Breast & Breastfeeding

practices

Akadri A.A
Senior Registrar, Dept of OBGYN
OOUTH.
 Introduction.
• The breasts are modification of sweat gland -
ectodermal in origin.
• They become prominent in females as the
hallmark of pubertal development .
• The size & shape of the breast are dependent on
age, race, genetic xteristic, physiologic state
such as pregnancy & lactation, breast disease.
• Normal cyclical changes are associated with
puberty , menstruation, pregnancy, lactation and
postmenopausal involution.
• It functions mainly as an organ for infant feeding.
 Anatomy.
• Overlies 2 to 6 rib, pectoralis major, serratus
nd th

ant, upper part of rectus sheath.

• Alveoli lobuleslobes(15-20)lactiferous
ductnipple
• Each lact dct lined by myoepithelial cells
• Areola & nipple also composed of some smooth
muscle  makes nipple erectile and cause
emptying of lact sinus during suckling.
• Large sebaceous glands abound in the areola.
These become more prominent during
pregnancy  Montgomery tubercules
lubricates areola
 Physiology.
• The breast begins to grow at puberty under
influence of estrogen.
• Far greater growth occurs during the high
estrogen state of pregnancy.
• Estrogen causes growth of ductal system &
alveolar budding. Prolactin , growth hormone,
adrenal glucocorticoids and insulin also take
part.
• Progesterone important for growth of lobule-
alveolar system i.e optimal maturation of
alveolar glands.
 Lactation.
• An intact hypothalamic-pituitary axis is
essential for initiation &maintenance .
• Can be divided into 3 stages :-
• Mammogenesis mammary growth &
devlop
• Lactogenesis initiation of milk secretion.
• Galactopoiesis maintenance of
established milk secretion
 Lactation.
• Prolactin is necessary for milk production,
but lactogenesis also requires a low-
estrogen environment.
• Sex steroids and prolactin are synergistic in
mammogenesis but antagonistic in
galactopoiesis.
• Lactation is not initiated until plasma
estrogen, progesterone and hPL fall after
delivery.
 Lactation.
Mammogenesis Lactogenesis Galactopoiesis

Estrogen Prolactin ↓Gonadal hormones

Progesterone ↓Estrogen Suckling (oxytocin,

prolactin)

Prolactin ↓Progesterone Growth hormone

Growth hormone ↓hpl Glucocorticoids

Glucocorticoids Glucocorticoids Insulin

Epithelial growth factor Insulin Thyroxin and parathyroid

hormone.
 Milk ejection
• Nipple stimulation by suckling4th -6th
intercostal nerves dorsal roots 
neurohypophysis oxytocin.
• adenohypophysis  inhibits
PIH(dopamine) prolactin milk
production
• Oxytocin  myoepithelial cells of alveoli
milk expressed into ducts milk let-down.
 Human milk
• Has the right amt of fat, sugar, water & protein
necessary for baby’s growth and development
• Colostrum, the premilk secretion, is a yellowish
alkaline secretion that may be present in the
last months of pregnancy & for first 2-3 days. It
has a higher protein , vitamin A,
immunoglobulin, and NaCl content; and a lower
CHO, K and fat content than mature milk. It is
an ideal natural starter food.
• All classes of immunoglobulins are found in
milk, but IgA constitute 90%.
Constituents Human milk% cow milk%

Water 88.5 3.5

Fat 3.3 3.5

Lactose 6.8 4.8

Casein 0.9 2.7

Lactalbumin &other 0.4 0.7

proteins

Ash (Ca &other minerals) 0.2 0.7

 Advantages of breastfeeding-
mother
• Convenient, economical and emotionally
satisfying to most women.
• Contracts uterus & accelerate uterine
involutn
• Promotes mother-infant bonding
• Improves maternal tolerance to stress via
oxytocin associated antifight/fight response
• May help in postpartum weight loss.
• Natural contraceptionlactation
amenorrhea
 Long term benefits- mother
• Protects against breast & ovarian cancer
• Lactation for at least 24 months
associated with a 23% lower risk of
coronary Ht dx
• Breastfeeding diabetic mothers require
less insulin.
• Reduced risk of metabolic syndrome
• Reduced risk of rheumatoid arthritis
 Advantages -infant
• Breast milk is digestible, of ideal
composition, right temperature , right time,
free of bacteria contamination.
• Greater immune health  contains
antibodies, anti-infective factors, lactoferin
(binds to iron and prevent growth of
intestinal bacteria), immunoglobulin A
• Fewer infectionsLower incidence of
diarrhoea, LRTI, UTI, Otitis media
 Advantages -infant

• Protection against NEC in preterm infants.

