BREAST FEEDING

Dr. Yahia Solan

Objectives

At the end of this presentation trainees will be able to:

# Identify 3 parts of breast anatomy.

# Describe what a good latch looks like.

# List 3 hormones that help or hinder milk production.

# List 4 common concerns that prevent a new mother from exclusively breastfeeding their baby.

# List 4 strategies that help to overcome the concerns listed above .

Breast Anatomy

# Breast Size –Depends on fatty tissue

–Not related to making milk –One breast often different than the other

# During pregnancy –Breasts get larger –Veins show more

–Area around the nipple darkensIf a pregnant mother has NOT noticed any ofthese changes: REFER her to Gynecologist

Breast Anatomy

AreolaMontgomeryglandsNippleAlveoliMilk ducts

# Everted (most common type)# Flat

# Semi-Inverted #Inverted

# Wide or Non-stretchable

Types of Nipples

Everted Nipple

Flat Nipple

Inverted Nipple

Type of Nipples (continued)

#Wide or non-stretchable –May not reach back of baby’s mouth

–Hard for a newborn to latch-on –May need a breast pump to express milk

# If a mother is worried about her nipples, lether know that she should be able to breastfeed

REFER HER

Breast Surgery

# Most mothers who have had surgery for: –Larger breasts (implants)

–Smaller breasts (reduction) –Other chest surgery

…Can breastfeed!

# Some breast/chest surgeries may limit theamount of milk she can make

Milk Production

–Hormones play an important role in milkproduction

–Hormones cause many of the feelings mothershave while breastfeeding

–3 important hormones during breastfeeding are…

#Progesterone #Prolactin #Oxytocin

Stages in Milk Production

#Colostrum – First Milk –Thick, yellow milk

–Made last 3 months ofpregnancy & afterdelivery

–Perfect for newborns“ –First Immunization”

–Helps baby passmeconium stool

–Colostrum changes tomature milk over time

Breast milk

# Mature milk changes to meet baby’s needs –Breast milk varies by day

–At beginning of a feeding, breast milk may be:# Bluish and watery

# High in milk sugar (lactose)# Low in fat

# Sometimes called “foremilk”

Breast milk

# Towards the end of the feeding, breast milk is: –Thicker

–Whitish (not clear) –Higher in fat, lower in milk sugar

–Higher in calories (energy) –Sometimes called “hindmilk”

–Needed for growth

Baby needs hindmilk before switchingto the other breast

Milk Ejection Reflex (MER)

# Caused by Oxytocin (hormone)

# Mothers often see or feel: –Uterus contracting (cramps)

–Tingling sensation (may not feel this at first) –Milk dripping from opposite breast –Milk in the corner of baby’s mouth

–Sounds of baby swallowing –A feeling of calmness and relaxation

Feedback Inhibitor of Lactation

Autocrine or local control of milk production

# Can affect each breast differently# Decreases rate of milk production when

mammary gland is full# Its absence allows the rate of milk production

to increase when mammary gland is drained

Breast Storage Capacity

# Babies of mothers with larger storagecapacity feed less often

# Babies of mothers with smaller storagecapacity feed more often

Factors that Affect Supply

# Decreased stimulation of the breast –Infrequent feedings –Shortened feedings

–Baby not transferring milk well# Fatigue

# Stress# Pain (poor latch)

# Early introduction of bottle/formula

Getting Breastfeeding Off to aGood Start

Positioning

# Learning to breastfeed

# 4 common positions –Clutch Hold (football)

–Cross-Cradle Hold (transitional) –Cradle Hold (traditional)

–Side-lying Hold

Positioning

#For all breastfeeding positions:

–Breast must be easy to get to –Mother needs to be comfortable –Back straight & arms supported

–Knees level with hips when sitting –Remove extra clothing

Positioning

# Hold baby with her palm facing ceiling# Bring baby to breast

# Baby’s head, chest & knees face same direction (toward mother’s body)

Clutch position

Cross cradle

Cradle position

Helping with Positioning

# Talk her through correct positioning# Let her position the baby

# Let her decide the best position# Always ask permission before touching

# Put your hands over hers, if you need to help# Have her position the baby & describe it

Latch-On

Correct latch-on is important to:

