Anatomy

y Milk producing glands y Lactiferous canaliculi y Lactiferous sinuses y Myoepithelial tissue y Adipose tissue

PHYSIOLOGY OF LACTATION
y Milk is produced as a result of the interaction between

hormones and reflexes.

y Two hormones come into play during lactation. y PROLACTIN
y OXYTOCIN

PROLACTI REFLEX
(ALSO K OWN AS MILK SECRETION REFLEX)

PROLACTIN REFLE

y More the baby sucks at breast, greater is the milk

production.
y Earlier the baby is put to breast, sooner is the reflex

initiated.
y The greater the demand, more is the milk produced.

y Feed early, frequently and completely y Empty both breasts at each feed y Ensure that the baby is properly attached to the breast. y Prolactin is produced during night

OXYTOCIN REFLEX
(ALSO CALLED IL EJECTION REFLEX)

PROLACTIN REFLEX

y Oxytocin is post. pituitary hormone which causes

contraction of the milk from the glands into the lactiferous sinuses and the lactiferous ducts.
y Suckling, thought, sight and sound of the baby

stimulation of nerve endings oxytocin secreted contraction of glands breast milk secreted

OXYTOCIN REFLEX
HELP THINKS LOVINGLY OF BABY HINDER WORRY

SOUND OF BABY SIGHT OF BABY CONFIDENCE

STRESS PAIN DOUBT

y This stresses the importance of a supportive health professional or a relative to reassure the mother and help her gain confidence so that she can successfully breastfeed her baby.

Neonatal reflexes
y Rooting Reflex y Suckling Reflex
y

Drawing nipple and areola to form a elongated teat inside mouth Pressing streched nipple & areola with the jaw and tongue against the palate Drawing milk from the lactiferous sinuses by wave like peristaltic movement of the tongue on the underneath of areola & nipple compressing against palate above.

Neonatal reflexes
y Swallowing Reflex
y One to three suckles fill baby's mouth with milk

following which baby swallows and then breathe.

y Suck-swallow-breathe cycle lasts for one second

CO POSITION
y Different at different stages after birth:y Colostrum y Transitional milk y Mature milk( Fore milk & Hind milk) y Preterm milk

CO POSITION :- COLOSTRU
y Milk secreted during the initial 3-4 days after delivery. y Yellow and thick y Contains y More minerals & Proteins
y More antibodies and cells y Increased amounts of vitamins A, D,E and K.

CO POSITION:- Transitional milk

y The milk secreted after 3-4 days and until 2 weeks. y The immunoglobulin and protein content decrease y The fat and sugar content increases.

CO POSITION:-

ature

ilk

y Mature milk follows transitional milk. y It is thinner and watery but contains all the nutrients

essential for optimal growth of the baby.

CO POSITION:-

ature

ilk

y FOREMILK :- Milk secreted at the start of a feed. y It is watery and is rich in proteins, sugar, vitamins,

minerals and water that satisfies the baby s thirst.

y HINDMILK:- Milk produced at the end of feed and is

richer in fat content and provides more energy, and satisfies the baby s hunger.

CO POSITION:-

ature

ilk

y Bacterial & Viral antibodies esp IgA y Many factors which inhibit growth of virus & bacteria y Macrophages which synthesize :y Complement y Lysozyme y Lactoferrin (inhibitory effect on E.Coli) y Bile salt stimulated lipase (inhibit giardia lamblia & entamoeba histolytica. y Breast milk is defecient in Vitamin D, K iron &

flouride.

