Transcript Document

BREAST-FEEDING
Myrna D.C. San Pedro MD, FPPS
BREAST-FEEDING
• Breast milk: the most ideal, safe &
complete food
• Breast milk protein of good biological
value
• Thus by WHO, lactation may
continue to 18-24 months
BREAST STRUCTURE
• Each breast has 15 to 20 lobes of
milk-producing glandular tissue
• Each lobe is made up of many
smaller lobules
• Special channels called ducts run
from these lobes
• Spaces around the lobules and
ducts are filled with fatty &
connective tissue stroma that
determines the size
• The actual milk-producing
structures nearly the same in all
• Nipple skin contains many nerves,
oil & sweat secreting glands
WHAT HAS CHANGED?
University of Western
Australia’s Human
Lactation Research
Group, with Medela,
investigated the
lactating breast using
sophisticated
ultrasound technology
& research results
overturned 160 years
of received wisdom
concerning the female
breast.
SUCKLING HORMONE REFLEX ARC
• Nipple stimulation from
baby’s breast suckling
• Message sent to spinal
cord, then brain
• Increased prolactin
levels released by
anterior pituitary for
milk production
• Increased oxytocin
levels released by
posterior pituitary for
milk ejection reflex
TYPE
COLOSTRUM
TIMING
1st 2-4
days
TRANSITIONAL From the
4th to
the 10th
day to
the 1st
month
MATURE
By end
of 1st
month of
lactation
QUANTITY
CHARACTERISTICS
10-40 ml/day
Deep, yellow fluid w/ more protein
(95% globulins & more IgA) but less
fat & sugar, more vitamins especially
vitamin A, more salt (Na+ & K+), sp.
gr. 1.040-1.060 w/ alkaline pH of 7.7
Increases to
less than 600
ml
Fall in protein due to decreasing
cells/cu mm & concentration of
immunoglobulins but total volume
increases w/ gradual increase in fat &
lactose, concentrations of Na+, K+ &
Cl- decrease but Ca+ & PO4- constant
About 600 ml
in the 1st
month to 800
ml in the 6th
month after
which falls to
25-400 ml on
the 2nd yr of
life
About 5% fat, 1.1% protein & 7%
lactose that is fairly consistent, fatty
acids generally reflect maternal diet,
total N2 content of 1.2% includes a
significant portion of non-protein N2,
sp. gr. 1.026-1.036 average being
1.031 w/ pH 6.8-7.4 average of 7
**In poorly nourished women,
composition constant but total yields
lower
ADVANTAGES OF BREAST-FEEDING
1.
2.
3.
4.
5.
Proper quality & quantity
of nutrients
Rates of growth better in
the 1st 3-4 months
Anti-infective properties
universally accepted
Prevents allergy due to
high IgA preventing
antigen absorption
Contraceptive property,
high levels of prolactin
inhibit synthesis of
ovarian steroids causing
delay of ovulation &
pregnancy
6. Psychological advantages
a. Fosters mother-child relationship
b. Tactile contact makes babies
more secure, emotionally stable
c. A sense of fulfillment,
satisfaction & joy for the mother
7. Protective against
a. Necrotizing enterocolitis
b. Otitis media
c. Dental caries
8. Others:
a. Safe, contains no pathogens
b. Always at the right temperature
c. Convenient & always available
ANTI-INFECTIVE PROPERTIES
a.
b.
c.
d.
e.
f.
Breast milk esp colostrum
contains plenty of
antibodies
E. coli antibodies present
High % of lactose
stimulates Lactobacillus
bifidus
Lactoferrin binds iron &
inhibits growth of E. coli,
staphylococci & Candida
albicans
Lysozyme bacteriostatic
against
enterobacteriaceae &
staphylococcus species
Anti-staphylococcus factor
g. Lactoperoxidase kills streptococcic &
enteric bacteria
h. Secretory IgA against intestinal
bacteria
i. Macrophages 90% of leucocytes
involved in phagocytosis & synthesis
of bacteriostatic proteins: lactoferrin,
lysozyme & complements C3, C4
j. Lymphocytes comprise 10%,
approximately 34% B-lymphocytes
responsible for synthesis of IgA
k. T-lymphocytes 50% against E. coli,
rubella, CMV & mumps viruses &
transfer delayed hypersensitivity
ANTENATAL PREPARATION
TECHNIQUES
1. Wear fitted maternity bra from 5th month
2. Daily bath enough for cleaning nipples, avoid soap,
alcohol & drying agents
3. Rub nipples & areolae with little anhydrous lanolin to
make more supple
4. Express colostrum from 7th month by squeezing
areola between index finger & thumb about 3x each
side
5. Practice Hoffman’s maneuver (tactile stimulation by
thumb & opposing forefinger in the horizontal &
vertical planes) for flat or pseudo-inverted nipple
POSTNATAL PROCEDURES
1.
