HOLY CROSS COLLEGE OF NURSING, KOTTIYAM, KOLLAM

OBSTETRIC AND GYNAECOLOGICAL NURSING

SEMINAR ON

BREAST FEEDING AND BABY FRIENDLY

HOSPITALS

SUBMITTED BY SUBMITTED TO

MS DEVUCHANDANA R MS PRIYANKA C PRAKASH

I YEAR MSc NURSING LECTURER

HCCNK HCCNK

SUBMITTED ON : 20/02/2020

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INTRODUCTION

Breast milk is the most nutritious food for babies. It also protects from infection, allergies,
some chronic diseases and childhood cancers, and sudden infant death syndrome
(SIDS). Breastfeeding allows eye-to-eye contact and physical closeness, strengthening the
bond between the child and mother after solids are introduced at around six months of age,
continued breastfeeding is recommended. The AAP recommends that babies be breastfed at
least until 12 months or longer if both the mother and child wish. WHO's guidelines
recommend "continue[d] frequent, on-demand breastfeeding until two years of age or
beyond."

Lactation is the process by which milk is synthesized and secreted from the mammary
glands of the postpartum female breast in response to an infant sucking at the nipple. Breast
milk provides ideal nutrition and passive immunity for the infant, encourages mild uterine
contractions to return the uterus to its pre-pregnancy size (i.e., involution), and induces a
substantial metabolic increase in the mother, consuming the fat reserves stored during
pregnancy.

STRUCTURE OF THE LACTATING BREAST

Mammary glands are modified sweat glands. The non-pregnant and non-lactating female
breast is composed primarily of adipose and collagenous tissue, with mammary glands
making up a very minor proportion of breast volume. The mammary gland is composed of
milk-transporting lactiferous ducts, which expand and branch extensively during pregnancy
in response to estrogen, growth hormone, cortisol, and prolactin. Moreover, in response to
progesterone, clusters of breast alveoli bud from the ducts and expand outward toward the
chest wall. Breast alveoli are balloon-like structures lined with milk-secreting cuboidal cells,
or lactocytes, that are surrounded by a net of contractile myoepithelial cells. Milk is secreted
from the lactocytes, fills the alveoli, and is squeezed into the ducts. Clusters of alveoli that
drain to a common duct are called lobules; the lactating female has 12–20 lobules organized
radially around the nipple. Milk drains from lactiferous ducts into lactiferous sinuses that
meet at 4 to 18 perforations in the nipple, called nipple pores. The small bumps of the areola
(the darkened skin around the nipple) are called Montgomery glands. They secrete oil to

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cleanse the nipple opening and prevent chapping and cracking of the nipple during
breastfeeding.

THE PROCESS OF LACTATION

The pituitary hormone prolactin is instrumental in the establishment and maintenance of

breast milk supply. It also is important for the mobilization of maternal micronutrients for
breast milk.

Near the fifth week of pregnancy, the level of circulating prolactin begins to increase,
eventually rising to approximately 10–20 times the pre-pregnancy concentration. We noted
earlier that, during pregnancy, prolactin and other hormones prepare the breasts anatomically
for the secretion of milk. The level of prolactin plateaus in late pregnancy, at a level high
enough to initiate milk production. However, estrogen, progesterone, and other placental
hormones inhibit prolactin-mediated milk synthesis during pregnancy. It is not until the
placenta is expelled that this inhibition is lifted and milk production commences.

After childbirth, the baseline prolactin level drops sharply, but it is restored for a 1-hour spike
during each feeding to stimulate the production of milk for the next feeding. With each
prolactin spike, estrogen and progesterone also increase slightly.

When the infant suckles, sensory nerve fibers in the areola trigger a neuroendocrine reflex
that results in milk secretion from lactocytes into the alveoli. The posterior pituitary releases
oxytocin, which stimulates myoepithelial cells to squeeze milk from the alveoli so it can
drain into the lactiferous ducts, collect in the lactiferous sinuses, and discharge through the
nipple pores. It takes less than 1 minute from the time when an infant begins suckling (the
latent period) until milk is secreted (the let-down). Figure 1 summarizes the positive feedback
loop of the let-down reflex.

