Class session -15 Physiology of breast milk production Binitha /Maternal Nursing /2017 Objectives 1. Describe physiology of breast milk production. 2. Discuss the advantages of breastfeeding. 3. Describe breastfeeding technique. 4. Discuss nursing care plan related to newborn breast feeding(SLA). Binitha /Maternal Nursing /2017 • It is universally agreed that breast milk is preffered method of feeding new born. Binitha /Maternal Nursing /2017 Binitha /Maternal Nursing /2017 • BREASTS – 2 glands situated over pectoralis muscles; 15 to 20 lobes each with many lobules ↓ acini cells( Alveolar Cells) – begin to secrete colostrum in mid-pregnancy and milk after birth • Closed lactiferous ducts connects lobes and lobules under areola to make sinuses (ampullae), which can enlarge to serve as reservoir for colostrum and milk. Binitha /Maternal Nursing /2017 • In areola (pigmented skin around nipple), sebaceous glands form Montgomery’s tubercles (secrete oil to lubricate and protect nipple) • Montgomery’s tubercles – small, white, elevated patches on pigmented areola. • Nipple – outlet for the ducts Binitha /Maternal Nursing /2017 • 1.) PRODUCTION OF MILK - when placenta is expelled, Progesterone levels fall → Prolactin to be released by Anterior pitutory Gland + - When infant suck the breast ,the nerve impulse travells fron nipple to hypothamus stimulate prolactin production + acts on acinar cells(alveolar cells )of breast to stimulate the production of breast milk Binitha /Maternal Nursing /2017 • 2.) Flow of milk Milk flow from Alveoli → Through small tubules flows to the Reservoir- lactiferous sinus located behind nipple. - act of sucking a lactating breast creates a neurohormonal reflex Release of Oxytocin from posterior pitutory gland) Causes the collecting sinuses of mammary glands to contract, forcing milk forward through nipple making it available for baby (this is called “let-down reflex” but can be inhibited by pain, anxiety…. Binitha /Maternal Nursing /2017 • 3.)Withdrawal of milk -when baby sucks, he takes nipple and areola into mouth and by creating and clamping action of his jaws, milk is pushed into his mouth and swallows. - sucking reflex causes flow of prolactin Binitha /Maternal Nursing /2017 Hormones help in lactation 1. Prolactin – Stimulate the production of breast milk by acting on acinar cells of breast 2. OxytocinCauses the collecting sinuses of mammary glands to contract and milk will flow to the nipple making it available for baby 3. Adrenocorticotropic hormone,Thyroid stimulating hormone and growth hormone – Help in the growth of breast and it’s ability to secrete breast milk Binitha /Maternal Nursing /2017 Colostrum – • Thin watery yellow fluid composed of protein,sugar , minerals,vitamins and maternal antibodies secreted by acinar breast cells. • Colostrum production start in the fourth month of pregnancy and continues upto first 3 or 4 days after birth. • Since it is high in protein,low in sugar and fat very easy to digest and provide complete nutrition • Colostrum is replaced by transitional breast milk on 2nd to 4th day after delivery • True or mature breast milk is produced on 10th day Binitha /Maternal Nursing /2017 • Fore milk – constantly forming breast milk is called foremilk • Hind milk – New milk produced after the letdown reflex .Hind milk is higher in fat than foremilk ,is the milk that help the baby to grow fastly Binitha /Maternal Nursing /2017 MAINTENANCE OF LACTATION Factors: • Stimulus • Complete emptying of breast Binitha /Maternal Nursing /2017 Advantages of Breast feeding Binitha /Maternal Nursing /2017 Advantages to the mother For the mother: • Breastfeeding prevent breast cancer. • The release of oxytocin from the posterior pituitary gland aids in uterine involution. • Successful breastfeeding can have an empowering effect, because it is a skill only a woman can master. • Breastfeeding reduces the cost of feeding and preparation time. • Breastfeeding provides an excellent opportunity to enhance a true symbiotic bond between mother and child. Binitha /Maternal Nursing /2017 Advantages for the baby For an Infant: B.I.L.L.L.S • Bifidus factor: promote the growth of lactobacillus bifidus in GIT which reduces the incidence of diarrhea. • Interferon(a protein that protects against viruses): help interfere with virus growth. • Lactoferrin: is an iron-binding protein in breast milk that also kills pathogenic bacteria Binitha /Maternal Nursing /2017 Contd…. • Leukocytes: in breast milk provide protection against common respiratory infectious invaders. • Lysozyme: in breast milk apparently actively destroys bacteria by lysing (dissolving) their cell membranes. • Secretary immunoglobulin A(IgA): keeping viruses and bacteria from being absorbed from the infant’s gastrointestinal tract Binitha /Maternal Nursing /2017 ADVANTAGES OF BREAST FEEDING To the baby : • Breast milk has easily digested