this slide contain physiology of lactation and management of breast feeding, lactation failure and BFHI

1. PHYSIOLOGY OF LACTATION
MANAGEMENT AND BFHI
shipra sachan
Assistant professor
Rama University

2. INTRODUCTION
Lactation starts following delivery or birth of
baby. the preparation of effective lactation
starts during pregnancy . After delivery when
oestrogen level fall prolactin stimulate milk
production.

3. Anatomy And Physiology Of Breast
the breast are bilateral glandular structures.
which are concern with lactation following
childbith.the shape of breast varies in women
& in different period of time. they usually
extend 2 to 6 rib in the midclavicular line.

4. Structure{non lactating breast}
• The areola is situated about the center of the
breast & is pigmented. It has numerous
sebaceous gland over it. The nipple is a
muscular projection covered by pigmented
skin. It is vascular & surrounded by unstriped
muscles that make it erectile. it contain about
15-20 lactiferous duct & their opening.bihind
the nipple the main duct dilate to form
ampulla where the milk is stored in lactating
mothers.

7. Lactation;-the process of preparing &
maintaining the production & secretion of
milk including –monogenesis ,lacto genesis
,galactokinesis, galactopoisis

8. Purpose of lactation
• Provide nutrition & immune protection .
• Provide optimal birth spacing.

9. PHYSIOLOGY OF LACTATION
Preparation of breast [mammogenesis]
Secretion& synthesis from breast alveoli
[lacto genesis]
Ejection of milk [galctokinesis]
Maintenance of lactation [galactopoisis]

10. Mammogenesis;-
Pregnancy is associated with the
remarkable growth in size of breast. the
enlarged size of breast in pregnancy is
due to duct & lobuloaveolar {duct &
segments} system in breast.

11. LACTOGENESIS:-
Some secretary activity is evident in form
of colostrums or early milk during
pregnancy or just after child birth. The
secretary activity is accelerated following
birth of baby. It refer to the milk in the
milk producing unit of breast {alveoli}.
milk secretion starts actually on 3 or
4 day after delivery.

12. GALACTOKINESIS:-
Discharge of milk from memory gland depend
not only on the suction exerted by the baby
during sucking but also on the contractile
mechanism which express the milk from the
alveoli into the duct.oxytocin is the major
galactokinetic hormone.

13. MILK
EJECTION
REFLEX

15. Milk Letdown Reflex

16. GALACTOPOISIS:-
prolactin is the single most factor for
maintenance of lactation. Sucking is also
important for maintenance of lactation. It is
not only important for removal of milk from
the gland but also for the release of prolactin.

17. MILK PRODUCTION:-Healthy mother will
produce about 500-800 ml milk/day to feed her
infant.
This require 700 k/cal/day for mother which must
be made up by diet or from her body stored. For
this purpose a
store of about 5kg fat during
pregnancy is essential to
Make up any nutritional
deficit During lactation.

18. Drugs :_used to improve milk
production
Metoclopramide:- 10mg,TDS {increase milk
volume by increasing prolactin level}.
Intranasal oxytocin :- contract myoepithelial
cell & cause milk let down.

19. Hormonal Influences:-
From the 24 weeks of pregnancy a women body
produce hormone that stimulate the growth.
PROGESTRONE:-
Influence the growth in size of alveoli & lobes.
Inhibit lactation before birth.
Drop after birth.

20. OESTROGEN:-
Stimulate the milk duct system to grow.
Inhibit lactation.
Breast feeding mother avoid oestrogen
based birth control methord,it reduce
mother milk supply.
Oestrogen level decreases following
delivery.

21. PROLACTIN:-
Contribute to the increase growth of alveoli.
Regulating milk production.
OXYTOCIN:-
Contract smooth muscle of uterus during &
after birth.
Contract the cell surrounding the alveoli to
squeeze produced milk into the duct.
Important for milk ejection reflex.

23. MANAGEMENT OF Breast
FEEDING

24. ANTENATAL PREPRATION
Teach all the women about
advantage of breast feeding.
Daily cleaning of nipple.
 If nipple are inverted or flat
nipple rolling must explained.

25. BREASTFEEDING
Breastfeeding should begin as soon as
possible after delivery.
The frequent sucking
stimulate the production
& let down reflex & reduce
the risk of engorgement.

26. • B - best for baby
• R - reduce incidence of allergy
• E - economical (low cost)
• A - antibodies
• S - stool is semisolid,
• T - temperature ideal for baby
• F - fresh milk
• E - enhances security
• E - emotional
• D - digested easily
• I - immediately available
• N - natural
• G - gain weight

27. PREPARATION & POSITION OF
MOTHER
Comfortable position.
Without discomfort & bladder empty.
Hand washing
Cleaning of nipple with plain water.

29. PREPARATION & POSITION OF BABY
Clean, dry diaper & wrapped {loose enough}
Let the baby find nipple & grasp it.
Help the mother learn to
hold her breast in such a
way to guide & facilitate
the baby grasping of it.
 touch the baby cheeks
with the nipple so baby will turn toward breast

30. Continue……………………………………..
Express a few drop of colostrum / milk .
As the baby grasp the nipple the mother make
sure the proper positioning of mouth.
Baby must grasp more than just the end of
nipple.
The baby must compress the lactiferous
sinuses located beneath the areola.