2.
3.
4.
5.
Breast-feeding maybe started about 30 min after NSD & 3-4 hrs
after C/S
The baby should be in a comfortable, semi-sitting position with
the baby’s lips engaging considerable areola & the breast not
obstructing breathing
The mother should be seated comfortably & relaxed (she can feed
in the recumbent position if she prefers) with the areola held
between her index & middle fingers or between thumb & index
finger to enable & control milk flow
Baby obtains 95% of milk in the 1st 5 min & frequent feeds as
well as short feeds on alternate breasts ideal then burp after
It is important to teach mother how to break suction of baby
when she feels it is time to stop by pressing on a portion of the
breast near baby’s lips to let air into mouth which prevents painful
tagging between mother & child minimizing sore nipples
FACTORS INFLUENCING
COMPOSITION
1.
2.
3.
4.
5.
6.
Time of day
Mother’s diet
Mother’s emotional state
Whether fore or hind milk
Drugs
Smoking
CONTENT
BREAST MILK
COW’S MILK
pH
Both have pH 6.8-7.4 w/ average of 7
Water content &
Specific gravity
Both have water content of 87-87.5% w/ sp. gr.
1.026-1.036 average being 1.031
Proteins
1-1.5%
3.3%
a. Whey-to-casein
ratio
60:40
20:80
b. Whey proteins
a-lactalbumin (40%)
lactoferrin (25%)
lysozyme (0.08%),
albumin (0.08%), IgA,
IgG, IgM (0.15%)
Mostly b-lactoglobulin,
some a-lactalbumin &
traces of lactoferrin
c.
Low ratio of methionine
to cystine, lower levels
phenylalanine & tyrosine
High ratio of methionine
to cystine, higher levels
phenylalanine & tyrosine
Softer, smaller
Less digestible
Casein
d. Curds
CONTENT
Fats
BREAST MILK
COW’S MILK
3.5% but varies w/ maternal
diet
a. Neutral fat or
Twice as much of the more
triglycerides
absorbable olein
palmitin, stearin &
olein
b. Volatile fatty acids 1.3%
butyric, capric,
caproic & caprylic
c.
Linoleic acid
9%
4-5% of fat calories, hence,
better source of this
d. Digestion &
absorption
Contains bile-salt stimulated
Steatorrhea may
lipase plus specific fatty acids, occur
hence, more efficient
Carbohydrates mainly
lactose
7%
4.8%
CONTENT
BREAST MILK
COW’S MILK
Mineral content
0.15-0.25%
0.7-0.75%
a. Water
Ensures free water
Need for extra water
b. With diarrhea
Hypotonic dehydration
Hypertonicity & acidosis
common
c.
2:1
Neonatal hypocalcemia
may occur
Although low, sufficient
because better absorbed
Lower & lesser absorbed
Ca+2/P- ratio
d. Iron
Vitamins
a. Fat-soluble
Both contains large amounts of vitamin A, minimal
vitamin D & should be given vitamin K to prevent
hemorrhagic disease of the newborn
b. B complex
More niacin
More thiamine & riboflavin
c.
More vitamin C
Lesser
Ascorbic acid
DETERMINING ADEQUACY
• If infant is satisfied after breast feeding
• Sleeps well, about 2-4 hours, and
contented till next feeding time
• Regularly and adequately gaining weight
• The “let-down” or milk rejection reflex in
the mother is an important sign
REASONS FOR NOT OR
STOPPING BREAST-FEEDING
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Lack of motivation or preparation of mothers
Anxiety, fear & uncertainty in the mother
Aesthetic reasons
Status seeking & effective promotion of infant foods
Mothers work to increase & augment family income
Separate maternity & nursery wards
Milk formula easily sucked from the bottle nipple
Cultural milieu
Mothers who can’t despite all desires & attempts
Presence of contraindications
CONTRAINDICATIONS
1. Absolute: chronic diseases like open TB, cardiac
diseases, thyrotoxicosis, advanced nephritis, mental &
seizure disorders
2. Relative: when mother is taking anticoagulants,
antibiotics, steroids or potentially toxic substances like
benzene products
3. Mechanical contraindications on the part of the
mother: retracted or oversized nipples
4. Mechanical contraindications on the part of the
baby: congenital anomalies like harelip & cleft palate
but breast milk may be pumped & given
5. Allergy should be proven
WET NURSING
• When breast milk fed to an infant is obtained from a
lactating woman other than the mother
• For infants, like LBWs, who don’t seem to do well
with any other type of milk
• A good lactating woman should be able to supply
milk for 2-3 babies at same time
• A wet nurse should be in good health, have good
personal hygiene & enough milk for another infant in
addition to her own who is thriving well
The positive thinker sees the invisible, feels the
intangible, and achieves the impossible.