Breastfeeding

Also called nursing, is a natural and inexpensive way for a mother to feed her child. According to the
American Academy of Pediatrics (AAP) Policy Statement on Breastfeeding, women who don’t have
health problems should exclusively breastfeed their infants for at least the first six months of life. The
AAP further recommends that women breastfeed for at least the first 12 months of life if possible, and
as long thereafter as mutually desired, because of the benefits to both the mother and baby.

Anatomy and physiology

The breast contains several milk ducts, which open to the nipple. Montgomery's tubercles secrete
substances that lubricate the breast. Milk is made by glands in the alveolus. Milk is made between
and during breastfeeding sessions. Milk travels through the lactiferous ducts and sinuses to reach the
nipple. Some milk is stored in these ducts and sinuses between
breastfeeding.

When a nursing infant squeezes the areola, the pressure stimulates the
release of the hormone oxytocin. Oxytocin then increases the size of
the milk ducts, which allows the milk to "let down."

Prolactin is another hormone that stimulates milk production. Many

other hormones, such as insulin and cortisol, also work to help a
woman breastfeed.

During pregnancy, estrogen, progesterone, and prolactin stimulate the breast to grow. The growth is
due to enlargement of the lobules and alveoli. Milk production begins after delivery, when estrogen
and progesterone levels drop and prolactin levels increase.

Continued milk production is stimulated by the baby's suckling. Milk production is a basic supply and
demand phenomenon. If the breast is emptied, more milk will be made. If the breast is not emptied,
the body sees this as a sign that less milk is needed, so less milk is made.

Relactation

Women who have previously breastfed an infant can sometimes breastfeed adopted children. This is
termed relactation. Some women use medications or herbs to stimulate this process, while others
only need an infant suckling to produce this milk.

Women who have never been pregnant can also sometimes produce milk and breastfeed adopted
children.

Breastmilk
Breastmilk is a dynamic food. It is made on demand and in needed forms. Its composition changes
throughout the child's life as well as during each nursing session.

Colostrum is made immediately after delivery. This substance contains a large amount of antibodies,
proteins, vitamins, and minerals. Transitional milk production usually begins 4 to 10 days after the
baby is born. Mature milk contains fat, proteins, carbohydrates, antibodies, vitamins, and minerals.
The type of fat secreted in the milk depends on the types of fat in the mother's diet. One study
showed that eating sardines increased omega-3 fatty acid levels in milk.

Milk made at the end of a nursing session is higher in fat. This is called hindmilk.

Breastmilk contains iron. The amount of iron is small, but it is very well-absorbed by infants. It is
generally recommended to begin adding foods rich in iron around six months of age.

Breastfeeding positions

There are several positions in which a baby can be breastfed. Mothers may need help finding a
comfortable position at first. Different positions help with nipple soreness.

Cradle hold

Many mothers find this the most comfortable position. In this position, the mother
sits with good support for her back and cradles the baby in her arms with the
baby's head in the bend of the elbow. The baby's body is supported with the arm.
The other hand supports the breast. The baby is brought close, facing the breast,
with baby's belly touching the mother's abdomen.

Football hold

The baby is held at the side, resting on the arm, like running with a football. A
pillow supports the arm and raises the baby to the level of the breast. The baby's
head is held in the palm of the hand, with the baby's legs tucked by the mother's
side. Nursing twins at the same time may be the easiest with the football hold.

Lying down

Mother lies on her side, supporting her back and head with pillows. The baby is
turned onto his or her side to face the mother, with the baby's mouth at the nipple.
The baby is brought to the breast, with the baby's belly touching the mother's
abdomen. A rolled towel or a small rolled blanket is placed behind the baby to
prevent the baby from rolling onto his or her back. The mother may put her lower
arm up over her head or under the baby, depending on what is most comfortable. The lying-down
positiong may be more comfortable after a cesarean birth.

How to position the baby

Positioning the baby properly onto the breast is important for comfortable breastfeeding, and for the
baby to get a good feeding of breast milk. The baby should be held close to the body, facing the
breast, so that mother and baby are tummy-to-tummy.

The breast is supported with the free hand. The breast is lightly cupped in the hand, by holding the
fingers underneath and the thumb on top. Care is taken not to squeeze or pinch the breast.

The nipple is brushed against the baby's lips until her mouth opens wide. While her mouth is open,
the baby is brought to the breast. When the baby feels the nipple on her tongue, her lips will close
over the areola (dark area around the nipple). To avoid discomfort, the baby should take as much of
the areola as possible into her mouth. This is called "latching on." If the baby is sucking only on the
nipple, the nipple will hurt and get sore, and the baby will get less milk. If the baby has latched onto
the breast properly, the mother will feel pressure but the sucking will not hurt or pinch.

If the baby is not latched on correctly, she can be removed from the breast by slipping the little finger
in the corner of the baby's mouth to break the suction. Pulling the baby off the breast without first
breaking the suction will result in soreness of the nipple.

These steps are repeated until the baby is latched on properly. A lactation consultant can help with
problems latching on. A proper latch is one of the most important parts of breastfeeding successfully.

Benefits

Breastfeeding offers many benefits to the baby.

