WHO

Breastfeeding:

• is the normal way of providing young infants with the nutrients they need for healthy growth and development.

• ... Virtually all mothers can breastfeed

• Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.

LactationAnatomy and Physiology

Breast enlargement

– During pregnancy and lactation indicates the mammary glands are becoming functional

– Breast size before pregnancy does not determine the amount of milk a woman will produce

Hormones during pregnancy

– Estrogen stimulates the ductile systems to grow, then estrogen levels drop after birth

–Progesterone increases the size of alveoli and lobes

–Prolactin contributes to increasing the breast tissue during pregnancy

• Alveoli secrete milk and contract when stimulated

• Oxytocin stimulates milk secretion and is released during the ‘let down’ or milk ejection reflex

• After let down, milk travels into the ductules, then to the larger – lactiferous or mammaryducts

• Hormones during breastfeeding

–Prolactin levels rise with nipple stimulation

–Alveolar cells make milk in response to prolactin when the baby sucks

–Oxytocin causes the alveoli to squeeze the newly produced milk into the duct system

Latch On and sucking

Oxytocin Release

Releases Milk

Infant Empties Breast

Production Increases

Milk Production Occurs

• the yellowish, sticky breast milk produced at the end of pregnancy,

• recommended by WHO as the perfect food for the newborn,

• and feeding should be initiated within the first hour after birth.

– Small amount for the immature digestive system

– ‘paints’ the digestive tract

– Low fat for easy digestion

– Contains mothers antibodies which boost infants’ immune system

– Acts as a laxative to ease passage of meconium

• The milk comes in– Transitional milk for up to 2 weeks

• May still have yellow appearance

• Amounts increase quickly as infant hungers and digestive system matures

– Mother's" milk making” changes from endocrine to autocrine system

– Mature milk• Supply/demand system engorgement decreases

• Properties of fore milk and hind milk present

• Lower risk of

– Diarrhea

– Constipation

– Infections

• Ear, respiratory, meningitis, urinary tract

– SIDS

– Allergic diseases

– Chronic digestive diseases

– Juvenile onset diabetes

– Acute leukemia

– Adult obesity

• Provides immunologic protection while the infant’s immune system is maturing

– Antimicrobial agents

– Anti-inflammatory agents

– Immunomodulating agents

Preterm Infants

– Decreased necrotizing enterocolitis

– Decreased infection rates

– Better able to tolerate feedings

– Increased IQ rates

• Contains long chain polyunsaturated fatty acids that help the infant’s brain develop – these are normally provided by the mother in late pregnancy, therefore preterm infants miss this

Mother Health Benefits

• Less postpartum bleeding

• More rapid uterine involution

• Weight loss

• Decreased premenopausal breast cancer rates

• Decreased ovarian cancer rates

• Lactational amenorrhea– Should still use progesterone only contraceptives

– Combined contraceptives dry up milk

Parent Benefits

• Saves money

• Saves time

• Babies love it

Management of breast feeding

• 1) Preparation of prospective mother:

a- emotional support.

b- education on benefits of B.F. and Technique.

c- good maternal health and nutrition.

d- avoidance of drugs that interfere with breast feeding i.e. ergometrine ; sedatives ; analgesics

2) Early initiating of breast feeding

Within first 30-60 minutes after delivery :

a- Psychological bonding by skin contact is maximal.

b- Rooting and suckling reflexes are maximal.

c- Suckling stimulates milk secretion or let down reflex.

d- Colostrum has nutritious anti-infective characters.

Criteria of good position

1- infant body is close to the mother.

2- infant body is turned to the mother.

3- infant whole body is supported (not only head or neck).

4- infant neck is straight or bent slightly back.

5- how to carry and protect (as above).

6- Rooting reflex : by touching the baby cheek or lower lip with the nipple.

7- when mouth is open the nipple or lower part of the areola are pushed well back in the infant's mouth against it's palate ; so that hard palate compress and massage the milk senuses which lie beneath the areola.

8- mother should be shown how to attach her baby to the breast

9- Baby's face must not be buried in the breast (interfere with nasal breathing).

10- Continue feeding till baby releases nipple.

11- Mouth especially corners are wiped.

12- Baby is held vertically and tapped gently 2-3 times on the back to drive any swallowed air.

13- Baby placed in bed either lying on its right side or prone.

The 4 criteria of good attachment:

The 4 criteria of good attachment:

1)) infant chin is touching the breast.

2)) infant mouth is widely open.

3)) lower lip is turned outwards.

4)) more aleady tissue above than below the mouth.

Adequate Breast feeding

Baby feeds at least 8 times \ 24 hrs.

Baby is calm satisfied after feeds.

Baby sleeps well 2-4 hours after nuring.

Normal motion no constipation.

5) Normal amount of urine :- 6 or more / 24 hours.