Nutrient Macronutrient Calories Proteins Fat Lactose Micronutrients Sodium Potassium Calcium Phosphorus Iron Zinc Vitamins Vitamin A Vitamin C 67 kcal 1.1 gm 3.5 gm 7.0gm

Content/100 ml

0.9meq 1.4meq 35mg 15mg 30-50 ugm 120 ugm 5.2 mg

CONSTITUENT PROTEINS: casein soluble proteins lactalbumin beta-lactoglobulin lactotransferrin immunoglobulin lysozyme Non protein nitrogenous substances:

BREAST MILK(gms/ltr) 11 04 07 3.5 00 1-2 1-2 0.5 0.32

CO POSITION:- Preterm
contains more:y proteins, y sodium, y iron, y immunoglobulins y calories

ilk

y Milk produced by mother who delivers prematurely,

Parameter Bacterial contamination Anti infective subtance Protein Amino acid Fat Lipase Lactose alts (Na, , l)

Human milk None Many 1% total & 0.5 % casein More for growing brain & retina 4% but more unsaturated & essential fatty acid Present 7% orrect amount orrect amount mall amount but well absorbed Enoug

Cow milk Likely None 4% & 3% less 4% but less EFA & more saturated Absent 4.5 % ery ig ery ig mall amount but poorly absorbed Extra needed

Minerals ( a, PO4) Iron itamin

INITIATION OF BREASTFEEDING
BREASTFEEDING SHOULD BE INITIATED AS EARLY AS POSSIBLE,WITHIN 30 MINS IN VAGINAL DELIVERY AND 4 HRS IN CEASERIAN DELIVERY.

POSITIONING:her.

OTHER

y Mother can take any position that is comfortable to

y Her back should be well supported and she should not

be leaning on her baby.

POSITION OF BABY
y Baby s whole body must be well supported not just

neck or shoulders.

y Baby s head and body are in a line without any twist in

the neck.

y Baby s body turned towards the mother with the

baby s abdomen touching the mother s abdomen.

y Baby s nose is at the level of the nipple.

GOOD POSITION

POOR POSITION

ATTACH ENT
y After proper positioning, the baby s cheek is touched

and that will make the baby open her mouth(rooting reflex)

y Allow the baby to have a wide open mouth and the

baby should be quickly brought on to the breast ensuring that the nipple and most of the areola is within the baby s mouth.

y It is important that baby is brought on the mother

rather than mother leaning on to the baby.

SIGNS OF GOOD ATTACH ENT

y The baby s mouth is wide open. y Most of the nipple and areola in the mouth , only

upper areola visible, not the lower one.

y The baby s chin touches the breast. y The baby s lower lip is everted.

INCORRECT SUCKING POSITION

y Mouth is not wide open y Chin is away from the breast y Baby is sucking only nipple y Most black portion of the breast is outside the baby s

mouth y Tongue away from the teat

y MOTHERS AT RISK FOR PROBLEMS IN BREAST

FEEDING. -Primipara mothers -Mothers who have had problems in breastfeeding in previous pregnancy. -Mothers with inverted nipple , retracted nipple. -Mother who have not been motivated to breastfeed.

EFFECTIVE SUCKLING
y Baby suckles slowly pauses in between two swallow. y Baby s cheeks are full and not hollow or retracting

during sucking.

Global Recommendations for Infant and Young Child Feeding

y Exclusive breastfeeding for 6 months y Continue breastfeeding for up to 2 years or beyond. y Introduce nutritionally adequate and safe

complementary foods after the infant reaches 6 months of age, while continuing to breastfeed for 2 years or beyond.

What is Exclusive Breastfeeding?

y Giving an infant only breastmilk, with the

exception of drops or syrups consisting of vitamins, mineral supplements, or drugs

y No food or drink other than

breastmilk not even water

BREAST

ILK:BENEFITS

y Nutritional superiority-contains all the nutrients. y Carbohydrates-contains lactose in high conc.(6-

7mg):- helps in absorption of calcium & enhances the growth of lactobacilli in the intestine. y Proteins-low protein content as baby cannot metabolize high protein load. contains lactalbumin & lactoglobulin which are easily digested.

y Contains taurine and cysteine,necessary for

neurotransmission & neuromodulation. y Fats-rich in pufa s,necessary for the myelination of the nervous system. Contains omega 2 & omega 6 important for formation of prostaglandins and cholesterol,base for steroid hormones.

BENEFITS OF BREAST FEEDING

To the Mother
y Reduces post delivery bleeding and anemia y Helps delay next pregnancy y Protective effect against breast and y ovarian cancer y Helps to loose weight