Breast feeding (benefits,phisiology,anatomy,problems,cures,cancers,bussines mom,schematic)

Lactation
Anatomy 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
Amirhossein Talebi 3

Lactation
 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

Lactation
 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 mammary
ducts

NF- 9Teaching Aids: ENC
Anatomy of breast
Myoepithelial cells
Epithelial cells
ducts
Lactiferous sinus
Areola
Montgomery gland
Alveoli
Supporting tissue
and fat
Nipple

Lactation
 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

NF-11Teaching Aids: ENC
Enhancing factors Hindering factors
Emptying
of breast
Good attachment
& effective suckling
Early initiation
of breastfeeds
Frequent feeds
including night
feeds
Delay in initiation
of breastfeeds,
Pre-lacteal feeds,
Bottle feeding,
Incorrect positioning,
Painful breast
Sensory impulse
from nipple
Prolactin in
blood
Prolactin “milk secretion” reflex

Baby sucking
Sensory impulse from
nipple to brain
Oxytocin contracts
myoepithelial cells
Oxytocin “milk ejection” reflex

•Thinks lovingly of baby
•Sound of the baby
•Sight of the baby
•CONFIDENCE
•Worry
•Stress
•Pain
•Doubt
Stimulated by Inhibited by
Oxytocin reflex

Lactation
Latch On and sucking
Oxytocin Release
Releases Milk
Infant Empties Breast
Production Increases
Milk Production Occurs
Interference with this cycle decreases the milk supply.Amirhossein Talebi 11

Rooting reflex
Swallowing reflex
Sucking reflex
Feeding reflexes in the baby

Breastfeeding
Infant Health Benefits
 COLOSTRUM
 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

Colostrum
Property
 Antibody-rich
 Many white cells
 Purgative
 Growth factors
 Vitamin-A rich
Importance
 protects against infection and
allergy
 protects against infection
 clears meconium; helps prevent
jaundice
 helps intestine mature; prevents
allergy, intolerance
 reduces severity of some
infection (such as measles and
diarrhoea); prevents vitamin A-
related eye diseases

Summary of differences between
milks
Human milk Animal milks Infant formula
Protein
correct amount, easy
to digest
too much, difficult to
digest
partly corrected
Fat
enough essential fatty
acids, lipase to digest
lacks essential fatty
acids, no lipase
no lipase
Water enough extra needed may need extra
Anti-infective
properties
present absent absent
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization,
2015 (WHO/CDR/93.6).

No water necessary
Country
Temperature
°C
Relative
Humidity %
Urine
osmolarity
(mOsm/l)
Argentina 20-39 60-80 105-199
India 27-42 10-60 66-1234
Jamaica 24-28 62-90 103-468
Peru 24-30 45-96 30-544
(Normal osmolarity: 50-1400 mOsm/l)
Adapted from: Breastfeeding and the use of water and teas. Geneva, World Health Organization,
1997.

Breastfeeding
 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

Breastfeeding
 Provides immunologic protection while the
infant’s immune system is maturing
 Antimicrobial agents
 Anti-inflammatory agents
 Immunomodulating agents

1. Mother
infected
4. Antibody to
mother’s
infection
secreted in milk
to protect baby
2. WBC in
mother’s
body
make
antibodies
to protect
mother
3. Some
WBCs go
to breast
and make
antibodies
there
Protection against infection

Breast milk in second year of
life
31% 38% 45%
95%
0%
20%
40%
60%
80%
100%
Energy Protein Vitamin A Vitamin C
%
daily
needs
provided
by
500 ml
breast
milk
From: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).

Breastfeeding
 Lower risk of
 Diarrhea
 Constipation
 Infections
 Ear, respiratory, meningitis, urinary tract
 SIDS
 Allergic diseases
 Chronic digestive diseases
 Juvenile onset diabetes
 Acute leukemia
 Adult obesity

Risk of diarrhea by feeding
method
for infants aged 0-2 months,
Philippines
1.0
3.2
13.3
17.3
0
5
10
15
20
Breast milk only Breast milk &
non-nutritious
liquids
Breast milk &
nutritious
supplements
No breast milk
Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal
morbidity. Pediatrics, 1990, 86(6): 874-882.

