MODULE 2: Unit : 3

MANAGEMENT OF LACTATION

Dr. N. Mukerenge

N3633MM/ NMS 3680

May 2024
 SPECIFIC OUTCOMES
At the end of the unit, the student will be able to:
• Define related terms
• Explain the relationship between breastfeeding, family planning and child survival.
• Explain physiology of lactation.
• Discuss the composition of breastmilk
• Explain the advantages of breastmilk to mother and baby respectively
• Manage lactation
• Demonstrate the correct breastfeeding attachment technique
• Promote baby-mother-friendly initiative in community, home, workplace and health
facilities
 Definitions of terms
Lactation
• The process of milk secretion and excretion
Lactogenesis
• The initiation and production of milk by the breast
Galactopoiesis
• Maintenance of lactation
Hypergalactia
• Overproduction of milk
Galactorrhoea
• Abnormal milk production
Agalactia
• Inability to lactate
Rooming in
• Infant remaining in the room with the mother – important in the development of relationships
between new mother and her baby
 Breastfeeding and child survival
Unique characteristics of human milk
• Immunological properties,
• macrophages that kills bacteria, viruses and fungi
• neutrophils,
• lactoferin coats and protect baby’s intestines
• IgA and others immunoglobulins
• Protect ENT, GI tract against viruses and bacteria
• Fight allergens and pathogens
• Decreases infants chances of developing allergies, resp.infections,
otitis media and asthma
 Breastfeeding and child survival (2)
Composition Of Breastmilk
• Enzymes → fat metabolism
• Electrolytes, minerals and water – sodium, potassium chloride etc…
• Glucose →milk production, source of energy
• Fats →lipids for cell membrane integrity in the brain and other parts
of body
• Protein →produced by free amino acids in the cells
• Vitamin content → vitc,A,riboflavin,vitb6 etc…
• nucleotides →protein synthesis and provide energy and growth
Functions Of Colostrum For The Newborn Baby [Sellers
2012:119; Sellers 1993:626-627]

• Provide adequate kilojoules 1st days of life

• Contains protein values to satisfy hunger

• Provide antibodies ; IgA,IgM

• Natural Laxatives

• Sodium potassium, chloride for optimal development of baby’s heart,

brain and CNS
Breastfeeding and child survival (2)
 Breastfeeding and child survival (2)

• The protein content of colostrum is largely a concentration of

immunoglobulins, especially secretory immunoglobulin A

• 24 hours after delivery, colostrum includes an estimated 80 mg of IgG, 120

mg of IgM and 11,000 mg of sIgA, and provide passive immunization
against bacterial and viral infections.

• Concentration of immunoglobulins decreases in transitional and mature

milk.
Breastfeeding and child survival (2)
 Breastfeeding and child survival (2)
• The development of the breast tissue and secretion colostrum and milk
actually begins about the 12th week of pregnancy and extends until shortly
after delivery.
• This first stage is known as lactogenesis I.
• Lactogenesis II begins to occur between the 2nd and 4th postpartum day
and is characterized by the milk “coming in” in greater quantity.
• The mother notes that her breasts feel full, and the baby’s swallowing
pattern becomes more distinct.
• Approximately 7 to 10 days after delivery, milk is defined as”transitional”.
• By 14 days milk is considered “mature”. A volume of 600-900 ml can
eventually produced every 24 hours
Breastfeeding and child survival (2)
 Physiology Of Lactation
Anatomy and physiology
• Latch on and sucking
• Oxytocin release
• Release of milk
• Infant empties breast
• Production increases
• Milk production occurs

Interference with this cycle decreases the milk supply

 Lactation (2)
Physiology Of Lactation

• Neuro-hormonal reflex Baby suckling → transmission of impulses to

hypothalamus and to pituitary gland

• Anterior pituitary gland (adeno hypophysis) release hormone

prolactin

• Posterior pituitary gland (neuro hypophysis) release hormone

oxytocin
Lactation (3) (Physiology of lactation)
Lactation Maintenance
• A system of supply and demand

