Ways to promote Breastfeeding and

Lactation

Physiology of Lactation
Factors affecting Breastfeeding
production
Breastfeeding problems and
management
 Definition of Terms
Lactation
The secretion of milk from the
mammary glands of the breast

Breastfeeding
The feeding of an infant at the
mothers breast; nursing
Physiology of
Lactation
Hormones involved in lactation:
Estrogen
Progesterone
Prolactin
Oxytocin
Insulin
Growth Hormone (GH)
Adrenal Corticoids (Cortisol)
Hypothalamus:
Gonadotropin Releasing Hormone
Pituitary Gland: (anterior)
Gonadotropin (LH and FSH)
Prolactin
Pituitary Gland: (posterior)
Oxytocin
Pancreas:
Insulin
Adrenal Cortex:
Glucocorticoids (cortisol)
Ovaries:
Follicle Estrogen
Corpus Luteum Progesterone
Placenta:
Human Chorionic Gonadotrophin Hormone
Progesterone
Estrogen
Stages of Lactation:
1. Mammogenesis (Growth of the Breast)
Hormones; Estrogen, growth hormone,
prolactin, insulin and adrenal corticoids
. Breast enlargement
. Ductal system growth and branching
. Last stage development of breast lobules
and alveoli (progesterone)
2. Lactogenesis (Functional changes of the
breast to secret milk)
. Lactogenesis I The ability of the mammary
glands to secrete milk from mid-pregnancy
to late pregnancy.
 Lactogenesis II The formation of
large amount of milk after parturition
3. Galactogenesis (Maintaining the
production of milk)
Starts around 9 days after parturition
and finishes at the beginning of
involution.
4. Involution (The termination of milk
production)
Starts 40 days after the last
breastfeeding.
The Milk:
1. Colostrum
. A thin, watery, yellow fluid
composed of protein, sugar, fat,
water, minerals, vitamins, and
maternal antibodies (IgA)
. Secreted starting the 4th month of
pregnancy to 3-4 days after birth.
. High in protein and fairly low in
sugar and fats
. Easily digested
2. Transitional Milk
Replaces colostrum from day 2 and end at day
10 after birth.
3. True/mature Milk
Produces by day 10 onward

Types of Milk
Fore milk milk reserves on the lactiferous
ducts behind the nipples, produced by the
alveoli and is released through let-down-
reflex.
Hind milk formed after the let-down-reflex.
Higher in fat than fore milk. Makes a breastfed
infant grow most rapidly.
Composition of breast milk:

Water 88.5%
Fat 3.3%
Lactose 6.8%
Casein 0.9%
Lactalbumin
and other proteins 0.4%
Calcium and minerals 0.2%
 Advantages of
breastfeeding
1. Readily available
2. Affordable
3. The baby acquires natural and passive
immunity beacuse mother's milk contains
antibodies and other anti-infection agents.
4. Breastfeeding prevents menstruation for the
first 6 months after delivery (Lactation
amenorrhea)
5. Helps the mother returns to the pre-pregnancy
weight because lactation uses lots of energy
6. It may reduce the risk for breast and
ovarean cancers.
7. It is thought to reduce rate of
obesity, therefore, it reduces the risk
of type- 2 diabetes,
hypercholesterolaemia, and
hypertension.
8. Those who have been breastfeed
achieve better in intellegence tests.
 Disadvantages of
Breastfeeding
1. Risk for transmission of diseases like HIV
and hepatitis C from mother to baby
2. May not be economically viable because
some woman have to return back to work,
so they cannot breastfeed their child
exlusively.
3. Sometimes breastfeeding can become
uncomfortable, with some mother
suffering from nipple pain
4. Breastfeeding in the public is still taboo;
so feeding "on demand" may not be
socially acceptable.
5. If a mother does not replenish the
quality of calcium phosphate in the
milk, the body responds by enlarginf
the parathyroid glands which causes
her bones to decalcif, making her
more susceptible to freacture.

WHO recommendation for

breastfeeding
1. Breastfeeding should begin within
an hour after birth.
2. Breastfeeding should be "on
demand", day and night
3. Bottles and dummies should be
4. Exclusive breastfeeding (only breast
milk should be given not even water
until the baby is 6 moths old)
5. After 6 moths, supplementary
breastfeeding should occur unitl age
2.
6. New mother should have at least 16
weeks of work after birth (maternity
leave) so that she can rest and
breastfeed her baby.
Relactation:
Stimulation of the breast after
involution with the purpose of
reproducing milk again.
 Common concerns of
Breastfeeding and Management
Concern:
Mother worries about amount of milk
being taken
Cause:
Mother cannot see the amount taken
Intervention:
Assure mother that the best way to judge
amount taken is to note whether the infant
appears content between feedings and is
wetting
Concern:
Infant does not suck well
Cause:
Possible effect of analgesia from labor
Infant brought to mother when not hungry
Infant exhausted by crying from hunger
Intervention:
Adjust feeding pattern to childs needs; assure
mother that effect of analgesia is temporary.
Encourage rooming-in. Encourage feeding on
cue, not on demand.
Concern:
Mother reports infants stool are
loose and thin.
Cause:
Stools normally looser and lighter in
color than in formula-fed babies
Intervention:
Examine stools; explain normal stool
pattern and transition
Concern:
Sore nipple
Nipple kept wet
Cause:
Infant not gripping entire areola
Intervention:
Help infant to grasp nipple correctly; expose
nipple to air between feedings; aloe vera or
vitamin E applied to nipples helps heal tissue
Concern:
Engorgement
Cause:
Lymphatic filing as milk production begins
Intervention:
Encourage infant to suck (engorgement
subsides best if infant can be encouraged
to suck); apply warm packs to breast or
have mother take a warm shower before
feeding to help soften breast tissue.
Concern:
Breastfeeding in public
Cause:
Some people make a woman feel
uncomfortable breastfeeding at work or
other public places.
Intervention:
Encourage woman to use discretion
to avoid confrontation (unless she
wants to make point that
breastfeeding is a natural action) and
to speak to work site administrator
about comfortable arrangements.
Techniques of Breastfeeding:
1. Lips of the infant clamp in a C-shape.
The cheek muscles contract
2. The tongue thrusts forward to grasp
nipple and areola
3. The nipple is brought against the hard
palate as the tongue pulls back,
bringing the areola into the mouth
4. The gums compress the areola,
squeezing milk into the back of the
throat.
Latch Breastfeeding Charting system
Legend: 0, 1, 2
(L) Latch
(A)Audible Swallowing
(T) Type of nipple
(C) Comfort (breast/nipple)
(H) Hold