all about breast feeding

1. PRESENTED BY: E SRIKAANTH REDDY

2.  Introduction
 Anatomy and Physiology of Lactation
 Composition and Storage of Human Breast Milk
 Achieving Optimal Breastfeeding
 Breastfeeding Techniques and Positions
 Benefits of Breastfeeding to Infants and Mothers
 Barriers to Effective Breastfeeding
 Contraindication to Breastfeeding
 Reason for supplementation
 Role of the Family Physician
 Conclusion
Breastfeeding
Effective Practices, Benefits to Mothers and Infants and
The Role of the Family Physician

3. Introduction
 Breastfeeding is the optimal source of nutrition. The Human Milk is
specie specific and it provides all the essential nutrients necessary for
the growth and development of the newborn infant.
 The AAP, AAFP and WHO recommend exclusive breastfeeding for
the first six months of life , and continuous breastfeeding for at least
12 months of life.
 The Target of USDHHS “Healthy People 2010” initiative is to achieve
breastfeeding at birth of 75%, 50% at 6 month and 25% at 12
months of life.
 2008 data published by the CDC shows that 77% of mothers in the US
initiate breastfeeding at birth. Only about 30% of women continue
with breastfeeding of the infant to 6 months of age.

4. Anatomy and Physiology of Lactation
Structure of the Human Breast
Source: Lactation Education Program Nutrition Policy and Education

5. Structure of the Human Breast
 The Human breast are modified sweat glands responsible for lactation
(milk production).
 The breast contains adipose tissue and fibrous connective tissue.
 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.

6. Structure of the Human Breast (Cont’d)
 Each breast contains about 20 lobes, each lobes contains several
lobules which at the end have alveolar in which milk is produced.
 Milk production and secretion are responsive to two major hormones
– prolactin and oxytocin; and the sucking reflex.
 After production of milk in the alveolus, the milk moves through the
ducts and are stored in the lactiferous sinus. When the infant latches
on the breast, milk is expressed from the sinuses.

7. Suckling Hormonal Reflex Arc
Source: Lactation Education Program Nutrition Policy and Education

8.  The sucking reflex arc is a hormonal positive feedback mechanism.
 The sucking of the breast by the infant stimulates the nipple; this sends
messages to the spinal cord and subsequently to the brain.
 Prolactin is released from the anterior pituitary for milk production and
oxytocin from the posterior pituitary for the milk let down.
 Prolactin receptors are established within the first eight days of delivery.
 Suckling at breast increases prolactin levels, so at each feeding, levels rise,
hence more milk production.
Suckling Hormonal Reflex Arc (Cont’d)

10. Types and Composition of Human Breast
Milk
 Types of Breast Milk:
 Colostrum or Early Milk
 Transitional Milk
 Mature Milk
 Colostrum or Early Milk is produced in the late stage of pregnancy till
4 days after delivery; and is rich in antibodies.
 Transitional Milk produced from day 4 – 10 is lower in protein in
comparison to Colostrum.
 Mature milk is produced from approximately ten days after delivery up
until the termination of the breastfeeding.

11. Types and Composition of Human Breast
Milk (Cont’d)
 Fat - The main lipids found in human milk are the triglycerides
phospholipids and essential fatty acids.
 Protein – Whey ; lactoferrin, lysozymes, immunoglobulin , A-
lactalbumin, Casein; lower concentration in human milk.
 Carbohydrate – Include lactose and oligosaccharides.
 Leukocytes - Include neutrophils, marcrophages , lymphocytes.
 Non protein nitrogen – urea, uric acid
 Other constituents : steroid hormones, peptides, insulins, growth
factors, minerals, vitamins, lipase.

12. Storage of Breast Milk
 Human milk can be stored at room temperature for 6-8 hours.
 Expressed milk can be stored in an insulated cooler bag with icepacks
for 24hours.
 Breast milk can be stored in the refrigerator for about 5 days at about
40° F.
 It can also be kept in a freezer compartment of a fridge for up to two
weeks at 0 - 5°F
 It can be stored in a deep freezer for about 3-12 months
 Breast milk should be stored in BPA (Bisphenol A) free containers.

