1. BREAST FEEDING
Dr. Yahia Solan

2. Objectives # Identify 3 parts of breast anatomy.
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.

3. 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 darkens
If a pregnant mother has NOT noticed any of
these changes: REFER her to Gynecologist

4. Breast Anatomy
Areola
Montgomery
glands
Nipple
Alveoli
Milk ducts

5. # Everted (most common type) # Flat # Semi-Inverted # Inverted
Types of Nipples
# Everted (most common type)
# Flat
# Semi-Inverted
# Inverted
# Wide or Non-stretchable

6. Everted Nipple

7. Flat Nipple

8. Inverted Nipple

9. 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, let
her know that she should be able to breastfeed
REFER HER

10. 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 the
amount of milk she can make

11. Milk Production – Hormones play an important role in milk production
– Hormones cause many of the feelings mothers
have while breastfeeding
– 3 important hormones during breastfeeding are…
# Progesterone
# Prolactin
# Oxytocin

12. Stages in Milk Production
# Colostrum – First Milk
– Thick, yellow milk
– Made last 3 months of
pregnancy & after
delivery
– Perfect for newborns
– “First Immunization”
– Helps baby pass
meconium stool
– Colostrum changes to
mature milk over time

13. 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”

14. Baby needs hindmilk before switching
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 switching
to the other breast

16. 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

17. 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

18. # Babies of mothers with larger storage capacity feed less often
Breast Storage Capacity
# Babies of mothers with larger storage
capacity feed less often
# Babies of mothers with smaller storage
capacity feed more often

19. 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

20. Getting Breastfeeding Off to a
Good Start

21. Positioning # Learning to breastfeed # 4 common positions
– Clutch Hold (football)
– Cross-Cradle Hold (transitional)
– Cradle Hold (traditional)
– Side-lying Hold

22. 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

23. Positioning # Hold baby with her palm facing ceiling
# Bring baby to breast
# Baby’s head, chest & knees face same
direction (toward mother’s body)

24. Cross cradle
Clutch position
Cradle position

25. 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

26. 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

27. Latch Activity # Inflate balloon # Use lipstick # Place balloon
straight in your
mouth
# Check to see
where your lips
were

28. Latch Activity # Ridge the “breast” into a sandwich # Place balloon
straight in your
mouth
# Check to see
where your lips
were

29. Latch Activity # Ridge the “breast” # Place lower lip on
the underside of
“breast”
# Roll the “breast”
into your mouth
# Check to see
where your lips
were

30. “Breastfeeding” is not “nipple feeding”
4 Steps to a Successful Latch
1. “Ridge” the breast (sandwich)
2. Bring baby’s nose toward nipple
3. Lower lip touches breast first
4. Mouth takes in the underside of the areola & breast
“Breastfeeding” is not “nipple feeding”

31. 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

32. LATCH

33. Feeding

34. 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

35. 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

36. Feeding Patterns
Newborns
# Frequent feedings
# Cluster feedings

37. Signs that Breast feeding
is Going Well

38. Weight Gain # Best sign baby is getting enough breast milk
# Babies lose weight after birth - regain weight by 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

39. 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

40. 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)

41. Stool: Day 1 & 2
(1 - 2 thick, dark, tarry stools)

42. Stool: Day 3
(3 greenish-yellow stools)

43. Stool: Day 5 and beyond
(3-5 mustard-yellow, seedy, thinner stools)

44. Breastfeeding Problems
Discussion: Early
Breastfeeding Problems

45. Sore Nipples
# Nipple soreness in beginning – NORMAL
# NOT normal:
Bruised
Bleeding
Blistered nipples

46. 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

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

48. “Damaged Nipple”

49. “Badly Damaged Nipple”

50. 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

52. Normal Fullness
vs.
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

53. “Engorged Breasts”

54. Helping Mothers with
Engorgement
# 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

55. Engorgement is a breastfeeding emergency!
Helping Mothers with
Engorgement
# 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!

56. 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

57. 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

58. 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 days
or starts to get a fever...
REFER

59. 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!

60. “Mastitis - both breasts”

61. 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.

62. 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

63. 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

64. Babies that Refuse to 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

65. 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

66. 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.

67. Help mothers initiate breastfeeding within half an hour of birth.
10 Steps to Successful Breastfeeding (endorsed by the AAFP)
Develop a written breastfeeding policy and routinely communicate it to all health care staff.
Train all health care staff in skills necessary to implement the policy.
Inform all pregnant women about the benefits and management of breastfeeding.
Help mothers initiate breastfeeding within half an hour of birth.
Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
Give newborn infants no food or drink other than breast milk, unless medically indicated.
Practice rooming-in: 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.

68. Questions to Ask to Assess 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?

69. Questions to Ask to Assess 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?

70. Questions to Ask to Assess 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?

71. Case Studies
My baby is nursing so much that my
nipples are sore. Can I have formula?

72. "Exclusive breastfeeding for the first
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

73. ادام الله لكم لباس الصحة والعافية ودمتم سالمين
وفي الختام نقول لكم
ادام الله لكم لباس
الصحة والعافية
ودمتم سالمين

74. THANK YOU