Demand

Supply milk Supply

Demand
 Lactation(4)

Physiology Of Lactation

Hormones influences on breast

• Oestrogen and progesterone- development of breast

• Oestrogen- causes ducts to grow and branch and increases

quantity of connective tissues

• Progesterone- causes congestion and fullness of breast prior

menstruation
Lactation(5)

Other hormones affecting lactation

• Growth hormone ACTH → establishes , maintain lactation

• Human placenta lactogen → support prolactin

• Thyroxine → maintenance of lactation

• Prolactin inhibiting factor→ controls secretion of prolactin

• Insulin→ support prolactin synthesis

 Lactation maintenance (2)
• Lactation usually starts the first –third day after delivery, the more the baby suck
the more milk is produced.

• Rest and sleep also have an important role in the process.

1. Suckling and nipple stimulation

2. Mother’s emotional state

3. Adequate rest of mother-prolactin secretion and milk production take place during
rest and sleep

4. Adequate and balanced maternal diet and fluids intake

[Sellers 2012:547]
The Correct Technique And Process For positioning, Suckling
And Attachment During Breastfeeding [Sellers 2012:544]
The Correct Technique And Process For positioning, Suckling
And Attachment During Breastfeeding [Sellers 2012:544]

• Whole nipple and primary areola are drawn into the baby ‘ s mouth

• The baby’s jaw closed onto areola tissue situated over the lactiferous sinuses

• This expressed milk from the sinuses into the baby ‘s mouth

• The milk is then swallowed

• A vacuum is created in the baby’s mouth

• This helps to draw more milk from the lactiferous ducts

Positionins
The Correct Attachment During Breastfeeding
[Sellers 2012:544]
The Correct Attachment During Breastfeeding
[Sellers 2012:544]

• Whole nipple and primary areola are drawn into the baby ‘ s mouth

• The baby’s jaw closed onto areola tissue situated over the lactiferous sinuses

• This expressed milk from the sinuses into the baby ‘s mouth

• The milk is then swallowed

• A vacuum is created in the baby’s mouth

• This helps to draw more milk from the lactiferous ducts

The Correct Attachment During Breastfeeding
[Sellers 2012:544]
The Correct Attachment During Breastfeeding
[Sellers 2012:544]
 Poor attachment
• Poor attachment reflected by:
• tight pursed lips
• space between chin and breast
• space between breast and nose
• infant's lower lip pulled in
• mother may feel pain
• nipple may be flattened after a feeding
• nipple abrasions and/or cracking
 Advantages of breast milk to babies

Sellers 2012:121

• Babies who are breastfed have decreased chance of developing:

• Respiratory and ear infections

• Allergies and atopic diseases

• Asthma
Early problems with breastfeeding
• Inverted nipple
• Painful cracked nipple
• Engorged breast

1. Prevention of engorged breast (Sellers 2012 pg. 54)

2. Baby mother friendly Initiative (Sellers 2012 pg. 542- 555)
Breast Fullness (milk engorgement) vs Breast Engorgement
(venous engorgement) [Sellers 2012:549; Sellers 1993:653

BREAST FULLNESS BREAST ENGORGEMENT

• Breast fullness is physiological • Breast engorgement is pathological

• From day 2-6 • From day3-10
• Bilateral • Breast full, hard, tender
• Temperature normal • with distended prominent veins
• No pain • skin is tense and hot
• Milk plentiful and available • maybe unilateral
• general breast pain
• milk retained and unavailable
Breast Fullness (milk engorgement) vs Breast Engorgement
(venous engorgement) [Sellers 2012:549; Sellers 1993:653

• What causes venous engorgement?