13. Achieving Optimal Breastfeeding
 Activities, attitudes and procedures during the delivery and post
partum period have an impact on breastfeeding .
 There is well documented evidence that skin to skin contact between
infant and mother helps to maintain the body temperatures, reduce
risk of hypoglycemia, enhance oxytocin release and beneficial
nutrition with intake of colostrum
 Skin to skin contact should occur for about 1-2 hours after delivery.
Procedures after delivery like weighing, administration of vitamin K,
eye prophylaxis and other procedures should be delayed

14.  Breastfeeding should be started and fully established before discharge
from the hospital
 Physicians and health care professionals should observe at least one
feeding and ensure this is done properly and breast milk is produced
 Lactation specialist should also work with parents that are having
difficulty with breast feeding.
 Early follow up after leaving the hospital is required.
Achieving Optimal Breastfeeding
(Cont’d)

15. Signs of Effective Breastfeeding
 Frequent feedings 8-12 times daily.
 Intermittent episodes of rhythmic sucking with audible swallows
should be heard while the infant is nursing.
 Infant should have about 6-8 wet diapers in a 24 hour period once
breast feeding is established.
 Infant should have minimum of 3-4 bowel movements every 24 hours.
 Stools should be about one tablespoon or larger and should be soft
and yellow after day 3.
 Average daily weight gain of 15 -30g.
 Infant has regained birth weight by day 10 of life.

16. Good Breastfeeding Techniques
 The baby should be properly positioned to achieve effective latching.
 The mother should wear comfortable apparel, with the breast well exposed for the
infant to be able to latch.
 The infant’s mouth, chin and umbilicus should be lined up with the head in a
neutral position.
 The infant is brought to the breast, with the nose touching or close to the breast.
 The gum line should overlap the areola, and the nipple straight back into the
mouth.
 The tongue moves forward beyond the lower gum, cupped and forming a
reservoir.
 Milk is removed for the lactiferous sinuses, the jaw moves down creating a
negative pressure gradient that helped transfer milk to the pharynx.

17. Good Breastfeeding Techniques

18. Breastfeeding Positions
Cradle Hold
 This is the most common position
used by mothers.
 Infant’s head is supported in the
elbow, the back and buttock is
supported by the arm and lifted to
the breast.
Adapted from AAFP Journal September 2001

19. Football Hold Position
 The infant’s is placed under the
arm, like holding a football
 Baby’s body is supported with the
forearm and the head is supported
with the hand.
 Many mothers are not comfortable
with this position
 Good position after operative
procedures
Adapted from AAFP Journal September 2001
Breastfeeding Positions

20. Side Lying Position
 The mother lies on her side propping
up her head and shoulder with pillows.
 The infant is also lying down facing the
mother.
 Good position after Caesarean section.
 Allows the new mother some rest.
 Most mothers are scared of crushing
the baby.
Breastfeeding Positions
Adapted from AAFP Journal September 2001

21. Cross Cradle Hold Position
 Ideal for early breastfeeding.
 Mother holds the baby crosswise in
the crook of the arm opposite the
breast the infant is to be fed.
 The baby's trunk and head are
supported with the forearm and palm.
 The other hand is placed beneath the
breast in a U-shaped to guide the
baby's mouth to your breast.
Breastfeeding Positions
Adapted from AAFP Journal September 2001

22. Australian Hold Position
 This is also called the saddle
hold
 Usually used for older infants
 Not commonly used by
mothers.
 Best used in older infants with
runny nose, ear infection.
Breastfeeding Positions
Adapted from AAFP Journal September 2001

23. Benefits of Breastfeeding to Infants
 Helps in Gastrointestinal development and function
 Helps in development of the immune system
 Helps in cognitive development of the infant
 Infants who are breastfed have reduced risk of infection compared to
formula fed infants.