Percentage of babies bottle-fed and breastfed for the
first 13 weeks that had diarrheal illness at various
weeks of age during the first year,
Scotland
19.5 19.1
22.3 22.4
3.6
7.1
12.9 11.9
0
5
10
15
20
25
0-13 14-26 27-39 40-52
Incidence of diarrhoeal illness by age in weeks
Percentwithdiarrhoea
Bottle-fed Breastfed
Adapted from: Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CV. Protective effect of
breastfeeding against infection. Br Med J, 1990, 300: 11-15.

Percentage of babies bottle-fed and breastfed for the
first 13 weeks that had respiratory illness
at various weeks of age during the first year, Scotland
38.9
47.1 45.5
54.1
23.1
36.2
42.4 40
0
10
20
30
40
50
60
0-13 14-26 27-39 40-52
Incidence of respiratory illness by age in weeks
Percentwithrespiratory
illness
Bottle-fed Breastfed
Adapted from: Howie PW, Forsyth JS, Ogston SA, Clark A, Florey CV. Protective effect of
breastfeeding against infection. Br Med J, 1990, 300: 11-15.

Frequency of acute otitis media in relation
to feeding pattern and age, Sweden
1
45
7
13
6
14
20
0
5
10
15
20
1-3 4-7 8-12
months
Percentwithacuteotitis
media
breastfed mixed fed weaned
Adapted from: Aniansson G, Alm B, Andersson B, Hakansson A et al. A prospective coherent study on
breast-feeding and otitis media in Swedish infants. Pediat Infect Dis J, 1994, 13: 183-188.

Percentage of infants 2-7 months of age reported
as experiencing ear infections, by feeding category
in the preceding month in the U.S.
6.6 6.6
9.4
11.1
13.2
0
2
4
6
8
10
12
14
Breast
milk only
(100)
High
mixed
(89-99)
Middle
mixed
(58-88)
Low mixed
(1-57)
Formula
only (0)
Percent Ear Infection
Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant
morbidity and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).

Protective effect of breastfeeding
on infant mortality

Relative risks of death from diarrhoeal disease
by age and breastfeeding category in Latin America
1
4.1
1
15.1
2.2
0
2
4
6
8
10
12
14
16
Diarrhoea 0-3 mo Diarrhoea 4-11 mo
exclusive
breastfeeding
partial
breastfeeding
no breastfeeding
Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast
feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.

Relative risks of death from acute respiratory
infections by age and breastfeeding category
in Latin America
1
4
2.1
2.9
1
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
ARI 0-3 mo 4-11 mo
exclusive
breastfeeding
partial
breastfeeding
no breastfeeding
Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast
feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.

Breastfeeding reduces the risk of
chronic disease

Breastfeeding decreases the risk of allergic
disorders – a prospective birth cohort study
Type of feeding Asthma Atopic
dermatitis
Allergic
rhinitis
Children exclusively
breastfed 4 months or
more
7.7% 24% 6.5%
Children breastfed for a
shorter period
12% 27% 9%
Adapted from Kull I. et al. Breastfeeding and allergic diseases in infants - a prospective birth
cohort study. Archives of Disease in Childhood 2002: 87:478-481.
Amirhossein Talebi
Transparency 2.31

Breastfeeding decreases the prevalence
of obesity in childhood at age five and six years,
Germany
4.5
3.8
2.3
1.7
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
months breastfeeding
Prevalence(%)
0 months
2 months
3-5 months
6-12 months
Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity: cross
sectional study. BMJ, 1999, 319:147-150.

Breastfeeding has psychosocial
and developmental benefits

Duration of breastfeeding associated with higher
IQ scores in young adults, Denmark
99.4
102.3
106
101.7
104
96
98
100
102
104
106
108
Duration of breastfeeding in months
< 1 months
2-3 months
4-6 months
7-9 months
> 9 months
Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association
between duration of breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.

Breastfeeding
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

Breastfeeding
Parent Benefits
 Saves money
 Saves time
 Babies love it

National Health Care Savings
If 90% of women breastfeed exclusively to
6 months, the U.S. could save annually
>$13 billion
and prevent the deaths of nearly
1,000 infants
Bartick M & Reinhold. (2010). The burden of suboptimal breastfeeding in the United
States: a pediatric cost analysis. Pediatrics, e1048-e1056.Amirhossein Talebi 38

Breast Pump

Risks of artificial feeding
 Interferes with bonding
 More diarrhoea and
respiratory infections
 Persistent diarrhoea
 Malnutrition
Vitamin A deficiency
 More likely to die
 More allergy and
milk intolerance
 Increased risk of some
chronic diseases
 Overweight
 Lower scores on
intelligence tests
 May become
pregnant sooner
 Increased risk of anaemia,
ovarian and breast cancer
Mother
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health
Organization, 1993 (WHO/CDR/93.6). Amirhossein Talebi 41