# Make sure baby gets enough milk# Avoid sore nipples

# Get the breast to make more milk# Some babies need a little help

Latch Activity

# Inflate balloon# Use lipstick

# Place balloonstraight in yourmouth

# Check to seewhere your lipswere

Latch Activity

# Ridge the“breast” into a

sandwich# Place balloon

straight in yourmouth

# Check to seewhere your lipswere

Latch Activity

# Ridge the “breast”# Place lower lip on

the underside of“breast”

# Roll the “breast”into your mouth

# Check to seewhere your lipswere

4 Steps to a Successful Latch

1“ .Ridge” the breast (sandwich)2 .Bring baby’s nose toward nipple

3 .Lower lip touches breast first4 .Mouth takes in the underside of the areola & breast

“Breastfeeding” is not “nipple feeding”

Signs of a Good Latch

•Lack of constant pain •Chin touching the breast

•Cheeks rounded •Nipple may come out

longer, not pinched or discolored

•Lips curled outward •Nostrils barely touch breast

•Baby’s swallows can be heard

•Breasts are softer & feel lighter after feeding

LATCH

Feeding

Hunger Cues

# Baby’s early hunger signs –Hands near face of mouth

–Turning to face mother –Sucking movements/sounds

–Fussiness

# Baby’s late hunger cues –Fingers making a fist over chest, abdomen or face

–Stiff, straight arms or legs –Crying

Full Cues

# Baby’s full cues –Less sucking

–Hands opened and relaxed –Arms relaxed over chest or abdomen

–Legs relaxed –Fingers relaxed

–Mouth lets go of breast –Baby is relaxed or falls asleep

Newborns

# Frequent feedings# Cluster feedings

Feeding Patterns

Signs that Breast feedingis Going Well

Weight Gain

# Best sign baby is getting enough breast milk# Babies lose weight after birth - regain weight by 10-

14 days# Babies should gain:

–One Kg a week for the 1st month –2-4 Kgs a month in the next few months

# Birth weight doubles by 6 months& triples by 1 year

Growth Spurts

# Increase in the number of times to breastfeed# Baby goes back to breastfeeding the same

# Growth spurts usually occur around: # 2-3 weeks old

# 6 weeks old # 3 months olds

# every couple of months after that

Adequate Output

# Another way to tell if baby is getting enough breast milk# Count the number of wet and stool diapers

– Wet Diapers: # For the first 5 days of life: 1 wet diaper for each day of

life # After day 5: 6-8 wet diapers each day

– Stool Diapers: # Increase each day for the first few days

# Major changes in color and texture (NORMAL) # May pass stool every time they breastfeed (1st few

weeks)

Stool: Day 1 & 2

)1 - 2 thick, dark, tarry stools(

Stool: Day 3

)3 greenish-yellow stools(

Stool: Day 5 and beyond

)3-5 mustard-yellow, seedy, thinner stools(

Discussion: EarlyBreastfeeding Problems

Sore Nipples

# Nipple soreness in beginning – NORMAL #NOT normal:

Bruised Bleeding

Blistered nipples

Sore Nipples

# In just 1 day, nipples can become sore/injured# Most common causes:

– Poor Positioning – Poor Latch

– Relief right away with correct positioning/latch

Sore Nipples

Look at the pictures of sore nipples on the next few slides...

“Damaged Nipple”

“Badly Damaged Nipple”

Sore Nipples

# Continue to breastfeed while nipples heal# Drying drops of breast milk helps healing

# Lanolin may help# NO soap or alcohol

# Use different positions

If sore nipples continue after helping with position and latch on...

REFER HER

Normal Fullnessvs.

Engorgement

# Normal Fullness – Normal between day 2-4

– Breasts get fuller, heavier & larger – Colostrum is changing to mature milk

# Engorgement – Not normal – Breasts are hard, red & painful

– Mother not breastfeeding enough – Fluid and milk builds up

“Engorged Breasts”

Helping Mothers withEngorgement

# Breastfeed often! (8-12 times in 24 hrs.)# Hand express or pump small amount

# Lean breasts into a bowl of warm water& lightly massage

# If leaking or can express milk - lightly massage & apply heat just before

breastfeeding

Helping Mothers withEngorgement

# If not able to express any milk Apply cold compresses - SEEK HELP !

Apply pressure around nipple (reverse pressure cycling(

Apply cold cloths often between feedings

If she has tried all of the above and baby is still having problems latching on…refer

Engorgement is a breastfeeding emergency!

