Cebu Doctors’ University

College of Nursing
Mandaue City, Cebu

NCM 107:
RLE MODULE 3M

Breast Care, Breast Feeding, and Bottle

Feeding

Group F3:
Granada, Giolie Ann Celesty D.
Letrondo, Zi P.
De Gracia Dominic O.
Papa, Mechiella Frangievive
Tarongoy, Lorainne Anne S.

Facilitator: Mr. Jetier Pinote

Date Submitted:
 Table of contents

CLO#1: define the terms related to breast care. pg.6

CLO#2: review the anatomy and physiology of the breast. pg.6-8

CLO#3: enumerate the importance of breast care. pg.9

CLO#4: explain the scientific principles involved in breast care. pg.9-10

CLO#5: state the guidelines in breast care. pg.10-11

CLO#6: demonstrate beginning skills in breast care. pg.11-12

CLO#7: define the terms related to breastfeeding and bottle feeding. pg.12-16

CLO#8: explain the physiology of lactation. pg.16

CLO#9: enumerate the advantages of breastfeeding. pg.17

CLO#10: state the types of nipples. pg.18-19

CLO#11: discuss the importance of breastfeeding. pg.20

CLO#12: list the indications and contraindications of breastfeeding pg.20-21

and bottle feeding.

CLO#13: state guidelines in breast and bottle feeding pg.21

CLO#14: discuss the principle involved in breastfeeding and bottle pg.22

feeding.

CLO#15: discuss the maternal breastfeeding reflexes. pg.22-23

CLO#16: discuss the technique used during pregnancy to prepare nipples pg.23
for nursing.

2
CLO#17: illustrate the positions in breastfeeding. pg.24-25

CLO#18: list common problems in breastfeeding. pg.25-28

References: pg.29
Learning Outcomes:

CLO1:define the terms related to breast care.

● Breast Care
● Breast
● Nipples
● Areola
CLO2:review the anatomy and physiology of the breast.
Anatomy and Physiology of the Breast:
● Quadrants
● Composition
● Muscles associated
● Anatomical Location
● Tissues
● Axillary
● lymph nodes
● Lymphatics
CLO3: enumerate the importance of breast care.
CLO4: explain the scientific principles involved in breast care.
● Anatomy & Physiology
● Body Mechanics
● Microbiology
● Epidemiology
● Time & Energy
● Physics
● Chemistry
CLO5: state the guidelines in breast care.
● For the breastfeeding and non-breastfeeding mother
CLO6: demonstrate beginning skills in breast care.
● Breast care
CLO7: define the terms related to breastfeeding and bottle feeding.
● Breastfeeding
● Lactation
● Prolactin
● Colostrum
● Oxytocin
● Burping
● Breast pump
● Latch-on
CLO8: explain the physiology of lactation.

CLO9: enumerate the advantages of breastfeeding.

CLO10: state the types of nipples.

● Inverted
● Flat
● Everted
CLO11: discuss the importance of breastfeeding.

CLO12: list the indications and contraindications of breastfeeding and bottle

feeding.

CLO13: state guidelines in breast and bottle feeding

● Breast milk & Breastfeeding
● Bottle Feeding
CLO14: discuss the principle involved in breastfeeding and bottle feeding.
● Anatomy & Physiology
● Body Mechanics
● Microbiology
● Physics
● Time & Energy
CLO15: discuss the maternal breastfeeding reflexes.
● Milk Production
● Milk
● Ejection Reflex (MER) or Letdown reflex
● Nipple Erection
CLO16: discuss the technique used during pregnancy to prepare nipples for
nursing.
CLO17: illustrate the positions in breastfeeding.

CLO18: list common problems in breastfeeding.

CLO#1: define the terms related to breast care.
ADD PICTURE
● Breast Care
○ The activity to prepare and clean the breasts during pregnancy and
lactation for breastfeeding
○ Breast care during the postpartum period includes cleanliness and support
and is the same whether or not a woman is breastfeeding.

● Breast
○ The breast refers to the front of the chest or, more specifically, to the
mammary gland. The mammary gland is a milk producing gland.
● Nipples
○ The pigmented projection on the surface of the chest in the male and the
breast in the female. In the mature female, ducts that conduct milk from
the mammary glands to the surface of the breast exit through the nipple.
● Areola
○ The circular, pigmented area surrounding the nipple.

CLO#2: review the anatomy and physiology of the breast.

● Quadrants
○ The breast is divided into quadrants by vertical and horizontal lines across
the nipple

○
● Muscles Associated
○ The muscles involved include the pectoralis major, serratus anterior,
external oblique, latissimus dorsi and rectus abdominis fascia.

