BREAST-FEEDING

1. BREAST-FEEDING Myrna D.C. San Pedro MD, FPPS

2. BREAST-FEEDING • Breast milk: the most ideal, safe & complete food • Breast milk protein of good biological value • Thus by WHO, lactation may continue to 18-24 months

3. BREAST STRUCTURE • Each breast has 15 to 20 lobes of milk-producing glandular tissue • Each lobe is made up of many smaller lobules • Special channels called ducts run from these lobes • Spaces around the lobules and ducts are filled with fatty & connective tissue stroma that determines the size • The actual milk-producing structures nearly the same in all • Nipple skin contains many nerves, oil & sweat secreting glands

4. WHAT HAS CHANGED? University of Western Australia’s Human Lactation Research Group, with Medela, investigated the lactating breast using sophisticated ultrasound technology & research results overturned 160 years of received wisdom concerning the female breast.

5. SUCKLING HORMONE REFLEX ARC • Nipple stimulation from baby’s breast suckling • Message sent to spinal cord, then brain • Increased prolactin levels released by anterior pituitary for milk production • Increased oxytocin levels released by posterior pituitary for milk ejection reflex

7. Proper quality & quantity of nutrients Rates of growth better in the 1st 3-4 months Anti-infective properties universally accepted Prevents allergy due to high IgA preventing antigen absorption Contraceptive property, high levels of prolactin inhibit synthesis of ovarian steroids causing delay of ovulation & pregnancy Psychological advantages a. Fosters mother-child relationship b. Tactile contact makes babies more secure, emotionally stable c. A sense of fulfillment, satisfaction & joy for the mother Protective against a. Necrotizing enterocolitis b. Otitis media c. Dental caries Others: a. Safe, contains no pathogens b. Always at the right temperature c. Convenient & always available ADVANTAGES OF BREAST-FEEDING

8. Breast milk esp colostrum contains plenty of antibodies E. coli antibodies present High % of lactose stimulates Lactobacillus bifidus Lactoferrin binds iron & inhibits growth of E. coli, staphylococci & Candida albicans Lysozyme bacteriostatic against enterobacteriaceae & staphylococcus species Anti-staphylococcus factor Lactoperoxidase kills streptococcic & enteric bacteria Secretory IgA against intestinal bacteria Macrophages 90% of leucocytes involved in phagocytosis & synthesis of bacteriostatic proteins: lactoferrin, lysozyme & complements C3, C4 Lymphocytes comprise 10%, approximately 34% B-lymphocytes responsible for synthesis of IgA T-lymphocytes 50% against E. coli, rubella, CMV & mumps viruses & transfer delayed hypersensitivity ANTI-INFECTIVE PROPERTIES

9. ANTENATAL PREPARATIONTECHNIQUES • Wear fitted maternity bra from 5th month • Daily bath enough for cleaning nipples, avoid soap, alcohol & drying agents • Rub nipples & areolae with little anhydrous lanolin to make more supple • Express colostrum from 7th month by squeezing areola between index finger & thumb about 3x each side • Practice Hoffman’s maneuver (tactile stimulation by thumb & opposing forefinger in the horizontal & vertical planes) for flat or pseudo-inverted nipple

10. POSTNATAL PROCEDURES • Breast-feeding maybe started about 30 min after NSD & 3-4 hrs after C/S • The baby should be in a comfortable, semi-sitting position with the baby’s lips engaging considerable areola & the breast not obstructing breathing • The mother should be seated comfortably & relaxed (she can feed in the recumbent position if she prefers) with the areola held between her index & middle fingers or between thumb & index finger to enable & control milk flow • Baby obtains 95% of milk in the 1st 5 min & frequent feeds as well as short feeds on alternate breasts ideal then burp after • It is important to teach mother how to break suction of baby when she feels it is time to stop by pressing on a portion of the breast near baby’s lips to let air into mouth which prevents painful tagging between mother & child minimizing sore nipples

11. FACTORS INFLUENCING COMPOSITION • Time of day • Mother’s diet • Mother’s emotional state • Whether fore or hind milk • Drugs • Smoking

15. DETERMINING ADEQUACY • If infant is satisfied after breast feeding • Sleeps well, about 2-4 hours, and contented till next feeding time • Regularly and adequately gaining weight • The “let-down” or milk rejection reflex in the mother is an important sign

16. REASONS FOR NOT OR STOPPING BREAST-FEEDING • Lack of motivation or preparation of mothers • Anxiety, fear & uncertainty in the mother • Aesthetic reasons • Status seeking & effective promotion of infant foods • Mothers work to increase & augment family income • Separate maternity & nursery wards • Milk formula easily sucked from the bottle nipple • Cultural milieu • Mothers who can’t despite all desires & attempts • Presence of contraindications

17. CONTRAINDICATIONS • Absolute: chronic diseases like open TB, cardiac diseases, thyrotoxicosis, advanced nephritis, mental & seizure disorders • Relative: when mother is taking anticoagulants, antibiotics, steroids or potentially toxic substances like benzene products • Mechanical contraindications on the part of the mother: retracted or oversized nipples • Mechanical contraindications on the part of the baby: congenital anomalies like harelip & cleft palate but breast milk may be pumped & given • Allergy should be proven

18. WET NURSING • When breast milk fed to an infant is obtained from a lactating woman other than the mother • For infants, like LBWs, who don’t seem to do well with any other type of milk • A good lactating woman should be able to supply milk for 2-3 babies at same time • A wet nurse should be in good health, have good personal hygiene & enough milk for another infant in addition to her own who is thriving well

19. Thank You! The positive thinker sees the invisible, feels the intangible, and achieves the impossible.