Lactation

“The nature has designed the provision that infants fed upon their mother’s milk. They find their food and mother at the same time. Its complete nourishment for them both for their body and soul.” –Rabindranath Tagore

Physiology of lactation

When you are pregnant, your body is preparing to breastfeed and your breast undergoes many changes throughout pregnancy. The various changes in hormones that take place during pregnancy influence the growth & development of your breast.

Breast development & function

1. Mammogenesis:
   Means breast development which begins when we are born & continue through puberty and the process is completed during Pregnancy.
2. Lactogenesis:
   • Stage 1:
     Mid Pregnancy till 2 days of Postpartum. Beginning of breast milk secreation.Stage 2:
     From day 2 to Day 3 of Postpartum.  Starts at about 28 weeks of pregnancy. During this time you may begin to realize that you are  leaking colostrums which is held in milk duct and its secreted during the initial postpartum  period.
   • Stage 3:
     Also known as Galactopoiesis, from establishment of milk to weaning.  Starts at about 72 hrs.postpartum. It is the beginning of mature breast milk supply, which is  made up of fore milk & hind milk.
   • Stage 4:
     Involution, from weaning to when completely stop producing milk.

Breast changes during pregnancy

Breast changes begin after conception and the weight of the breast increases approximately 12 ounces during pregnancy.

• As the pregnancy progresses, the breast will increase in size and areola will darken.
• The skin surrounding the breast will seem thinner and veins will be more noticeable.
• The Montgomery gland (tiny little bumps on the areola that secrete natural oil to lubricate the area and help to prevent bacteria) becomes larger and more noticeable and the nipples become more pronounced.

The Breast consists of ducts, alveoli and fibro fatty connective tissue.

Mammogenesis    :   Preparation of Breast

Lactogenesis         :   Synthesis and secretion of milk by breast

Galactokinesis      :   Ejection of milk

Galactopoiesis      :   Maintenance of lactation

Position for Breast feeding

There are multiple positions to breastfeed the baby. Any position is acceptable.

The most important aspect of breast feeding is Proper sitting position with back support, as bad posture can aggravates backache.

The various positions for Breast Feeding are as follows:

1. Cradle Hold ( Same arm): Holding your baby across your lap supporting her with the same arm as your breast.Rest your elbow on pillow to avoid numbness in hand.
2. Cradle Hold ( Opposite arm) : Holding your baby across your lap, using the opposite arm to the breast.
3. Rugby Ball Hold: Holding your baby under arm
4. Twins Hold :  Using a cushion under your babies as you gentlysupport them with your hands on their upper backs
5. Laid – Back Breastfeeding After a Caesarean:
   Semi- reclined, with your baby lying vertically on you, to protect your caesarean wound

Latching – The Right Technique

Latching on is the creation of a tight seal around nipple and most of the areola through the baby’s mouth.
Ideally baby’s lower lip should be covering more of aerola than the upper lip and nipple should not hurt after few mins.
To make sure Your baby is positioned properly at the breast, check the following points:

• Your baby’s entire body, including her neck, shoulder and abdomen, should be facing you and close to your body. Her chin should touch the breast.
• The Mouth should be wide open with her lips curled outwards.
• The baby should be taking slow and deep sucks
• After the feed, the baby should appear relaxed and satisfied.
• One breast at a time of feeding will supply “hind Milk” which is important for baby’s immunity to fight against infection and baby’s hunger.

Frequency & Duration:

Babies are born with an innate ability and desire to breastfeed. When a healthy infant given an opportunity and time to breastfeed, they usually get themselves to the mother breast and begin nursing.

At the earliest:
In the healthy neonates suckling reflex is at its peak 30 – 40 mins after birth. So breastfeeding should start in the delivery room itself, soon after baby is born.

Frequency of breast feeding follows the principle of  “on Demand”

• Newborn babies want to feed on demand, which is usually every 1 to 3 hrs
• Breastfed babies feed more than bottle fed babies because breast milk is more easily digested as it contents vitamins, minerals and enzymes which aid digestion
• Baby should be fed throughout the day & the night as per demand, breast feeding on Demand results in milk ejection reflex.

Advantages of breastfeeding are numerous

• Breast milk is the only food that a baby needs upto 6 months of life, and it gives the best possible nutritional start to the neonate.
• Colostrum, the first milk, it’s vital for the baby.
• Size of the breast does not have any effect on the quantity of milk produced.
• Women of all ages with either small or big breast can breastfeed their babies well. Breastfeeding does not spoil a woman’s figure, on the contrary it helps to loose the weight.