• Breast milk provides the right balance of nutrients to help an infant grow into a
strong and healthy toddler.
• Breastfed infants, and those who are fed pumped breast milk, have fewer deaths
during the first year and experience fewer illnesses than babies fed formula.
• Some of the nutrients in breast milk also help protect an infant against some
common childhood illnesses and infections, such as diarrhea, middle ear infections ,
and certain lung infections.
• Breastfeeding helps to protect babies from the development of allergies.
• Some recent research also suggests that breast milk contains important fatty
acids (building blocks) that help an infant's brain develop. Two specific fatty acids,
known as DHA and AA, may help increase infants’ cognitive skills. [8] Breastfed babies
score slightly higher on IQ tests, especially babies who were born prematurely.

Breastfeeding also benefits the mother.

 • In response to the baby's sucking, the mother's body releases a hormone that
makes her uterus contract and get smaller.
• Many mothers also get emotional benefits from breastfeeding because of the
closeness of this interaction with the baby and from the satisfaction of helping to nourish
their babies.
• Some research suggests that mothers who breastfeed their babies have fewer
episodes of postpartum depression.
• Some research suggests that certain types of cancer (such as breast, uterus,
and ovarian cancer) occur less often in mothers who have breastfed their babies.
• Breastfeeding burns 500 to 800 calories per day, which may make it easier for
breastfeeding mothers to drop their "baby weight." Because breastfeeding burns so
many calories, it is important for mothers to ensure they have a well-balanced diet
sufficient in calories.

Breast Care

Importance:

Experts suggest that a woman breastfeed a newborn infant for his first six months of life, without
giving other liquids or food. You should keep on breastfeeding after 6 months, even while having your
baby try other foods and drinks. Your breast milk gives your baby all of the liquids and nutrition that
he needs to grow and develop. Breastfeeding your baby is healthy for you and your baby, now and in
the future. Breast and nipple problems and certain conditions can make a woman not want to
breastfeed as long as experts suggest. Caring for your breasts while breastfeeding your baby can
help both you and your baby enjoy the benefits of breastfeeding.

Problems encountered during breastfeeding:

• Nipple soreness:

Many women have painful nipples when they begin to breastfeed a baby. A small amount of
nipple pain is normal. Repositioning your baby and helping him latch on to your breast
correctly may decrease or stop the pain in your nipples.

Breast infections, skin conditions, and certain diseases can cause nipple soreness. Your
nipples can become painful and swollen when you use a breast pump to collect your breast
milk. Changes in your hormones can also cause nipple soreness. Infant problems such as
tongue-tie can affect the way your baby latches on to your breast. This can cause sore nipples.
Work with your caregiver to help your baby latch on correctly so he gets the milk that he
needs.

Do not use nipple creams, ointments, or any other medicine or devices on your breasts or
nipples unless your caregiver tells you to. Do not use a new kind of soap to wash your bra.
Placing warm, wet compresses, tea bags, or breast milk on your nipples may help decrease
pain. Ask your caregiver for more information about breastfeeding and nipple soreness.

• Engorgement:
 Your breasts may grow swollen and painful as your milk comes in soon after you begin
breastfeeding. This is called engorgement. Feeding your baby often and emptying your breasts
is the best way to decrease engorgement symptoms. Feeding your baby when he shows signs
of being hungry instead of feeding him on a set schedule can help prevent engorgement.
Massaging your breasts or expressing some milk by hand may decrease your discomfort.

Engorgement can make it hard for your baby to latch on to your breast. If this happens,
express a small amount of milk, and then have your baby latch on. Your caregiver may
suggest medicine to decrease pain or swelling. Cabbage leaves placed on your breasts may
also decrease your symptoms. Cold compresses or gel packs may help you feel better. Breast
redness, pain, and a fever (high body temperature) are signs that engorgement is getting
worse. If engorgement worsens and is not treated, your baby may not get enough milk, and
your nipples may be damaged.

• Plugged milk ducts:

Plugged ducts cause painful breast lumps. Plugged ducts can be caused by not emptying your
breasts fully. To prevent plugged ducts, empty your breasts through breastfeeding or using a
breast pump at each feeding. Do not wear underwire bras or tight clothing over your breasts.
Find ways to manage stress, and try to get enough sleep. Drink plenty of fluids. Ask your
caregiver about diet changes that can decrease your risk of getting plugged milk ducts.
Changes may include avoiding high-fat dairy products or adding a diet supplement. To help
avoid plugged ducts as you are weaning your baby, slowly increase the time between
feedings. You can stop breastfeeding and begin using a breast pump to drain your breasts
instead. Feed breast milk to your baby using a bottle or a cup. Slowly increase the time
between pumping your breasts.

• Breast infections:

Having plugged ducts or not emptying your breasts can lead to a breast infection called
mastitis. With mastitis, your breasts grow red, swollen, and painful. Treatment includes
emptying your breasts fully and often by breastfeeding or using a breast pump. When your
baby pauses while breastfeeding, massage and gently squeeze your breast. Gentle massage
may unplug a blocked milk duct. Pump out the milk left in your breasts after your baby is done
breastfeeding. Ask your caregiver about feeding your baby when you have a breast infection.

Using heat on your breasts may decrease the pain. You may want to place a moist, warm cloth
on the painful breast or both of your breasts. Ask your caregiver how often to do this. Your
caregiver may suggest anti-inflammatory medicine to decrease pain and swelling. Your
caregiver may order antibiotics (germ-killing medicine) to treat mastitis. Getting enough rest
and sleep and drinking more liquids can also help. If the mastitis is not treated, you may get
flu-like symptoms, such as a fever and chills. Mastitis can lead to a serious infection called
cellulitis, or can lead to a breast abscess (pus pocket).