Plugged Ducts

# A plugged duct: – Tender spot or lump in breast caused by

the duct getting blocked with thick milk – Happens slowly

– May not let milk drain

Plugged Ducts

# May happen because: – Missed feedings

– Bra too tight – Pulling up bra (instead of loosening it)

– Mother sleeping on stomach – Too much pressure on breasts while

feeding

Plugged Ducts

# Mother may feel ok - no fever# If not treated, may cause mother to:

– make less milk – get a breast infection

If a mother has symptoms for more than a few daysor starts to get a fever...

REFER

Mastitis

# Breast infection# Can happen at anytime

# Happens quickly# Mother feels like she has the flu (fever ≥38º)

# Breasts swollen, tender & red – small/large area# Treated with antibiotics

NEEDS to be seen by health care provider!

“Mastitis - both breasts”

Mastitis

# Encourage a mother with mastitis to: – Breastfeed often (milk not infected!)

– See health care provider & follow instructions – Get plenty of rest

– Drink plenty of fluids (even when not thirsty) – Breastfeed often! If unable to breastfeed, then

needs to pump or manually express milk.

Non-latching Babies

# May start in the hospital or early postpartum# May follow engorgement

# May follow introduction of bottle/formula or pumped milk# Baby becomes used to having the hard nipple in mouth

Non-latching Babies

# Mother needs to pump to maintain milk supply# Can try nipple shield to wean baby back to breast

# Supplemental nursing system/feeding device# Skin-to-skin contact

# Feed baby small amount before starting to breastfeed

Babies that Refuseto Breastfeed

# Baby may not want to breastfeed after breastfeeding has been going well

– Mother may think something wrong with milk – Mother may have hurt feelings

Bottle Nipple Preference

#“ Nipple confusion”# Giving bottles &/or pacifiers too soon

# Flow of the milk from bottle – Faster

“ – Easier” for baby to get milk# Encourage mothers - no bottles/ pacifiers

until baby is 4-6 weeks old

The Baby Friendly Hospital Initiative

The Baby-Friendly Hospital Initiative is a worldwide project of UNICEF and the World Health Organization (WHO). The goal of the initiative is to recognize hospitals and birth centers that take special steps to provide an optimal environment for breastfeeding. Approximately 14,000 hospitals

worldwide have received this prestigious award .

http://www.babyfriendlyusa.org

10 Steps to Successful Breastfeeding (endorsed by the AAFP)

1. Develop a written breastfeeding policy and routinely communicate it to all health care staff.

2. Train all health care staff in skills necessary to implement the policy. 3. Inform all pregnant women about the benefits and management of

breastfeeding. 4. Help mothers initiate breastfeeding within half an hour of birth. 5. Show mothers how to breastfeed, and how to maintain lactation even if they

should be separated from their infants. 6. Give newborn infants no food or drink other than breast milk, unless

medically indicated. 7. Practice rooming-in: Allow mothers and infants to remain together 24 hours

a day. 8. Encourage breastfeeding on demand. 9. Give no artificial teats or pacifiers (also called dummies or soothers) to

breastfeeding infants. 10.Foster the establishment of breastfeeding support groups and refer mothers

to them on discharge from the hospital or clinic.

Questions to Ask toAssess Breastfeeding

# How old is your baby today?# What is your concern today?

# Did the baby breastfeed in the hospital?# How many times in 24 hours does your baby breastfeed?

# How many wet diapers in 24 hours? How many dirty diapers in 24 hours?

Questions to Ask toAssess Breastfeeding

# How long will your baby breastfeed? One breast, both breasts?

# Do you hear the baby swallowing when at the breast?# Does the baby seem satisfied after a feeding?

# Are you using a pacifier at any time?

Questions to Ask toAssess Breastfeeding

# Was birth difficult? Cesarean or Vaginal# Are you using any supplements in a bottle before or after a

feeding?# Are you pumping or hand expressing any milk? What pump

are you using?

Case Studies

My baby is nursing so much that mynipples are sore. Can I have formula?

Why We Care

"Exclusive breastfeeding for the first six months goes a long way toward

canceling out the health differences between being born into poverty and

being born into affluence“.

James P. Grant, Past Executive Director, UNICEF

وفي الختام نقول لكم

ودمتم سالمين

لكم الله اداملباس

والعافية الصحة

THANK YOU