42
Problems in breastfeeding: Inverted
nipple
Treatment should begin
after birth
 Manually stretch and roll the
nipple between the thumb
and finger several times a
day
 Teach the mother to grasp
the breast tissue so that
areola forms a teat, and
allows the baby to feed
 Syringe suction method
Amirhossein Talebi

43
Inverted nipple: treatment by syringe method
STEP 1
STEP 3
STEP 2
Cut along this
line with blade
Mother gently pulls
the plunger
Insert the plunger
from cut end
Use 10 or 20cc syringe
Before feeds 5-8
times a day
STEP 4 Press at the edge and
allow air to enter before
removing the syringe
Amirhossein Talebi

Problems in breastfeeding: Sore
nipple
Look for a cause:
 Check the baby’s attachment
at the breast
 Check the baby’s position if
attachment is poor
 Examine the breasts –
engorgement, fissures,
candida
 Ask if mother washes the
breasts after each feed
(frequent washing leads to
sore nipple)
 If the problem persists, check
the baby’s oral cavity for
candida

Sore nipple: management
Give appropriate treatment:
 Build mother’s
confidence
 Improve the baby’s
attachment and continue
breastfeeding
 Reduce engorgement,
feed frequently, express
breast milk
 Treat candida
Advise the mother to:
 Wash breasts only
once a day; avoid
using soap
 Avoid medicated
lotions and ointments
 Gently apply hind milk
onto nipple and areola
after each feed

Steps to successful
breastfeeding
Step 1. Practice rooming-in —
allow mothers and infants
to remain together —
24 hours a day.

Rooming-in
A hospital arrangement where a
mother/baby pair stay in the same
room day and night, allowing unlimited
contact between mother and infant

Rooming-in
Why?
 Reduces costs
 Requires minimal equipment
 Requires no additional personnel
 Reduces infection
 Helps establish and maintain breastfeeding
 Facilitates the bonding process

Morbidity of newborn babies at Sanglah
Hospital before and after rooming-in
Adapted from: Soetjiningsih, Suraatmaja S. The advantages of rooming-in. Pediatrica
Indonesia, 1986, 26:231.
0%
2%
4%
6%
8%
10%
12%
Acute otitis
media
Diarrhoea Neonatal sepsis Meningitis
%ofnewbornbabies
6 months before rooming-in
6 months after rooming-in
n=205
n=17
n=77
n=11
n=61
n=17
n=25
n=4

Effect of rooming-in on frequency
of breastfeeding per 24 hours
Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-
in and breastfeeding variables. Acta Paediatr Scand, 1990, 79:1019.Amirhossein Talebi 50

Steps to successful
breastfeeding
Step 2. Encourage
breastfeeding on
demand.

Breastfeeding on demand:
Breastfeeding whenever the baby or
mother wants, with no restrictions on
the length or frequency of feeds.

Breastfeeding frequency during the first 24
hours after birth and incidence of
hyperbilirubinaemia (jaundice) on day 6
From: Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after
birth in full-term neonates. Pediatrics, 1990, 86(2):171-175.
28.1%
24.5%
15.2%
11.8%
0.0%
0%
10%
20%
30%
0-2 3-4 5-6 7-8 9-11
Frequency of breastfeeding/24 hours
Incidence
9
32
12
49
5
33
2
17
0
9
Slide 4.8.4

Mean feeding frequency during the
first 3 days of life and serum bilirubin
10.7
7.5
6.7
4.8
0
2
4
6
8
10
12
5 to 6 7 to 8 9 to 10 11+
Feeding frequency/24 hr
SerumBilirubin,mg/dl

Steps to successful
breastfeeding
Step 3. Give no artificial teats or
pacifiers (also called
dummies and soothers)
to breastfeeding infants.

Proportion of infants who were breastfed
up to 6 months of age according to
frequency of pacifier use at 1 month
Non-users vs part-
time users:
P<<0.001
Non-users vs. full-
time users:
P<0.001
From: Victora CG et al. Pacifier use and short breastfeeding duration: cause, consequence or
coincidence? Pediatrics, 1997, 99:445-453.Amirhossein Talebi 57

References
 Text book of Public health
 Babycenter.com
 Aap.com
 Unicef.org
 WHO newborn cc
 Department of health and senior services

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