Dr. Shivu. P

MBBS, DCH.

Consultant Pediatrician.

No. 757, Vinayamarga,

11th cross, Siddarthanagar, Mysore 11. PIN: 570011.

Mobile number: 9448477380,

Land phone: 0821 2561277, 0821 4000778

Mail: shivup.183@gmail.com

Visit: www.slideshare.net/drshivu

Breast feeding - Key words in Anatomy.

Breast: It is the milk

producing organ in

mammals.

Note: All the mammals

feed their off springs

till they are able to

eat other naturally

available food as they

don’t have artificial

feeds.

We don’t leave any one, some times for good.

Breast feeding - Key words in Anatomy. Nipple: the anterior most

projection of the breast

which contains the ducts to

let down the milk.

Note: Baby sucking only at the nipple will not get the milk as the ducts does

not contain milk in it, but it only participates in the process of flow of milk

as the baby creates strong negative suction force from below and

compression pressure over the milk containing pockets called lactiferous

sinuses which are present beneath the areola. Sucking only at the nipple

will cause physical trauma to the nipple, which leads to cracked nipple,

bleeding from the nipple skin and severe pain to the mother

Breast feeding - Key words in Anatomy. Areola: the brownish black skin

surrounding the nipple and contains oil

secreting glands called Montgomery's

gland which maintains the appropriate

lubrication during the process of sucking.

Note: Do not advice to wash the breast frequently or after each feed as it will remove

the lubricating oil and it make the skin dry and prone for injury and infection as

sucking will cause friction and physical trauma to the nipple and areola in the

absence of lubrication. Feeding mothers can wash their breast during their regular

bath.

Areolar glands or Glands of Montgomery are sebaceous glands in the areola

surrounding the nipple. The glands make oily secretions (lipoid fluid) to keep the

areola and the nipple lubricated and protected. Volatile compounds in these

secretions may also serve as an olfactory stimulus for newborn appetite.

Breast feeding - Key words in Anatomy. Milk pockets – Lactiferous sinuses: It is the

dilated spindle shaped space which stores small

volume of milk which is received from the

lactiferous duct proximally and discharges the

milk out through the ducts in the nipple by

suction from below and by the circumferential

compression pressure all around.

Note: baby gets the milk well, only when

1. the upper jaw and lower jaw circumscribes the areola to create the

circumferential pressure,

2. when the baby latch the breast with air tight grip , with no air gap between the

breast and the mouth of the baby,

3. with good suction pressure,

All these together makes good sucking with good shift of milk from the breast to

the mouth of the baby.

Breast feeding - Key words in Anatomy.

Note: When excess milk is collected in the gland space / duct /

sinus that leads to engorgement of the breast. Since the ducts

and the glands extends up to the base of the breast and also

in to the axilla, the manual expression of the milk by keeping

the flat of the hands should start from the base of the breast

and the hands are slided over the breast towards the nipple

as one hand gives counter pressure to the other hand.

Lactiferous ducts: they make the milk to flow which is secreted

from the lactiferous gland towards the milk pockets (lactiferous

sinuses).

This is repeated in all the quadrants of the breast by keeping the hands in diagonally

opposite side over the breast (that is above and below, inside and outside, upper outer side

and lower inner side, upper inner side and lower outer side). Do not squeeze the front of the

breast with single hand, it can cause severe pain with reverse flow pressure.

Breast feeding - Key words in Anatomy. Lactiferous glands (Milk secreting

glands); the exocrine gland which

secretes the milk by extracting the

nutrients from the interstitial space and

from the blood. The muscle cells which

surrounds the gland helps the gland to

contract and make the milk to flow

towards the ducts.

Note: the secretion of milk from the gland

and its contents depends on the

nutrition of the mother. Good nutrition

is vital in secreting good quality and

quantity of milk.

Breast feeding - Key words in Anatomy.

Good nutrition is vital

both in pregnancy and

lactation as the body

gains about 12 kgs in

pregnancy in which the

breast is going to gain

1 to 2 kgs of weight.