○
● Anatomical Location
○ Breast tissue is located on top of the muscles of the chest wall and
overlying the chest (pectoral) muscles.
● Composition
○ Lobules (mammary glands): where breast milk is produced during
pregnancy and breastfeeding.
○ Ducts: the lobules connect to ducts which carry milk out of the nipple
○ Glandular, connective and fatty tissue: within these tissues are
milk-producing cells, these fill the spaces around the ducts and lobules
● Tissues
○ Breasts are made up of lobules, ducts, and fatty and fibrous connective
tissue.
● Lobules produce milk and are often called glandular tissue.
 ● Ducts are the tiny tubes that carry milk from the lobules to the
nipple.
● Fibrous tissue and fat give breasts their size and shape and hold
the other structures in place.
● Axillary Lymph Nodes
○ The axillary lymph nodes, also known commonly as axillary nodes, are a
group of lymph nodes in the axilla and receive lymph from vessels that
drain the arm, the walls of the thorax, the breast and the upper walls of the
abdomen.

○
● Lymphatics
○ The lymphatic drainage of the breast is of great clinical importance due to
its role in the metastasis of breast cancer cells.
○ There are three groups of lymph nodes that receive lymph from breast
tissue – the axillary nodes (75%), parasternal nodes (20%) and posterior
intercostal nodes (5%).
○ The skin of the breast also receives lymphatic drainage:
 ● Skin – drains to the axillary, inferior deep cervical and
infraclavicular nodes.
● Nipple and areola – drains to the subareolar lymphatic plexus.

CLO#3: enumerate the importance of breast care.

MAKE SURE TO EXPLAIN THIS PROPERLY DURING THE REPORTING. ADD
MORE.
● Breast care can help you prevent and manage problems that can happen while
breastfeeding
● Improve breastfeeding experience for mother and for her baby
● To prevent plugged milk ducts or engorgement

CLO#4: explain the scientific principles involved in breast care.

● Anatomy and Physiology: Involves the anatomy of the breast and uses parts of the
body in performing breast care.

● Body Mechanics: Involves the proper position or posture in performing breast care.

● Microbiology: Cleaning the breast kills pathogenic microorganisms to prevent

infections and to promote personal hygiene.
● Physics: Involves friction in cleaning the breast. Involves gravity to prevent the breast
from sagging.

● Time and Energy: Preparation of necessary materials in performing breast care in

order to conserve time and energy.

● Epidemiology: Involves in knowing the factors determining and influencing the

frequency and distribution of diseases, injury, and other health-related events.

● Sociology: Helps establish trust and rapport gaining the client's cooperation.

CLO#5: state the guidelines in breast care.

● For Breastfeeding Women

1. Instruct mother to wash areola and nipples with water, without soap or a
washcloth to avoid washing away natural oils and keratin.
2. Advise the mother with sore or irritated nipples to apply ice compress just before
breast feeding. This numbs and firms the nipple making them less sensitive and
easier for the infant to grasp.
3. Suggest that lubricating the nipple with a few drops of expressed breast milk
before feeding may help prevent tenderness.
4. Recommend placing breast pads over the nipples to collect colostrum or milk
which commonly leaks during the first few breastfeeding weeks. Advise replacing
pads often to guard against infections.
5. Inform the mother that breast milk comes in 2 – 5 days after delivery and is
accompanied by a slight temperature elevation and breast changes – increase in
size, warmth and firmness.
6. Tell mother that a well fitting support bra may help control engorgement.
7. Advise mother with engorged breast to apply warm compress,massage the
breast, take a warm shower or express some milk before feeding. This dilates the
milk ducts, promotes let down and makes thenipples more pliable.

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 ● For non-breastfeeding Women

1. Instruct the mother to clean her breast using the same technique as the breast
feeding mother. Add that she may use soap however.
2. Advise her to wear a support bra to help minimize engorgement and to decrease
nipple stimulation.
3. Advise her to avoid stimulating the nipples or manually expressing her milk to
minimize further milk production. Instead provide medication as ordered, ice
packs or a breast binder.

CLO#6: demonstrate beginning skills in breast care.