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The prolactin-mediated synthesis of milk changes with time. Frequent milk removal by
breastfeeding (or pumping) will maintain high circulating prolactin levels for several months.
However, even with continued breastfeeding, baseline prolactin will decrease over time to its
pre-pregnancy level. In addition to prolactin and oxytocin, growth hormone, cortisol,
parathyroid hormone, and insulin contribute to lactation, in part by facilitating the transport
of maternal amino acids, fatty acids, glucose, and calcium to breast milk.

CHANGES IN THE COMPOSITION OF BREAST MILK

In the final weeks of pregnancy, the alveoli swell with colostrum, a thick, yellowish
substance that is high in protein but contains less fat and glucose than mature breast milk
(Table 3). Before childbirth, some women experience leakage of colostrum from the nipples.
In contrast, mature breast milk does not leak during pregnancy and is not secreted until
several days after childbirth.

*Cow‘s milk should never be given to an infant. Its composition is not suitable and its
proteins are difficult for the infant to digest.

Compositions of Human Colostrum, Mature Breast Milk, and Cow’s Milk (g/L) (Table
3)

Human colostrum Human breast milk Cow’s milk*

Total protein 23 11 31

Immunoglobulins 19 0.1 1

Fat 30 45 38

Lactose 57 71 47

Calcium 0.5 0.3 1.4

Phosphorus 0.16 0.14 0.90

Sodium 0.50 0.15 0.41

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Colostrum is secreted during the first 48–72 hours postpartum. Only a small volume of
colostrum is produced—approximately 3 ounces in a 24-hour period—but it is sufficient for
the newborn in the first few days of life. Colostrum is rich with immunoglobulins, which
confer gastrointestinal, and also likely systemic, immunity as the newborn adjusts to a
nonsterile environment.

After about the third postpartum day, the mother secretes transitional milk that represents an
intermediate between mature milk and colostrum. This is followed by mature milk from
approximately postpartum day 10 (see Table 3). As you can see in the accompanying table,
cow‘s milk is not a substitute for breast milk. It contains less lactose, less fat, and more
protein and minerals. Moreover, the proteins in cow‘s milk are difficult for an infant‘s
immature digestive system to metabolize and absorb.

The first few weeks of breastfeeding may involve leakage, soreness, and periods of milk
engorgement as the relationship between milk supply and infant demand becomes
established. Once this period is complete, the mother will produce approximately 1.5 liters of
milk per day for a single infant, and more if she has twins or triplets. As the infant goes
through growth spurts, the milk supply constantly adjusts to accommodate changes in
demand. A woman can continue to lactate for years, but once breastfeeding is stopped for
approximately 1 week, any remaining milk will be reabsorbed; in most cases, no more will be
produced, even if suckling or pumping is resumed.

Mature milk changes from the beginning to the end of a feeding. The early milk,
called foremilk, is watery, translucent, and rich in lactose and protein. Its purpose is to
quench the infant‘s thirst. Hindmilk is delivered toward the end of a feeding. It is opaque,
creamy, and rich in fat, and serves to satisfy the infant‘s appetite.

During the first days of a newborn‘s life, it is important for meconium to be cleared from the
intestines and for bilirubin to be kept low in the circulation. Recall that bilirubin, a product of
erythrocyte breakdown, is processed by the liver and secreted in bile. It enters the
gastrointestinal tract and exits the body in the stool. Breast milk has laxative properties that
help expel meconium from the intestines and clear bilirubin through the excretion of bile. A
high concentration of bilirubin in the blood causes jaundice. Some degree of jaundice is
normal in newborns, but a high level of bilirubin—which is neurotoxic—can cause brain

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damage. Newborns, who do not yet have a fully functional blood–brain barrier, are highly
vulnerable to the bilirubin circulating in the blood. Indeed, hyperbilirubinemia, a high level of
circulating bilirubin, is the most common condition requiring medical attention in newborns.
Newborns with hyperbilirubinemia are treated with phototherapy because UV light helps to
break down the bilirubin quickly.