• Protection from SIDS.
• Less tendency to develop allergies & atopic dx.
• Promotes maternal-infant bonding.
• Less likely to be obese as neonates &
adolescent.
• Decreased risk of developing IDDM, crohn’s dx,
ulcerative colitis, lymphoma
• Cognitive development and intelligence may be
improved.
 Contraindications
• Use of street drugs, excess alcohol.
• Human T-cell leukemia virus type 1
• Active herpes simplex infection of breast
• Breast cancer
• Active pulmonary T.B in mother
• Galactosemia in infant
• Maternal intake of cancer chemotherapeutic
agents or certain other drugs bromocriptine,
cocaine, cyclophos, doxorubicin, lithium, MTX
etc
• ??? HIV
 Early breast feeding.
• Initiated in the first half hour after delivery.
• Baby’s sucking reflex is strongest at this
time, and baby is more alert.
• Early breast feeding is associated with
fewer nighttime feeding problems.
• Breast feeding more successful.
 Exclusive breast feeding
• An infant’s consumption of human milk
with no supplementation of any type (no
water, no juice, no nonhuman milk, and no
food) except for vitamins, minerals and
medications.
• Usual recommendation is that all infants be
exclusively breastfed for 4-6 months.
• Breastfeeding may continue with addition
of appropriate food for 2yrs or more.
 Expressing breast milk
• When direct BF is not possible, a mother
can express her milk
• Manually or use of breast pump.
• EBM may be kept at room temp for up to 6
hrs, refrigerated up to 8 days or frozen up to
4-6 months.
• Research suggest that the antioxidant
activity of EBM decreases over time but is
still higher than that of infant formula.
Manual breast pump.
 Mixed feeding.
• Giving breast milk along with infant
formula, baby food.
• If artificial teat is used there is tendency
for artificial teat preference since flow is
constant and baby does not have to elicit
let-down.
• Also prone to overfeeding.
 Tandem nursing.
• Feeding two children at a time who are not
twins or multiples
• The feeding habit and appetite of each baby
may vary, this could mean feeding each
baby according to individual need and can
also mean breastfeeding them together, one
on each breast.
• Tandem nursing occurs when a woman has
a baby while breast feeding an older child.
Proper latching.
 Extended breast feeding.
• Breastfeeding for period beyond social
norm.
• Duration of BF varies widely worldwide.
• WHO recommends breastfeeding for at
least 2years.
• In USA BF beyond 1yr
• Indian women wean at 3-4yrs
 BFHI
• Baby friendly hospital initiative is a
worldwide program launched by WHO &
UNICEF in 1991

• A global effort to improve role of maternity

services to enable mothers to breastfeed
babies for the best part in life.
 BFHI criteria.
• -Have a written breastfeeding policy that is
routinely communicated to all health care
staff.
• Train all health care staff in skills necessary to
implement this policy
• -Inform all pregnant women about the
benefits and management of breastfeeding.
• Help mothers initiate breastfeeding within
one half-hour of birth.
• Show mothers how to breastfeed and
maintain lactation, even if they should be
separated from their infants.
 BFHI- criteria
• Give newborn infants no food or drink other
than breastmilk, not even sips of water, unless
medically indicated.
• Practice rooming in - that is, allow mothers
and infants to remain together 24 hours a day.
• Encourage breastfeeding on demand.
• Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding infants.
• Foster the establishment of breastfeeding
support groups and refer mothers to them on
discharge from the hospital or clinic.
 Disorders of lactation.
PAINFUL NIPPLES
• Cracked nipple
• Use of vit A & D ointment or hydrous
lanolin
• Begin BF on opposite breast
• Nipple shield should be last resort.
• Analgesics
 Engorgement
• Occurs in 1st weekpostpartum due
tovascular congestion and milk
accumulation.
• Breast becomes firm,warm and lobules may
be palpable as tender irregular masses
• Discomfort and slight fever.
• Treatment :- Analgesics, cool compress,
partial expression of milk before nursing.
 Mastitis
• Occurs frequently in primiparous nursing
patients
• Caused by coagulase +ve staph aureus
• Painful breast, high fever
• Treatment antibiotics, encourage
mother to continue breastfeeding or
manually expressing milk.
 Breast abscess
• Results when mastitis is not well treated
• Surgical drainage and broad spectrum
antibiotics.
 Suppression of lactation
• Stop nursing to avoid nipple stimulation.
• Refrain from expressing or pumping the
milk
• Wear tightfitting supportive bra
• Avoid nipple stimulation
• Other methods fluid restriction, use of
diuretics
• Medical bromocriptine, cabergoline.
THANK YOU