6) Normal weight gain (20-30 gm/ day or 150-210 gm / week Can be assessed by :-

a) Wt. charls.

b) Test weighing

Bottle feeding

•The advantages of bottle feeding.

•You can see exactly how much milk your baby is getting at each feed.•Your partner can share in the pleasure of feeding his baby•Formula milk is harder to digest than breast milk and stays in a baby’s stomach longer so babies tend to go longer between feeds.•You have more freedom ,allowing you to get a good night’s sleep!

How much ?

• as frequently as every one or two hours and will drink about 50ml

Is it safe to continue breast-feeding if I'm pregnant with another child?

Generally, it's safe to continue breast-feeding while pregnant — as long as you're careful about eating a healthy diet and diligently drinking plenty of fluids. There's an important caveat, however. Breast-feeding can trigger mild uterine contractions. Although these contractions aren't a concern during an uncomplicated pregnancy, your health care provider might discourage breast-feeding while pregnant if you have a history of preterm labor or you're experiencing uterine pain or bleeding.If you're considering breast-feeding while pregnant, be prepared for changes your nursing child might notice. Although breast milk continues to be nutritionally sound throughout pregnancy, the content of your breast milk will change — which might change the way your milk tastes. In addition, your milk production is quite likely to decrease as your pregnancy progresses. These factors could lead your nursing child to wean on his or her own before the baby is born.Your comfort might also be a concern. During pregnancy, nipple tenderness and breast soreness are common. The discomfort might intensify while breast-feeding. Pregnancy-related fatigue might pose challenges as well. If you want to continue breast-feeding while pregnant — or breast-feed both the baby and the older child after delivery — you might need additional support from loved ones or other close contacts. Also check with your health care provider about taking supplemental prenatal vitamins.

Breast-feeding and medications: What's safe?

If you're breast-feeding, you know you're giving your baby a healthy start. However, if you need to take medication while you're breast-feeding, you might have questions about the possible impact on your breast milk.Here's what you need to know about medications and breast-feeding.

Do all medications pass into breast milk?

Almost any drug that's present in your blood will transfer into your breast milk to some extent, although the level of medication in your breast milk is likely to be low. There are exceptions, though, in which drugs can become concentrated in breast milk. As a result, every medication must be considered separately.

Does my baby's health and age influence how he or she might be affected by exposure to medication in my breast milk?

Yes.Exposure to medication in breast milk poses the greatest risk to premature babies, newborns, and babies who are medically unstable or have poorly functioning kidneys. The risk is lowest for healthy babies 6 months and older.

Should I stop breast-feeding while taking medication?

Most medications are safe to take while breast-feeding. Also, the benefit of continuing to take a medication for a chronic condition while breast-feeding often outweighs any potential risks.Still, some medications aren't safe to take while breast-feeding.If you currently take a medication that could be harmful to your baby, your health care provider might be able to recommend a safe alternative medication. If not, he or she might recommend that you stop breast-feeding temporarily or permanently — depending on how long you need to take the medication.If you need to stop breast-feeding only temporarily, use a breast pump to keep up your milk supply until you're able to breast-feed again. Simply discard the milk you pump while you're taking the medication.If you need to stop breast-feeding permanently — which is unusual — ask your health care provider to help you choose an infant formula that will meet your baby's needs.

What medications are safe to take while breast-feeding?

With your health care provider's input, consider this list of medications found to be safe during breast-feeding. Keep in mind that this isn't a comprehensive list of safe medications.

Pain relieversAcetaminophen (Tylenol, others)Ibuprofen (Advil, Motrin IB, others)Naproxen (Aleve, Naprosyn, others) — short-term use only

Antimicrobial medicationsFluconazole (Diflucan)Miconazole (Monistat 3, Micaderm, others)Clotrimazole (Mycelex, Lotrimin, others)Penicillins (amoxicillin, ampicillin, others)Cephalosporins (Keflex, Duricef, others)

AntihistaminesLoratadine (Claritin, Alavert, others)Fexofenadine (Allegra)

DecongestantsSaline nasal dropsMedications containing pseudoephedrine (Sudafed, Zyrtec D, others) — use with caution because pseudoephedrine can decrease milk supply

Birth control pillsProgestin-only contraceptives, such as the minipillNew research suggests that combination birth control pills, oral contraceptives that contain estrogen and a progestin, don't affect milk production. Still, consider waiting until breast-feeding is firmly established — about six to eight weeks — before using this type of birth control pill.

Gastrointestinal medicationsFamotidine (Pepcid)Omeprazole (Prilosec)Cimetidine (Tagamet)

AntidepressantsParoxetine (Paxil)Sertraline (Zoloft)Fluvoxamine (Luvox)

Constipation medicationsDocusate sodium (Colace)