proteins. Lactose and fats • It gives the baby all the nourishment required(balanced nutrition) • Contains antibodies protecting baby from infections • Most hygienic and cleanest, does not require any preparation • Cheap and does not cost money Binitha /Maternal Nursing /2017 Techniques of Breastfeeding • Practicing breast massage to move the milk forward in the milk ducts (manual expression of milk) may be helpful. Binitha /Maternal Nursing /2017 Breast feeding positions Cradle Hold Position Foot Ball Hold position Side Lying Position The Cross cradle Position Same of cradle position but just the opposite hand was used to support the infant and the same side hand was used to hold the breast. Binitha /Maternal Nursing /2017 Binitha /Maternal Nursing /2017 Signs of Successful Breast feeding Acceptable crieteria during the first week of life• Wetting six to eight diapers • Within 24 hours or losing no more than 10% of birth weight. After the first week, weight gain and voiding six to eight times each 24 hours are good criteria Binitha /Maternal Nursing /2017 Measures to promote breast feeding • Sitting relaxed while feeding the baby and enjoying this time is an excellent way to rest • Increase the calorie intake by about 500 calories a day. • Remind women that adequate maternal fluid intake(1.5 Litres/day)is necessary to maintain an adequate milk supply Binitha /Maternal Nursing /2017 Burping the Breastfed Baby • Infants swallow air when they breastfeed. As a rule, it is helpful to bubble(burp) newborns after they have emptied the first breast and again after the total feeding. Technique1. Placing the baby over one shoulder and gently patting or stroking the back is an acceptable position. 2. Holding the baby in a sitting position on the lap, then leaning the child forward against one hand, with the index finger and thumb supporting the head, is often the best position to use. Binitha /Maternal Nursing /2017 Contraindications of Breast Feeding • Mothers suffering from HIV infection • Mothers with open pulmonary tuberculosis Binitha /Maternal Nursing /2017 Questions • What are the signs of successful breast feeding ? • What are the contraindications of Breast feeding ? Binitha /Maternal Nursing /2017 Nursing management Binitha /Maternal Nursing /2017 Nursing Diagnosis Related to Breast Feeding •Health-seeking behaviors related to lack of knowledge about lactation and breastfeeding Techniques •Effective breastfeeding related to wrong breast feeding positions/anxiety and inexperience •Anxiety related to inability to measure amount of milk taken by the baby •Pain related to primary breast engorgement Binitha /Maternal Nursing /2017 ENGORGED BREASTS – On the third or fourth day after birth, when breast milk forms, some women may notice breast distention, accompanied by hardness, tenderness, and heat in their breasts. The skin appears red, tense, and shiny. This is primary engorgement, Cause Vascular and lymphatic congestion arising from an increase in the blood and lymph supply to the breasts. Infants have difficulty sucking on engorged breasts,because the areola is too hard to grasp • • • • Breast engorgement – Management( Ng Intervention) Make the infant suck more often to empty the breast . Express milk by hand / breast pump to complete emptying of the breasts after the baby has nursed. Apply warm packs to both breasts or standing under a warm shower for a few minutes before feeding, combined with massage to begin milk flow, often promotes breast softness so an infant can suck. Good breast support from a firm-fitting bra helps prevent a pulling, heavy feeling SORE NIPPLES – Painful nipples result from the strong sucking action of a newborn. This may be worsened by: • Improper positioning of an infant (failure to grasp the areola as well as the nipple) • Forcefully pulling an infant from a breast • Allowing an infant to suck too long at a breast after the breast is emptied • Permitting a nipple to remain wet from leaking milk Sore Nipple-Nursing Intervention/Management Encourage a mother to position her baby slightly differently for each feeding. This helps prevent the same area of the nipple from receiving the majority of pressure. Advise her to expose her nipples to air by for 10 to 15 minutes after feeding. Applying a few drops of breast milk to the nipples after feeding and gently massaging it into the areola. Aloe vera or vitamin E applied to nipples helps heal tissue Advise women not to use a hand pump with sore nipples. Avoid use of soaps to clean the breast - to cause dryness. Sign of successful Breast feeding • One or two wet diapers during the first few days. • Six to eight wet cloth diapers (5 - 6 wet disposable diapers) per day (24 hours). • At least two to five bowel movements every 24 hours. • 6 - 10 feedings per24-hours. • Baby’s swallowing sounds are audible. • . Binitha /Maternal Nursing /2017 Binitha /Maternal Nursing /2017