• Infrequent nursing
• Ineffective milk removal (usually caused by poor attachment)
• Local consistent pressure on the breast, caused, for example, by tight
clothing
• Rarely but important, an obstructed duct may be caused by a tumor (benign
or malignant)
 Management Of Engorged Breasts [Sellers
1993:654;2012:549]

• Mothers should take hot showers and

• Gently massage breasts
• Iced cabbage leaves and ice packs can be applied to breasts
• Pain relief, such as paracetamol
• Gentle expression of breast milk before feed
• Exercise arms, apply gentle pressure and massage breasts gently
between her hands
• Position of baby very important –baby to be kept straight and held
across mother’s chest at nipple level
Painful or Cracked Nipples

•Incorrect positioning
•Faulty fixing of the baby
Management Of Cracked Nipples [Sellers 1993:653;Sellers 2012:549]

Proper positioning of the baby

• Correct attachment of baby to the nipple
• Gentle expressing of breast milk around the nipples to facilitate easier fixing
• Let the baby carry on feeding
• Encourage frequent feeding
• Avoid pulling baby off nipple – insert finger into baby’s mouth alongside
nipple
• Don’t apply any lotions or creams to nipples
• Application of weak vinegar to the nipple often speeds healing
 3/8

Good and Poor Attachment

• What differences do you see?

1 2
 Factors Affecting Initial Breastfeeding)

Psychological factors (Mother)

• Shyness, embarrassment
• Nervousness
• Over -anxiety
• Tiredness – long and strenuous labour
• Supervision given
• Husband and other family members
• Attitude of staff
• Other patients in ward
 Factors Affecting Initial Breastfeeding (2)
Physiological factors (mother and infant)
• Nipple and breast problem
• Problem resulting from labour -Perineal tears, c-section, episiotomy
etc…
• General problem -Cardiac, respiratory conditions
• Physical disability
• Inadequate rest
• Poor Nutrition and fluids intake The Baby
• Serious condition e.g. cerebral palsy
Discontinuation of Lactation

Suppression of breast milk due to: Is done for medical reasons or mother
not willing to breastfed or baby died, social or psychological issue or
use of certain medication, HIV PMTCT etc

• Avoid suckling

• Avoid expressing milk

• Limit fluid intake

• Contain in firm brazier

• Medication may be necessary

 Discontinuation of Lactation (2)

• Use of medication if breastfeeding was initiated

• Prolactin inhibitor like Bromocripton orally 2.5 mg twice a day for

two weeks or a single dose of Cabertonale 1 mg
Ten Steps to Successful Breastfeeding
• Have a written breastfeeding policy that is routinely communicated to
all health staff
• Train all health care staff in skills necessary to implement this policy
• Inform all pregnant women about the benefits and management of
breastfeeding.
• Help mothers initiate breastfeeding within a half-hour of birth
• Show mothers how to breastfeed and how to maintain lactation, even if
they should be separated from their infants
 Ten Steps to Successful Breastfeeding (2)
• Give newborn infants no food or drink other than breast milk, unless
medically indicated
• Practise rooming-in: allow mothers and infants to remain together 24 hours
a day
• Encourage breastfeeding on demand
• Give no artificial teats or pacifiers* to breastfeeding infants
• Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from hospital or clinic
 Promoting Exclusive Breastfeeding
• To maximize safe, effective breastfeeding:
• Place baby directly after birth on the mother to ensure skin-to-skin contact for
as long as possible until breastfeeding has been initiated.
• Baby should breastfeed within ½ hour after birth; do not limit the time for
breastfeeding.
• Help the mother to position and attach the baby and observe breastfeeding
• Review circumstances which may indicate an actual/potential feeding
problem
• Teach mother ways to minimize HIV transmission in the event of breast
infection or cracked nipples
• Emphasize EXCLUSIVE breast feeding!!
• Give no water, tea, or soft porridge to baby
 Self Directed Learning

• Functions of colostrum
• Advantages of breast milk to mother and baby
• Baby-mother-friendly initiative (BMFI)
• Breast feeding and child survival
• Benefits/advantages of breastfeeding (Sellers 2012 pg.121)
• Ten steps in breastfeeding (pg.543 Sellers)
THE END
THANK YOU