Session 3 How Bf Works

How breastfeeding works After completing this session participants will be able to: • name the main parts of the breast and describe their function • describe the hormonal control of breast milk production and ejection • describe the difference between good and poor attachment of a baby at the breast • describe the difference between effective and ineffective suckling

Anatomy of the breast Oxytocin makes them contract Prolactin makes Milk-secreting cells them secrete milk

Muscle cells

Ducts Larger ducts Nipple Areola Montgomery’s glands Supporting tissue and fat

Alveoli

Is there a difference between a small breast and a large breast ?

Is there a difference between a small breast and a large breast ?

The FAT and other tissue gives the breast the shape Both contains the same amount of gland tissue

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Prolactin • Secreted during and after feed to produce next feed Sensory impulses from nipples Prolactin in blood

Baby suckling • More prolactin secreted at night • Suppresses ovulation

What can we suggest to help a mother INCREASE her milk supply ?

What can we suggest to a mother so she could INCREASE her milk supply ?

The more the baby suckles is produced

the more milk

Mother to eat and drink enough More prolactin is produced at night Hormones related to prolactin suppresses ovulation so breastfeeding can help delay a new pregnancy

Oxytocin reflex • Works before or during feed to make milk flow

Oxytocin in blood

Baby suckling

Sensory impulses from nipples

• Makes uterus contract

Oxytocin is • produced more quickly than prolactin. • makes the milk in the breast flow for this feed • can start working when mother expects a feed, even before a baby suckles • If oxytocin reflex does not work well, breast produce milk BUT not flowing out

Oxytocin

• makes uterus contracts after delivery • helps reduce bleeding • sometimes causes uterine pain and a rush of blood during a feed for the first few days

……..

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Helping and hindering of oxytocin reflex

These help reflex

These hinder reflex

• Thinks lovingly of baby

• Worry

• Sounds of baby

•Stress

• Sight of baby

• Pain

• Touches baby • Confidence

• Doubt (temporary)

Why is it important to understand the oxytocin reflex in the way we care for mothers after delivery ?

Why is it important to understand the oxytocin reflex in the way we care for mothers after delivery ?

Mother needs her baby NEAR her all the time You must remember a mother’s feelings whenever you talk to her… make her feel good and built her confidence Mothers are often aware of their oxytocin reflex ….several signs…. Open manual to page 18 and read out

Signs & sensations of an active Oxytocin reflex Mother may notice: • Squeezing or tingling sensation in her breast • Milk flow from breast • Milk dripping from other breast when baby is suckling • Pain from uterine contraction, sometimes with rush of blood • Slow deep sucks and swallowing by the baby which shows that milk is flowing into the mouth

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Inhibitor in breast milk

Inhibitor

Function of the inhibitor ?

If breast remains full of milk, secretion stops

Inhibitor • Controls production of milk from within the breast… If one breast stops production, the other continues • Protects breast from harmful effects of being too full • If BM is removed, inhibitor also removed… breast makes more milk

The inhibitor helps us understand why… If baby : • stops suckling breast stops making milk

• For breast to continue making milk, milk must be removed

• suckles more from one breast - breast becomes more larger, more milk

• If baby cannot suckle, EXPRESS milk to enable production to continue

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Attachment to the breast

What do you see ? come n explain

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Attachment to the breast

• More areola & underlying tissue inside mouth • Large ducts inside mouth • Formed long teat • Nipple forms only 1/3 of the “teat” • Baby suckling from breast and NOT nipple

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Attachment to the breast Baby’s tongue … • forward over his lower gum and beneath the larger ducts • cupped round the “teat” • presses milk out of larger ducts into baby’s mouth

When a baby suckles effectively… the mouth and tongue do not rub the skin of the breast and nipple

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Good and poor attachment What differences do you see?

1

2

Good and poor attachment

1

2

Nipple ? Larger duct – where ? Tongue can reach larger duct ? Tongue pressing duct ?

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Attachment (outside appearance) What differences do you see?

1

2

Attachment – outside appearance

1

2

• more areola above upper lip – reaching the larger ducts with his tongue • mouth widely open (nipple to nose technique) • lower lip turned outwards • chin touches the breast

What do you think might be the result of poor attachment ?

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Results of poor attachment











Painful nipples Damaged nipples Engorgement Baby unsatisfied and cries a lot Baby feeds frequently and for a long time Decreased milk production Baby fails to gain weight Mother may loose self confidence

To prevent complications of poor attachment…

• Teach the skill of proper positioning and attachment • Do not give feeding bottles

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Reflexes in the baby Rooting Reflex When something touches lips, baby opens mouth, puts tongue down and forward

Sucking Reflex When something touches palate, baby sucks

Skill Mother learns to position baby Baby learns to take breast

Swallowing Reflex When mouth fills with milk, baby swallows

Summary of session 3 is found on pages 15 to 21 of the participants’ manual

IYCF : An Integrated Course (October 2005)