1. Practice good hygiene. Wash your hands before touching your breasts.
Keep your breasts and nipples clean by washing them each day with warm
water in the shower or bath. Avoid using soap on your breasts since it can
cause dry, cracked, and irritated skin. It can also remove the natural oils
produced by the Montgomery glands located on the dark area surrounding
your nipples. These oils help to keep the nipples and areola clean and
moisturized.
2. Wear a supportive bra. Choose a nursing bra or a regular bra that fits well,
but is not too tight. Cotton is an excellent choice of fabric since it allows your
skin to breathe.
3. Make sure your baby is latching on correctly. Getting your child to latch on
well from the first breastfeeding, and nursing very often at least every 2 to 3
hours can help prevent the development of painful breast problems such as
sore nipples, breast engorgement, plugged milk ducts, and mastitis.
4. Change your breast pads often. If you are using breast pads or cotton
squares inside your bra to soak up the breast milk from leaking breasts, be
sure to change them when they become wet. Clean, dry nursing pads can
help to prevent sore nipples, thrush, or mastitis from occurring.
 5. Moisturize your nipples with your breast milk. After nursing your baby, rub
some of your breast milk on your nipples and areola then let them air dry.
6. Remove your child from your breast correctly. When you're ready to take
your baby off of the breast, do not pull her off. Instead, place your finger in
the corner of her mouth to break the suction between her mouth and your
breast.
7. Treat breast engorgement. If your breasts become painfully overfull, hard,
and swollen, you can use cold cabbage leaves or cold compresses to
reduce inflammation and relieve pain.
8. Continue to perform your monthly breast self-examination. Even though you
are nursing, it's important to check your breasts each month. While it's
normal for your breasts to feel lumpy when they're full of milk, the lumps
should go away with breastfeeding, pumping, or massaging your breasts. If
you notice a lump that doesn't go away on its own within a few days, contact
your doctor to have it checked.

CLO#7: define the terms related to breastfeeding and bottle feeding.

● Breastfeeding
○ also known as nursing, is the feeding of babies and young children with
milk from a woman's breast.
● Lactation
○ the secretion of milk from the mammary glands and the period of time that
a mother lactates to feed her young.

● Colostrum
○ a nutrient-rich fluid produced by the mammary glands immediately after
giving birth.

● Burping
 ○ body's way of expelling excess air from your upper digestive tract which
helps to get rid of some of the air that babies tend to swallow during
feeding.

● Latch-on
○ refers to how the baby fastens onto the breast while breastfeeding. A good
latch promotes high milk flow and minimizes nipple discomfort for the
mother

INCLUDE THE CRITERIA OF A GOOD LATCH

● Prolactin
○ is a hormone produced by your pituitary gland which sits at the bottom of
the brain, it causes breasts to grow and develop milk to be fed after a
baby is born.

● Oxytocin
○ is a hormone that acts on organs in the body including the breast and
uterus controlling reproductive system including childbirth and lactation
○ stimulates the cervix leading to successive dilation during labour
 ● Breast pump
○ a device for extracting and collecting milk from the breast during lactation

CLO#8: explain the physiology of lactation.

THIS IS BEST EXPLAINED USING A FLOW CHART

● Mammogenesis: Preparation of breasts.

○ This process begins when the mammary gland is exposed to estrogen at
puberty and is completed during the third trimester of pregnancy.
● Lactogenesis: Synthesis and secretion of breast alveoli
○ onset of milk secretion and includes all of the changes in the mammary
epithelium necessary to go from the undifferentiated mammary gland in
early pregnancy to full lactation sometime after parturition.
● Galactokinesis: Ejection of milk
○ Discharge of milk from mammary glands depends upon the suction
exerted by the baby during suckling
○ Contractile mechanism also helps by expressing the milk from alveoli into
the ducts
● Galactopoiesis: Maintenance of lactation
○ Secretion and continued production of milk by the mammary glands.
○ Prolactin is released at milking along with adrenocorticotrophic
hormone (ACTH) and oxytocin.
CLO#9: enumerate the advantages of breastfeeding.

B- Best for Babies

R- REDUCE the incidences of allergies
E- Economical
A- Antibodies
S- Stool inoffensive
T- Temperature is always ideal
F- Fresh
E- Easy once established
E- Emotional bonding
D- Digested easily
I- Immediately available
N- Nutritionally optimal
G- Gastroenteritis greatly reduced
CLO#10: state the types of nipples.

● Bumpy. Small bumps around the areola, called Montgomery glands, are more
noticeable on some nipples.

● Inverted. Inverted nipples retract inward instead of standing out like erect
nipples.

● Flat. Flat nipples remain at the level of the areolae, though they may stand up
with stimulation.

● Hairy. It’s totally normal to have hair growing around your nipples, and some
people have more hair than others.
● Protruding. Protruding nipples tend to point outwards and are often raised by a
few millimetres, particularly noticeable, it can cause discomfort in your clothing .