Advantages of breast feeding to mother

• Loving Bond with Your Baby:
  Breastfeeding facilities a close, loving bond between you & your baby. This may also help your child to form good relationship with other people
• Lower Risk of Bleeding after Delivery:
  Breastfeeding the baby soon after birth helps to stop bleeding from uterus after delivery and assists in the explusion of placenta.
• Reduced Risk of Cancer:
  The risk of cancer of the breast and the ovaries is reduced in breastfeeding mother.
• Quicker Regaining of the Figure:
  Contrary to the popular belief, a women who breastfed regain her figure faster compared to a women who does not.
  This is because a breastfeeding mother utilizes the fat that is normally accumulated during pregnancy in different part of her body for production of breast milk.
  As the baby suckles, the mother’s system generates hormones that make her enlarged uterus contract. As the uterus goes back to its normal position the abdomen of a breastfeeding mother regain its shape faster than the abdomen of one who does not.
• Convenience:
  Breast milk is always ready to be given to the baby, it does not need any preparation.It does not get spoil in the breast even if the mother is not able to feed her baby for a number of days.
• Delayed Risk Of Conception:
  As long as a woman does not have her period and exclusively breastfeeds, she gets 98% protection from pregnancy in the first 6 months after delivery. However, the couple is also advised to use other family planning methods suitable to them.
• Calming Effect:
  For many women, breastfeeding confers a sense of calm and satisfaction which is probably related to be helpful hormonal changes while breastfeeding.

Before Breastfeeding your baby:

• Wash your hands
• Position yourself comfortably and
• Use lots of pillows or towels for support
• Turnover the breast you wish to offer first, and clean it with water first.

Advantages to Your Baby:

• Complete Nutrition:
  Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, proteins and fat everything your baby need to grow. And it’s all provided in a form more easily digested than infant formula.
• Protection against Infection:
  Breast milk contains antibodies that help your baby fight off viruses and bacteria.
• Better Teeth & Jaw Development:
  Breastfed baby is likely to have a better configuration of face and alignment of teeth.Caries in the teeth are also less in breastfed children.
• Lowered Risk of Diabetes:
  There is a reduced risk of insulin dependent diabetes mellitus among breastfed children.
• Enhanced Intelligence:
  Boost your child’s intelligence
• Sucking – Best Exercise:
  Sucking is the best exercise for baby as well as mother as to produce enough milk for a baby.
• Earlier Passage of Meconium
• Lowers maximal weight loss
• Breast milk flow is established soon
• Loss of neonatal jaundice

ABC’s of Breastfeeding

A = Awareness

• Watch your baby’s sign of hunger and breastfeed whenever your baby is hungry. This is called “On Demand’’ feeling.
• When Hungry the baby move their hands towards their mouth.
• Make sucking noise or mouth movement or move towards your breast.
• Don’t wait for your baby to cry, as it is very late by then.

B = Be Patient

Breastfeed as long as your baby wants to nurse each time. Infants typically breastfeed for 10 to 20 mins on each breast.

C = Comfort
This is key. Relax while breastfeeding and your milk is more likely to “let down’’ and flow.
Get yourself comfortable with pillow as needed to support your arms, head and neck.

Indication of Adequate Feed / Your Baby is getting enough to feed if:

• No of feeds each day ( 8 or on demand)
• If baby sleeps well for 2-3 hrs after feed.
• Urine output 6-8 diapers per day
• No. of stool 4-5 times per day
• Proper weight gain
• They fed 8-12 times in one day and alternately suck on each breast for 10-15 mnts.
• Adequate wet diapers 2/3 times per day by day 3 of birth and 6 or more per day after day 6 of birth.
• Weight gain – your baby should gain around 1 pound per month

Preparation of Breast for Lactation

• Massage your Nipple:
  Basically adviced for “flat nipples’’ in third trimester of pregnancy.  It is for preparing the breast for lactation do the nipple massage or pulling out the nipple gently with ghee/ oil before bath.
• Massage your Breast:
  Massage your breast and be gentle. Do not rough up. The massage should be gentle not painful. Start the massage above the breast with a circular motion using the tip of the fingers and move towards the nipple. Then move again to the outside of the breast in the different area and repeat moving towards the nipple. Do this until you have moved around the entire breast.
  Advantages:
  Massaging your breast will help you relax and prepare you in case you need to manually express milk for the baby. Avoid wearing Brassaries.

Care for Breast Feeding:

While you are breast feeding, you should get into a routine of taking care of your breast, especially the nipples, which will benefit you and your baby.

• Wash your breast each day with warm water during bath.
• Avoid using soaps, which can cause dry, cracked and irritated skin, and can removed the natural oils produced by the Montgomery gland located on the dark area surrounding your nipple. This oil is important as it cleans and moisturizes nipple and areola.
• After nursing your baby, moisturize your nipple and areola by rubbing some of your breast milk on them and letting them air dry.
• When removing your baby from breast do not pull off. Place your finger in the corner of the baby mouth to break suction between her mouth and your breast.