Breast feeding - Key words in Anatomy. Ligament of cooper:(also known as

the suspensory ligaments of Cooper)

and the fibrocollagenous septa are

connective tissue in the breast that help

maintain structural integrity and bears

the weight of the partially mobile breast

over the chest wall deep pectoral fascia.

Note: the weight of the breast of the non pregnant women varies and these

ligaments has to support about one kilogram of extra weight during

pregnancy and lactation, and they may become lax later. So supporting the

breast with appropriate inner were which neither compresses the breast

and make the impairment in milk flow nor very loose and thus does not

support the breast should be worn.

Breast feeding Physiology.Receptors in the nipple and areola will be

stimulated as the baby starts sucking at the breast

and the impulses will reach the brain /

hypothalamus.

Hypothalamus will release the ‘Prolactin releasing

hormone’ in to the anterior pituitary and the

pituitary gland will produce the ‘Prolactin’ which

acts on the alveolus of the breast to secrete the

milk.

Hormone oxytocin will be released from the

posterior pituitary and it makes the myoepithelial

cells which surrounds the milk containing alveolus

to contract and thus makes the milk to flow down.

Breast feeding Physiology. Love and affection, is the

physiological process through

which the blood vessels relax

and maintain the normal

pressure under physiological

condition, make the blood

supply to the breast optimum

and facilitates the milk

secretion, not only in the

feeding breast, but even from

the opposite breast.

Breast feeding Physiology.

Vision: Mother

looking at the baby

and enjoying the

process of breast

feeding enhances the

flow of breast milk.

Breast feeding Physiology.

Hearing; The cry of the child, the sounds produced by the

baby make the mother to secrete more milk.

Breast feeding Physiology.

Olfaction; child will have its own odor, which usually stimulates

the mother.

The milk and the secretions from the nipple and areola will have

its own odor which attracts the baby for feeding.

Breast feeding Physiology. Touch of the baby: every one

on this earth enjoys holding

the babies with close contact

and more by the mother.

Touch of the baby by the

mother induces positive

feeding reflex. Sucking and

rooting reflexes are all well

established which involves

the touch.

Breast feeding and Physics - Pressure.

Breast feeding and Physics-Circumferential pressure.

Breast feeding and Physics-Suction Pressure.

Breast feeding and physics.Circumferential pressure and suction pressure.

How Breasts Make Milk: The Physiology of Breastfeeding

A woman’s breasts start getting ready to make milk when she becomes pregnant.

Breast changes are caused by four main hormones.

These hormones cause the ducts and glandular tissue (alveoli) to grow and increase

in size .

Breasts start to make the first milk, colostrum, in the second trimester. Colostrum

is thick and clear to yellow in colour. Once the baby and the placenta are delivered,

breast starts to make more milk.

Over the next few days, the amount of milk from the breasts increase and the

colour will change to appear more watery and white.

Breast feeding Physiology.

Breast feeding Physiology.

Breast feeding Physiology.Hormones of Lactation.

The complex physiology of breastfeeding includes a delicate

balance of hormones.

There are four hormones that help breasts make milk are

estrogen, progesterone, prolactin and oxytocin.

The body naturally knows how to adjust the level of these

hormones to help the breasts to make milk.

Breast feeding Chemistry.Estrogen and progesterone:

They prepare the breasts to make milk.

These hormones are released by the

placenta during pregnancy.

They increase the size and number of

milk ducts in the breasts.

Once the baby is born and the placenta is

delivered, these hormones decrease. This

decrease signals the body that it is time

to make milk.

Breast feeding Chemistry.Progesterone :

It plays an important role in mammary

gland development in females.

In conjunction with prolactin, it

mediates lobuloalveolar maturation of

the breasts during pregnancy to allow

for milk production, and

thus lactation and breastfeeding after

childbirth.

Estrogen is required for progesterone

to mediate lobuloalveolar maturation.

Breast feeding Chemistry.

Prolactin is a hormone named

originally after its function to

promote milk production

(lactation) in mammals in

response to the suckling of

young after birth. It has since

been shown to have more

than 300 functions in the

body.

Breast feeding Physiology. Prolactin helps the breasts to make milk.

After the birth of the baby, prolactin levels increase.

At every time of breastfeed or pump, the body releases

Prolactin.