● Puffy (Cone Shape). Both the areola and the nipple make up a raised mound

● Supernumerary. This is just a fancy way of saying you have an extra nipple —
which, in case you’re wondering, is completely normal.

● Unilateral inverted. These nipples like to mix it up, as one is inverted and the
other is everted.
CLO#11: discuss the importance of breastfeeding.
A. For the baby
● Breast milk helps keep your baby healthy.
● It supplies all the necessary nutrients in the proper proportions.
● It protects against allergies, sickness, and obesity.
● It protects against diseases, like diabetes and cancer.
● It protects against infections, like ear infections.
● It is easily digested – no constipation, diarrhea or upset stomach.
● Babies have healthier weights as they grow.
● Breastfed babies score higher on IQ tests.
● Breast milk is always ready and good for the environment.
● It is available wherever and whenever your baby needs it.
● It is always at the right temperature, clean and free.
● No bottles to clean.
● Breastfeeding has no waste, so it is good for the environment
B. For mothers who breastfeed:
● Have a reduced risk of Type 2 Diabetes and certain cancers such as breast cancer
● May find it easier to return to what they weighed before they got pregnant
● Strengthen the bond with their children

CLO#12: list the indications and contraindications of breastfeeding and bottle

feeding.
Indications:
a) Exclusive breastfeeding (newborn to 6 months/ to 2yrs)
b) Nipples are intact (no redness, cracking, scabs, or bleeding), and nipple
tenderness is minimal.
c) Breasts are full, soft, and without engorgement, with no redness and minimal
tenderness to palpation.
d) Infants born weighing less than 1500 g (very low birth weight).
e) Infants born at less than 32 weeks of gestation (preterm).

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 f) Newborn infants who are at risk of hypoglycaemia by virtue of impaired metabolic
adaptation or increased glucose demand (such as those who are preterm, small
for gestational age or who have experienced significant intrapartum
hypoxic/ischaemic stress, those who are ill.

Contraindications:
a) Infants with classic galactosemia: a special galactose-free formula is needed.
b) Infants with maple syrup urine disease: a special formula free of leucine,
isoleucine and valine is needed.
c) Infants with phenylketonuria: a special phenylalanine-free formula is needed
(some breastfeeding is possible, under careful monitoring).
d) Severe illness that prevents a mother from caring for her infant, for example
sepsis.
e) Herpes simplex virus type 1 (HSV-1): direct contact between lesions on the
mother's breasts and the infant's mouth should be avoided until all active lesions
have resolved.
f) Mother is using an illicit street drug, such as PCP (phencyclidine) or cocaine1
(Exception: Narcotic-dependent mothers who are enrolled in a supervised
methadone program and have a negative screening for HIV infection and other
illicit drugs can breastfeed)

CLO#13: state guidelines in breast and bottle feeding

● At room temperature (77°F or colder) for up to 4 hours.

● In the refrigerator for up to 4 days.
● In the freezer for about 6 months is best; up to 12 months is acceptable.
● Avoid bottles with the recycle symbol number 7, which indicates that the
container may be made of a BPA-containing plastic.
● Use breast milk storage bags or clean food-grade containers with tight fitting lids
made of glass or plastic to store expressed breast milk.
CLO#14: discuss the principle involved in breastfeeding and bottle feeding.
● Breast feeding should be done in as clear and safe as manner as possible
● Both mother and child should be comfortable and relaxed during the feeding
time.
● Breast feeding should be initiated within the first hour after birth.
● The baby should be cuddled and held in a semi-upright position
● The baby should burp after feeding to release gas in the stomach also to prevent
vomiting
● Formula milk has more protein and mineral salt and less lactose than human
milk.

CLO#15: discuss the maternal breastfeeding reflexes.

FOCUS ON THE GIVEN EXAMPLE IN THE LEARNING PLAN

Primitive neonatal reflexes - Collective terminology defining a group of inborn

unconditioned reflex responses, spontaneous behaviours and reactions to endogenous
or environmental stimuli developing during foetal life and observed in all normal healthy
term neonates at birth.
Neonatal position - The relationship between the baby's body and the mother's
examining where the baby's body is facing, where the baby’s body is touching and close
apposition with a maternal body contour or part of the environment.
Neonatal behavioural state - A group of physiological and motor characteristics
occurring at the same time indicating levels of arousal including: body, eye and facial
movements, breathing pattern and level of response.
Maternal posture - relationship between the long part of the mother's body and the
horizontal axis, defined numerically by approximating the number of degrees in the
angle formed at their junction using a protractor.
Maternal comfort - Assessed through observations scoring
Body support - The amount of observed physical support under or around each of 12
maternal body parts from head to feet
Mobility - Observations of whether no hands, one hand or two hands were free, not
holding baby or breast
‘Best’ episode - episode where the latch was sustained for greater than 1 minute
leading to pain-free, effective feeding according to the above definitions of maternal
comfort and successful feeding.
Tension-free - Maternal shoulders appear balanced, not hunched.
Pain-free - The mother says that she does not feel pain