EXCLUSSIVE BREAST FEEDING

Breastfeeding has many health benefits for both the mother and infant. Breast
milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding
protects against diarrhoea and common childhood illnesses such as pneumonia, and may also
have longer-term health benefits for the mother and child, such as reducing the risk of
overweight and obesity in childhood and adolescence.

Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or
solids are given – not even water – with the exception of oral rehydration solution, or
drops/syrups of vitamins, minerals or medicines.

DEFINITION

Exclusive breastfeeding means that a baby is fed only breast milk for the first six months of its
life, with no additional food or drinks. This is the best nourishment for a baby and such babies are
not even given water.

Tips for Exclusive Breastfeeding

 Breastfeeding should be initiated within one hour of the baby being born.
 Exclusive breastfeeding for 6 months is ideal.
 The baby should only be given breast milk and nothing else, not even water.
 Breastfeeding should be done as and when the baby demands.
 Breastfeeding should be made possible by the mother even at night, co-sleeping can help to
achieve this.
 Nipple confusion should be avoided by not using artificial nipples etc.
 It is advisable for the mother to read and learn about potential problems with breastfeeding.
 Medical staff, caregivers and hospital authorities should be informed about the decision of
exclusive breastfeeding.
 Working moms can use expressed breast milk.

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 Breastfeeding support groups can be very helpful for exclusive breastfeeding.

Exclusive breastfeeding is perhaps the healthiest choice a mother can make for her
newborn baby. Babies that are exclusively breastfed are generally healthier than those that are
not. Exclusive breastfeeding is the strongest measure that can be taken to avoid infections and
diseases in babies. Furthermore, exclusive breastfeeding has numerous benefits for the mother as
well.

BENEFITS OF BREAST FEEDING

 Reduce the risk of infants mortality.

 Reduce infants morbidity from infections such as gastro-intestinal and ear infections .
 Enhance the child ‘s natural immunity .
 Reduce atopic disease such as eczema and respiratory problems
 Reduces the risk of diabetes
 Can result in increased intelligence
 Reduces the chance of obesity later in life
 Helps with digestion
 Can result in fever dental problems later in life such as braces and cavities

BENEFITS TO MOTHERS

 Reduce the risk of breast cancer and ovarian cancer.

 Helps reduces post –natal weight –gain by using extra calories
 Helps delay post-natal menstruation .
 Reduces the risk of hip fractures in later life
 Rapid uterine involution

BENEFITS TO BABY

 Readily available
 Easy available
 Neurological system development
 Prevent infections

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 BENEFITS TO THE FAMILY

 Breast feeding bonds mother and child

 Breastfeeding results result in betters health , nutrition and well being
 Portable means of nourishments
 Breast feeding saves money on formula and medical costs related to illness

POSITIONS FOR BREAST FEEDING

 Cradle position
 Football position
 Lying position
 Indian method
 Cross cadle method

Cradle position :
 Place baby‘s head in the crook of your arm .
 Support baby‘s back and bottom with mothers arm and hand
 Baby will be lying sideways facing you.
 Mothers breast should be right infront of the baby‘s face
Football position;
 Tuck baby under mothers arm like a football with his or her head resting on hand.
 Support the baby‘s body with mother‘s forearm
 This is good position, if recovering from a cesarean section.
Lying down position
 In this position lie on your side with baby facing mother
 Use pillow to prop up the head and shoulders
 This position good for mother in cesarean section and episotomy

TEN SIGHN FOR BREAST FEEDING

1. In the initial weeks, the baby feeds at least 8 to 12 times within 24 hours.
2. Starting from the fourth day of the baby‘s life, 5-6 nappies moist with urine should be
expected every 24 hours.