24.  Breastfed infants have reduced risk of obesity later in life compared to
formula fed infants.
 Reduced risk of sudden infant death syndrome, Hodgkin's lymphoma,
Leukemia and Type 1 Diabetes.
 Lower risk of infections e.g. otitis media, Lower respiratory tract
infection, Diarrheal diseases, Allergies , eczema, Meningitis and
inflammatory bowel diseases.
Benefits of Breastfeeding to Infants

25. Benefits of Breastfeeding to Mothers
 Enhance early maternal – infant bond.
 Aids involution of the uterus.
 Long term breastfeeding helps in loss of the excess weight acquired
during pregnancy.
 Prolonged Breastfeeding prolongs anovulation.
 Documented long term effect of breastfeeding include reduced risk of
breast, ovarian and endometrial cancers.

26. Supplements that increase lactation
 Herbal dietary supplement
- Fennel fruit
- Aniseed fruit
- Coriander fruit
- Fenugreek seed
- Blessed thistle herb
- Not FDA approved.

27. Socio-economic Benefits of Breastfeeding
 Income savings – average of $1000 - $1200 per infant per year.
 Reduced risk of infections and diseases hence reduced hospital visits
and attendant medical cost.
 Mothers are more economically productive since they will spend less
time caring for a sick child.

28. Barriers To Effective Breastfeeding
 Lack of confidence in mother
 Belief that breast milk is not sufficient
 Lack of adequate support system
 History of previous breast surgery
 Breast engorgement, cracked and sore nipples
 Retractile nipples

29. Barriers To Effective Breastfeeding
 Embarrassment by mother
 Jealousy by siblings
 Chronic illness in mother; psychosis, Cancer.

30. Contraindication to Breastfeeding
 HIV , HLTV 1 & 11 infections.
 Active Tuberculosis.
 Herpes lesions on mother’s breast.
 Infant with Inborn error of metabolism; galactosemia,
phenylketonuria.
 Mothers on certain medications ; anticancer therapy, radioactive
isotope etc.

31. Reason for Supplementation
 Birth weight < 1500 g or GA < 32 weeks
 Severe hypoglycemia
 Acute water loss
 Hyperbilirubinemia related to poor intake
 Delayed bowel movement or dark stools at day 5
 Delayed milk production
 Weight loss >8% of birth weight.

38. Role of the Family Physician
 Provide education about breastfeeding at first prenatal visit
 Physical exam should include breast exam
 Ensure rooming-in after delivery
 Ensure breastfeeding is started and established before discharge after
delivery.
 Observe at least a session of breastfeeding to ensure it is done
correctly

39. Role of the Family Physician
 Office should be breastfeeding friendly
 Staff should be well trained and willing to answer questions mothers
might have
 Prenatal package should have literatures and patient hand out that
outlines benefit of breastfeeding
 Prenatal records should have a checklist that ensure all question are
addressed.

40. World Breastfeeding Week
1 - 7 August
Breastfeeding :
A Winning Goal
For Life !

41. ORGANISATIONS CONCERNED
WITH BREASTFEEDING
WHO

42. Conclusion
 Breastfeeding is the best source of nutrition for a healthy term infant.
 AAP, AAFP and WHO recommends exclusive breastfeeding for the
first six month of life and for at least twelve month of life.
 Human milk is human specific and contains nutrients that are essential
for the proper growth and development of the newborn.
 Breast milk is beneficial to both infant and mother.

43. Conclusion
 Proper positioning on the breast helps ensure adequate latching on and
subsequently adequate breastfeeding.
 Breast milk can be stored away, and utilized later when needed.
 There are absolute contraindications to breastfeeding, these include
HIV, 1 and 11 , HTLV 1 and 11, active TB and active herpes simplex
lesions on the breast.
 The family physician has a significant role in promoting breastfeeding.