31. Lactation maintained by:-
Start breast feeding as son as possible.
No missed & supplement feeding.
Rotation of breast.
Rested & relaxed.
Baby properly
positioned on breast
Baby neck should be
Slightly extended &
Chin contact with breast

32. AAP Recommendation
Exclusive breastfeeding for the six month of
life.
Continued breastfeeding for at least one year.

33. CONTRAINDICATION:-
Drug used for cancer.
HIV infection.
Chronic medical illness –pulmonary
tuberculosis.
Women receiving high dose of epileptic &
antithyroid drug.

34. LACTATION FAILURE
Causes:-
Anatomical abnormality
Inadequate milk removal
Post partum depression

35. MASTITIS
Tender,swallen,usally unilateral, with fever ,
malaise & chills.
Treatment :-
Rest & fluids
Antibiotics
Empty the breast;-
frequent breast feeding

36. BREAST ABCESS
Flushing breast not responding to antibiotics ,
browny oedema of overlying
skin,tenderness,hard red , swinging
temperature.
3% of mastitis cases
develop into an
abcess.

37. TREATMENT:-
 Needle aspiration for culture & treatment.
Surgical drainage.
Follow up care:-
 Antibiotic
Continue breastfeeding

38. BABY FRIENDLY HOSPITAL INITIATIVE
It was launched by WHO & UNICEF in 1991.
the initiative is a global effort to implement
practices that
protect , promote ,
& support
breastfeeding also
known as BFI.

39. AIM:-improving the care of pregnant women ,
mother, & newborn at health facilities that
provide maternity services for protecting &
supporting breastfeeding.
BFHI:-it is a world health organization ,world
wide program that support mother & babies
to have the best start in life.

40. 40
 Have a written breastfeeding policy that is routinely
communicated to all health care staff.
 Train all health care staff in skills necessary to implement
this policy.
 Inform all pregnant women about the benefits and
management of breastfeeding.
 Help mothers initiate breastfeeding within one half-hour of
birth.
 Show mothers how to breastfeed and maintain lactation,
even if they should be separated from their infants.

41. 41
 Give newborn infants no food or drink other than breastmilk,
unless medically indicated.
 Practice rooming in - that is, allow mothers and infants to
remain together 24 hours a day.
 Encourage breastfeeding on demand.
 Give no artificial nipples or pacifiers (soothers) to
breastfeeding infants.
 Foster the establishment of breastfeeding support groups
and refer mothers to them on discharge from the hospital or
clinic.

42. Step 1. - policy
• Written policy based on 10 steps
• Health staff should know it and practise

43. Step 2 – train the staff
• All health care staff must be trained to
implement this policy

44. Step 3 – inform pregnant women
• On benefits of BF, physiology, lactation
management
• Encourage pregnat women to participate at
antenatal courses, information on BF should
be a part of the course

45. Step 4 – initiate BF within 1 hour
• Enable „skin to skin“
contact as soon as
possible
• „Skin to skin“ contact
important in first 24
hours
• Prevention of BF
problems
• Inform health profs and
public

46. Practices to support BF after SC
• Early initiation of BF ( within 1 hour)
• Choose the appropriate position
• Early rooming-in

47. Step 5 – show mothers how to breastfeed
• Correct positiong
• Correct attachment at the breast
Requires practical knowledge and counselling
skills, psychological support

48. Step 5 – show mothers how to maintain
lactation if separated from their infants
• Start expressing milk as soon as possible (
1. manual expression, 2. pumps)
• Train health staff
• Health staff provides support to mothers

49. Step 6 – no supplementation
• Give newborn infants no food or drink other
than breast milk, unless medically indicated,
then use alternative methods, no bottles
• Stress the importance of colostrum

50. Step 7 – Rooming-in
• 24 hours
• Inform mothers on its importance
• Enables feeding on demand
• Mothers learn to recognise fine signals of
readiness to breastfeed in the child
• RI – newborns cry less, mother sleep more
• Crying child – difficult to
breastfeed

51. Step 8 – encourage breastfeeding on
demand
• Do not restrict duration & frequency of BF
• Do not encourage a common schedule of BF
• Respect individual rhythm and needs of the
newborn
• Number of breastfeeds should not drop
below 8 in 24 hours

52. Step 9 – no bottles or teats
• Give no artificial teats or pacifiers (dummies,
soothers) to breastfeeding infants
• Interferes with suckling techniques
• Inform mothers about its importance
• Do not promote bottles or pacifiers at the
hospital

53. Step 10 – continuing breastfeeding support
• WHO encourages continuing support in the
community
• Lactation counselling after discharge from
hospital (lactation centres, lactation
counsellors, self-help groups)
• Effective help, provides also emotional
support

54. 54
ADVANTAGE
• Immediate postpartum breastfeeding helps
Mother/Child bonding
• Breast milk Alone is the perfect food for Baby’s first
6-months
– Nutrients, antibodies, Hormones, Antioxidants,
other factors
• Stimulates immune system – response to diseases
& vaccination
– Protects from diarrhea and acute respiratory
infections

55. • Easily digestible.
• It is readily available for baby at right
temperature.
• Decreased blood loss postpartum
• Delayed return to fertility
• Decreased risk of breast and ovarian cancer
• Provides social/economic benefits to the Family
• Health and emotional benefits for Mother
– Sense of empowerment and satisfaction.

56. THANK YOU