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3. From the fourth day until the age of approximately 5-6 weeks, at least 3-4 yellow liquid
bowel movements should be expected every 24 hours. Later, there may even be only one
bowel movement per week.
4. The nipples and breasts do not hurt while breastfeeding.
5. Suckling can be felt at a rate of approximately one suck per second.
6. The baby‘s swallowing sounds can be heard.
7. Baby feeds from one breast until he released the nipple. After a break, the other breast
should be offered.
8. Breasts are softer after breastfeeding.
9. Baby is content on completion of breastfeeding.
10. Baby is going up in weight (he will return to his birth weight wt in 3-4 weeks)

COMPLICATION
 Breast injury and surgery
 HIV infection
 Peuperal infection
 High dose of epileptic drugs
 Maternal infection

BABY FRIENDLY HEALTH INITIATIVE

The Baby Friendly Health Initiative (BFHI) is a joint UNICEF and the World Health
Organization (WHO) project that aims to give every baby the best start in life by creating
health care environments where breastfeeding is the norm and practices known to promote
the health and wellbeing of all women and babies are followed. ‗Baby Friendly‘
accreditation is a quality assurance measure that demonstrates a commitment by the facility
to offer the highest standard of maternity care

OBJECTIVES

 To re establish the superiority of breast feeding in order to protect the newborns

healthy by becoming baby healthy.
 To boost breastfeed and to counter the world wide trend towards bottle – feeding.
 To fulfill the inintative; UNICEF and WHO laid down ten steps to create the baby
friendly environment.

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10 STEPS IN BABY FRIENDLY HOSPITAL

Step 1. Comply fully with the International Code of Marketing of Breast-milk Substitutes and
relevant World Health Assembly resolutions.

Step 2. Ensure that staff have sufficient knowledge, competence and skills to support
breastfeeding.

Step 3. Discuss the importance and management of breastfeeding with pregnant women and
their families.

Step 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to
initiate breastfeeding as soon as possible after birth.

Step 5. Support mothers to initiate and maintain breastfeeding and manage common
difficulties.

Step 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless
medically indicated.

Step 7. Enable mothers and their infants to remain together and to practise rooming-in 24
hours a day.

Step 8. Support mothers to recognize and respond to their infants‘ cues for feeding.

Step 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.

Step 10. Coordinate discharge so that parents and their infants have timely access to ongoing
support and care.

BENEFITS FROM BFHI

The woman and her child

 Consistent care, information and advice. Staff in maternity and paediatric units have a
written policy, which they understand and follow.
 Early bonding between mother and baby. Skin-to-skin physical contact immediately
after birth in peace, without any unnecessary disturbance, allows psychological
adaptation as well as colonisation of the infant's skin with the normal skin flora of the
mother.
 Consistent and skilled help with breastfeeding. Staff are required to be able to support
women who wish to breastfeed.

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  Early initiation of breastfeeding. Babies are not unnecessarily removed from mothers at
birth, thereby encouraging the instinctive seeking and suckling behaviours. When
mother and baby need to be separated the mother is helped with expressing her milk and
the expressed milk is given to the baby.
 Mother's milk is valued. No food or drink other than breastmilk is given.
 Breastfeeding is valued. Artificial teats and dummies are avoided.
 Empowerment. The woman has authority for her own resource: breastfeeding.

Those who care for mothers and babies

 Increased breastfeeding knowledge and skill.

 Increased professional competence, as practices are investigated and challenged and
changes are made.
 Increased satisfaction and empowerment, as staff actively participate in reaching and
maintaining the best standard of care knowing that the benefits of breastfeeding are life-
long.
 Enhanced respect for the woman, the baby and their ability to breastfeed when given
appropriate support.
 As the care is woman-centred rather than task-centred, all staff respect the woman's
need for consistent advice and empowerment, thereby increasing cooperation and
collaboration between staff members.