With each release, the body makes and stores more milk

in the breast alveoli.

If the level of this hormone gets too low, the milk supply

will decrease. This is why it is important to breastfeed or

pump right after delivery and then at regular time

frames.

Breast feeding Physiology.

Breast feeding Physiology.

Oxytocin releases milk from the breasts.

When the baby (or breast pump) begins to suck and draw the

nipple in to the mouth, this hormone is released. This release

causes milk to be squeezed out of the alveoli, into the ducts

and out of the nipple, into the baby’s mouth. This process is

called let down or milk ejection reflex (MER).

Breast feeding Chemistry. Oxytocin is released in to the

bloodstream as a hormone in

response to stretching of the cervix

and uterus during labour.

It helps in the contraction of the

uterus during labour.

It is also secreted with the

stimulation of the nipples

from breastfeeding and thus helps

the uterus to contract , minimises the

bleeding and makes the uterus to

attain pre pregnancy size.

Good position in breast feedingBaby’s body is well supported.

Baby is held close to the mother.

The entire body of the baby is turned

towards the mother (But not only the

head).

Baby’s head is in close contact with

the mother with good attachment to

the nipple and areola.

Baby’s abdomen is in close contact

with the abdomen of the mother.

With this the baby ‘s mouth, chin and

the umbilicus will come in straight line

(i.e. the head, neck, and the body of the

baby are kept in the same plain).

Good position in breast feeding

Chin of the baby is in close contact with the breast , that is there is no gap

between the breast and the chin of the baby.

Most of the areola of the breast is inside the mouth of the baby.

Baby’s mouth is wide open.

Tongue of the baby latches the nipple and areola.

Lips are everted out (turned out) and grasping the areola well.

Lips and gums are fitted firmly and circumferentially like a purse string, over

the areola in air tight fashion.

Bad position in breast feeding

Poor attachment.

Poor attachment.

Good attachment.

Good attachment.

Good attachment.

If the baby breast feeds with good

attachment then only the milk will be filled

inside the stomach and there is no

collection of air.

Even then it is better to burp for about 20

minutes after each feed because, even a

minute amount of air can also cause

problem.

Poor attachment.

If there is poor attachment then some amount of air will enter in to the mouth

through the gap between the mouth of the baby and the breast, that will enter in to

the stomach as the baby swallows the milk mixed with the bubbles of air.

Later they may enter in to the intestine where they form the air columns or the child

may vomit the milk as the air bubbles comes out through the esophagus and then

through the nose and mouth.

Burping after the feed.

As the air is lighter than fluid (that is the milk) all the air bubbles will fuse at

the top of the stomach (that is at the fundus of the stomach) when the baby is

kept in erect posture either over the shoulder or over the lap. This fused air

bubble (that is only the air) will come out through the mouth of the baby

leaving only the milk which is settled at the bottom (Body and the Pylorus)

of the stomach . Thus only milk will enter in the intestine.

Poor burping – Short burping – No burping. Will lead to vomiting, as the air tries to come out of

the stomach which is mixed with milk.

Air mixed milk may come out both through the

mouth and nostrils.

When the milk sticks to the nose, they may get

discomfort in the nose or blocked nose and the baby

does not know how to clear the nose and it will not

be able breath through the nose, so it will

continuously cry to breath himself through the

mouth.

Baby may be hungry, but it will not be able to feed as

the mouth is going to be covered with breast during

the breast feeding and the nose is already blocked

and it gets suffocated if it tries to feed.

Poor burping – Short burping – No burping.

The air which enters the small intestine makes the

intestine to bloat up and thus the baby gets the

pain in the abdomen, and the baby will cry with

this pain disturbing the entire family and the

neighbors, till the air gets out of the intestine

from the bottom as flatus.

The air columns which are formed between the milk in the lumen of the

intestine and the wall of the intestine will interfere with the digestion and

absorption of the milk and thus poor weight gain by the baby.

Lack of sleep by the baby make it irritable child with poor growth and poor

performance in the life.

Sleepless night by the members of the family may interfere with the earning by

the family members.

Burping after the feed Any one in the family can involve in this lovely job of burping and enjoying with the baby.