ( premature baby, sick baby)

26. 13.2 Initiation and management of breast
feeding : Benefits to mother and baby
Breastfeeding
Definition:
• Breastfeeding is the method of feeding a baby with milk directly from
the mother's breast.
-Medical Dictionary
• Breastfeeding, also known as nursing, is the feeding of babies and
young children with milk from a women's breast.
-Wikipedia

27. Breastfeeding Contd.........
Introduction
• Breastfeeding is the best natural feeding .
• Breastfeeding is human right.
• It not only provides a natural opportunity for bonding but also
supports the growth and development of the newborn.

28. Breastfeeding contd....
To establish and sustain exclusive breastfeeding for 6 months, WHO
and UNICEF recommend:
• Early initiation of breastfeeding within the first hour of life.
• Exclusive breastfeeding : the infant only receives breast milk without
any additional food or drink , not even water.
• Breast feeding on demand: as often as the child wants, day and night.
• No use of bottles , pacifiers.

29. Mother Milk/ Breast milk
• Breast milk is complete food for infants.
• Exclusive breastfeeding meets all the nutritional needs of a baby for
the first six months and continue to be a sourse for nutrition and
protection with appropriate complementary foods for upto two year of
age or beyond .
• Anti infective properties: Macrophages, lymphocytes and polymorphs,
secretary IgA, Lyzozyme, Lactoferrin ( inhibits growth of E.coli) , anti
viral agents.

30. Contd.........
Composition of breast milk: (per 100ml)
• Water(g) - 88
• Energy(kcal) -65
• Protein(g) - 1.1
• Carbohydrate(g) -7.4
• Fat(g) -3.4

31. Contd......
• Calcium (mg) - 28
• Phosphorous (mg -11
• Carotene(microgram) - 137
• Thiamine(mg) - 0.02
• Riboflavin(mg) - 0.02
• Vitamin C(mg) - 3

33. Colostrum
"Colostrum is the first immunization for the
new born babies”

34. Colostrum
Definition:
Colostrum is the first form of milk produced by the mammary
glands of mammals(including human) immediately following delivery
of new born.
- Wikipedia

35. Contd.......
Introduction
• Colostrum is the first liquid that is produced in the first few days after
delivery.
• It is the perfect first food for newborns which is considered as an
infant’s first immunization.
• It is yellow, thick and contain more antibodies and white blood cells.
• Though secreted only in small quantities, it has higher protein content
and most suited for the needs of the baby, it should never be discarded.

36. Composition of colostrum (average values
per100 ml whole milk)
• Energy(kcal) - 58
• Fat(g) - 2.9
• Calcium(mg) -31
• Phosphorous(mg)-14
• Protein(g) - 2.7
• Lactose (g) -5.3
• Carotene(IU) -186
• vitamin A(IU) -296

37. Important of colostrum
• Antibody rich : Protects against infection and allergy
• Many white blood cells Protects against infection
• Purgative : Clear meconium, help prevent jaundice.
• Growth factors: Helps intestine mature, prevent allergy, intolerence.
• Vitamin A rich : Reduces severity of some infection ( such as measles
and diarrhoea . Prevent vitamin A related eye diseases.

38. Terms use for different breast
1. Transitional milk
• It follows the colostrums and secretes during first 2 weeks of postnatal
period.
• It has increase fat and sugar content and decreased protein and
immunoglobuline content.
• At this time breasts feel full, hard and heavy.

39. Contd...
2. Mature milk:
It is thiner and watery but contains all the nutrients essential for
optimal growth of the baby. Mature milk changes even during the length
of a single feed to exactly suit the needs of a baby.

40. Contd.......
3.Preterm milk:
It is the breast milk of a mother who deliver prematurely. It is
different from milk of a mother who has delivered a full term baby. This
milk content more proteins, sodium, iron, immunoglobulin and calories
appropriate for the requirement of the preterm neonates. The preterm
milk is ideal food for low birth weight babies.

41. Contd.....
Milk changes even during the length of a single feed to exactly suit the
needs of a baby.
Fore milk:
It is the milk secreted at a start of a feed. It is watery and is rich in
proteins, sugar, vitamins, minerals and satisfies the baby's thirst.

42. Contd..........
Hind milk:
• It comes later in a feed, is rich in fat which make it look whiter and
thicker than foremilk.
• It satisfies the babies hunger and supply much of the energy of a
breastfeed.
• It should be noted that a baby needs both the foremilk and the hind
milk for appropriate weight gain. Also , babies who are fed both
foremilk and hind milk sleep well.

43. Post - test
A) Fill in the blanks
1. .................. is the major galactokinetic hormone.
2. The first immunization for the new born babies is ................

44. •Summary

45. Home assignment
• Read about management of breast feeding.

46. Plan for next class
We will discuss about management of breastfeeding