The facility

 A high standard that is measured by the unit and confirmed by the Baby Friendly
assessment team representing professional and lay assessors.
 A Global standard recognised and respected by professionals and consumers around the
world.
 A quality measure that can be used to market the hospital or unit services.
 Considerable monetary savings through reduced reliance on breastmilk substitutes and
separate nursery care for well babies.

The family

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  The relationship between the mother and baby is protected, as the mother better
understands and responds to her child, is more satisfied in her role as a mother.
 Health and development of the infant are enhanced.
 Health of the mother is also protected.
 Cost saving immediate (breastmilk is free) and long term (reduced incidence of illness).

The community

 Recognition of the importance of breastfeeding flows on from the family.

 An increased level of respect for human rights of both women and children, in ensuring
access to a normal standard of health through BFHI's support of breastfeeding.

Environmental considerations: breastfeeding has no waste products and no environmental

degradation is involved in its production.
ADVICE TO PARTENR AND FAMILY MEMBERS

 Breastfeeding is certainly the best way to feed your baby. Mother‘s milk helps protect
babies from diseases and infections, and it is vital for growth and development.
Mother‘s milk is accessible, available and economical.

 positive opinion and your support for breastfeeding is one of the most important
factors that influence your partner‘s decision to breastfeed. According to studies that
have been done, the woman‘s chance of deciding to breastfeed is ten times higher if
she has a partner who supports breastfeeding.

 The Ministry of Health recommends feeding the baby by breastfeeding only until the
age of 6 months, and after this, continuing to breastfeed while adding foods from the
family‘s diet. A new baby joining the family involves a change from the life that you
were previously used to. The change occurs in all events, regardless of whether or not
the baby breastfeeds.
 It is easier for you and your partner to go out on excursions with your breastfeeding
baby. There is no need to worry about bottles, food, clean water, etc., etc.
Breastfeeding babies are ―perfectly portable‖.
EVIVENCE BASED PRACTICE
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Breast-feeding and cognitive development: a meta-analysis

Background: Although the results of many clinical studies suggest that breast-fed children
score higher on tests of cognitive function than do formula-fed children, some investigators
have suggested that these differences are related to confounding covariables such as
socioeconomic status or maternal education.

Objective: Our objective was to conduct a meta-analysis of observed differences in cognitive

development between breast-fed and formula-fed children.

Design: In this meta-analysis we defined the effect estimate as the mean difference in
cognitive function between breast-fed and formula-fed groups and calculated average effects
using fixed-effects and random-effects models.

Results: Of 20 studies meeting initial inclusion criteria, 11 studies controlled for ≥5

covariates and presented unadjusted and adjusted results. An unadjusted benefit of 5.32 (95%
CI: 4.51, 6.14) points in cognitive function was observed for breast-fed compared with
formula-fed children. After adjustment for covariates, the increment in cognitive function
was 3.16 (95% CI: 2.35, 3.98) points. This adjusted difference was significant and
homogeneous. Significantly higher levels of cognitive function were seen in breast-fed than
in formula-fed children at 6–23 mo of age and these differences were stable across successive
ages. Low-birth-weight infants showed larger differences (5.18 points; 95% CI: 3.59, 6.77)
than did normal-birth-weight infants (2.66 points; 95% CI: 2.15, 3.17) suggesting that
premature infants derive more benefits in cognitive development from breast milk than do
full-term infants. Finally, the cognitive developmental benefits of breast-feeding increased
with duration.

Conclusion: This meta-analysis indicated that, after adjustment for appropriate key cofactors,
breast-feeding was associated with significantly higher scores for cognitive development than
was formula feeding.

CONCLUSION

Human milk is the ideal nourishment for infants' survival, growth and development.
Exclusive breastfeeding means starting breastfeeding as early as possible ... Breastfeeding,

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also known as nursing, is the feeding of babies and young children with milk from a
woman's breast

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