CLO#16 discuss the technique used during pregnancy to prepare nipples for
nursing. ADD PICTURES

For flat and inverted nipples:

● Breast pumps
○ the suction from a breast pump to help draw out a flat or deeply inverted
nipple

● Hoffman Technique
Place your thumbs on either side of your nipple by placing thumbs at the
base of the nipple while pressing firmly into the breast tissue practicing
this technique at least once a day. Regular stimulation may help nipples to
protrude more often.

● Nipple shields
○ a flexible, nipple-shaped shield that fits over a mother’s flat nipple and
areola which is used as a temporary aid to encourage latching.

● Hand expression
○ Hand-expressing a bit of milk can soften your breast and avoid hardness
and flattening of the nipples so that your baby can latch on more easily.

● Breast shells
○ are plastic shells that are worn over your areola and nipples to draw out
nipples and also protects from sore nipples.
 CLO#17: illustrate the positions in breastfeeding.
INCLUDE THE BENEFITS AND INDICATION OF EACH HOLD.
1.Cradle Hold(tummy to tummy)
- easy and common position that allows the mother to hold the infant
horizontally across the front of the chest.

2. Cross cradle hold

-is ideal for mothers when initiating early breast-feeding.

3. Football hold/ clutch position

- the most comfortable hold allowing the mother to help baby latch when
sitting on a bed or chair.
 4. Side-lying position
-allows the mother to lay on her left or right side with the infant lying
parallel to her and allows the mother to rest at the same time.
-ideally suited for women after cesarean delivery because it reduces the
pain associated with pressure from the infant on their incisions.

CLO#18: list common problems in breastfeeding.

INCLUDE NURSING INTERVENTIONS PER IDENTIFIED PROBLEMS.

1. Latching pain
-improper latch of the infant into the mother's nipples.

2. Cracked nipples
-is a condition that can occur in breastfeeding women as a result of a
shallow latch, improper pumping, thrush dry skin.
3.Thrush
-medical condition in which a yeast-like fungus that overgrows in the
mouth and throat that are common to infants.

4. Painful Let-down
-a tingling or a prickly pins-and-needles kind of feeling felt deep in the
breasts when milk production has started.

5. Blood stained nipples

- are caused by epithelial proliferation that usually occurs in 2nd or 3rd
pregnancy and during 3 months of postpartum.
-discharges or unusual color of maternal milk during pregnancy or
lactation
6. Engorgement
- caused by inadequate or ineffective emptying of the breasts
- usually begins at 2nd or 3rd day of postpartum

7. Sore nipples
- soreness associated with breastfeeding as the skin gets used to the
constant moisture.

8. Plugged duct
 -an occlusion or plug has occurred in the milk passageways. The plug
prevents milk from passing through or slower than usual.

9. Mastitis
-inflammation of breast tissue that sometimes results into breast pain,
swelling, warmth and redness.
 References:

Donna Murray, R. N. (2020). How to Care for Your Breasts When You’re Breastfeeding.
Https://Www.Verywellfamily.Com/How-to-Care-for-Your-Nursing-Breasts-431863.
https://www.verywellfamily.com/how-to-care-for-your-nursing-breasts-431863

MD, M. (2020, September 21). Lymphatic drainage of the breast. Retrieved October 02,
2020, from
https://www.kenhub.com/en/library/anatomy/lymphatic-drainage-of-the-breast

Pacifici, S. (n.d.). Axillary lymph nodes: Radiology Reference Article. Retrieved October
02, 2020, from https://radiopaedia.org/articles/axillary-lymph-nodes-1

Proper Storage and Preparation of Breast Milk. (2020, January 22). Centers for Disease
Control and Prevention.
https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

Santos-Longhurst, A. (2018, September 13). How to Breastfeed with Flat Nipples: 11

Tips. Retrieved September 30, 2020, from
https://www.healthline.com/health/parenting/breastfeeding-with-flat-nipples

Conti T.D. (2020). Breastfeeding & infant nutrition. South-Paul J.E., & Matheny S.C., &
Lewis E.L.(Eds.), CURRENT Diagnosis & Treatment: Family Medicine, 5e. McGraw-Hill.
https://accessmedicine.mhmedical.com/content.aspx?bookid=2934&sectionid=2473974
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