Breast Feeding Complications:

Breast feeding may not always be easy and you can expect to have following complication

• Retracted nipple.
• Sore nipple & Crack nipple
• Engorgement
• Mastitis & Breast absess.
• Inverted Nipple
  Antenatal examinatation and counseling for cleaning and their antiversion is
  important.
  Treatment: 20cc syringe may be used for correcting retraction.
• Sore Nipple & Crack Nipple:
  It is commonest complication.
  Causes – Improper Latching
  Symptom – Pain, redness, crack , tender
  Treatment– Air drying and applying own milk
  Soft Silicon Nipple – Should not stop feeding due to crack or sore nipple
  Use soft silicon nipple, which is easily available in market and feed baby
  Apply Linolin cream or Aleovera gel

• Engorgement:
  Swollen breast due to increased milk production.It may be early or
  late. Early engorgement resolves with baby sucking
  Symptom – Pain, swelling, warm, hard
  Treatment – Warm compresses
  Milk Expression
  Gentle Massage
  Breast Support

• Mastitis & Breast Abscess:
  Symptoms – Pain, fullness, fever with or without chills, swelling,
  red,  tender.
  Treatment – Broad spectrum antibiotics
  Anti – inflammatory drugs
  Breast support
  Feeding Continue
  Untreated or under treated neglected cases may lead to abscess
  formation.

Prevention for Breast Feeding Complication:

• Breast feed frequently 8 – 12 times in 24 hrs.
• Express your milk when feedings are missed
• Alternate nursing position to consistently empty milk duct.
• Avoid using excess amount of soap on breast during bath.

Causes of Lactation Failure:

• Psychological Causes:
  • Lack of self confidence, primigravida, teen mother, unsuccessful breast feeding in earlier pregnancy &
    inadequate antenatal counseling.
  • Physical & Mental Stress
  • Inadequate maternal leave can also affect lactation as attention towards baby goes down & it will affect milk production.
• Incorrect Breast Feeding Practices:
  • Delay onset of breast feeding.
  • Infrequent or less vigorous breast feeding.
  • Painful breast or nipple condition
  • Weak or preterm baby.
  • Wrong position.
• Extremely sick mother

Storage of Milk:

Breast milk can be store in clean & sterilized container, glass or plastic bottle. Bottle should be label with date of expression.

Do not store milk in the door compartment of refrigerator or freezer.

Expression of Breast Milk:

Mother express milk for a variety reasons

• The baby needs breast milk as top-up feed following breast feed
• Baby may not suckle well at the breast or low birth baby.
• Mother going back for work
• Some women regularly express to maintain or increase their milk
  production

Three ways to express milk:

1. Hand Expression
2. Hand held breast pump or autoclave 20 ml syringe
3. Electric Breast pump

Remedies to Increase the Breast Milk

• In 8th month of pregnancy , start taking shatavari powder in milk or lactase twice a day
• Drink a glass of water before every feed.
• Back massage also helps in lactation
• Baby should be first & last priority to mother & should sleep when baby sleep so that she will not have any problem in feeding.

Food which increase breast milk:

• Whole grains,especially oatmeal
• Dark leafy green vegetableli>
• Garlic , Ginger
• Nuts & seeds especially almonds
• Spices like cumin seeds, turmeric powder
• Fenugreek, sesame seeds

Recipes for food which increase breast milk:

1. Sabudana (Tapioca Root)
   The humble Sabudana Khichadi has the incredible power to increase and boost milk supply in lactating mothers.
2. 
   02 Dalia (Broken Wheat)
   A traditional dish mostly given to nursing moms in North India, that helps in improving the quantity of milk. Simply roast dalia in ghee, add a cup of milk and bring it to boil. Add sugar and a pinch of salt. Also make sure to try the namkeen dalia upma in case you need a break from the sweet version.
3. 03 Moong Dal Palak (Green Gram Dal)
   This dish has has three power packed ingredients guaranteed to increase milk supply. Moong Dal, Palak and garlic will help lactating mothers and this curry goes well with roti or rice.
4. 
   04 Methi ki sabji or parathas (Fenugreek)
   Include plenty of methi in your diet. This promotes and increases milk secretion.
5. 05 Brown rice pulao
   AIt’s a good idea to skip the white rice while breastfeeding. Brown rice has the effect to stimulate the milk producing hormones in women. Brown rice pulao, brown rice idlis, brown rice dosas. Think and substitute brown rice any where you use white rice.
6. 
   06 Pomegranate Juice
   Excellent for boosting milk supply.
7. 07 Palak soup (Spinach Soup)
   Palak Soup or Spinach soup is super healthy and contains photo-oestrogen a plant based chemical similar to estrogen (hormone responsible for milk production in women).
8. 08 Bajra Raab/Soup (Pearl millet)
   Bajra Raab is a Gujarati soup dish made of bajra and ajwain (Carom Seeds/Thymol seeds/Thyme leaves). Both healthy ingredients recommended for nursing moms.