BREASTFEEDING

By
Prof Grace Irimu

Breastfeeding May 2017

 Appropriate breastfeeding
• Initiating breastfeeding within 1 hour

• Exclusive breastfeeding until 6 months age

• Continued breastfeeding to at least up-to 2 years of

age

• Breastfeeding on demand, day and night

Breastfeeding May 2017

Breastfeeding May 2017
 What are the advantages of
breastfeeding?
•To the infant
•To the mother
•To the family and nation

Breastfeeding May 2017

Benefits of initiating breastfeeding within 1
hour
Benefits to baby Benefits to Mum

3330,000 • Maternal-infant bonding.

deaths in first
• Prevents mothers deaths by
ONE month of 22% reduction of
life
preventing excessive bleeding
neonatal deaths if
breastfeeding
initiated in the first
1 hour
16% reduction if
breastfeeding
73,000 deaths initiated on the first
can prevented day

Breastfeeding May 2017

Benefits of appropriate breastfeeding

Reduces risk of Reduces risk of

death acute illness

Reduces risk of
Reduces risk of
mother
chronic illnesses developing
chronic illnesses
Breastfeeding May 2017
Benefits of Breastfeeding (1)

Increased hospitalization in
bottle fed babies

3/4 reduction in Reduces

admissions due to admissions due to
diarrhea pneumonia by 50%

Breastfeeding May 2017

Benefits of Breastfeeding (2)

Increased hospitalization in
Reduction
bottle in
fed babies
sudden infant
deaths in high
3/4 reduction in income countries
Reduces
admissions due to admissions due to
diarrhea pneumonia by 50%

Breastfeeding May 2017

 Benefits of breastfeeding (3)
• Prevents illnesses
Ear infection
Asthma

Chronic illness

Breastfeeding May 2017

Improves brain development

Breastfeeding May 2017

Towards achieving the SDGs

Better
Likely to performance Higher wages
survive in school (5 – 50% )
(33%)

Africa and Asia loosing 10-11% of the GDPs due to

under nutrition
Breastfeeding May 2017
Saving cost associated with improved
breastfeeding from societal perspective
Perspective Saving

Infant and FEEDS (Formula, commercial complementary feeds,)

parent MEDICAL COST ( physician cost, prescription cost, over the counter
medication)
FAMILY COST – ( care of sick child- seeking care & care at home or
hospital, lost wages, family disruption )
LONG TERM SEQUELE – ( decreased quality of life, reduced IQ)

Employer Less employee absenteeism

Less lost productivity
Lower insurance premium
Less employee turnover
State Purchase of formula
Medical cost
Worker productivity
Global competition
Breastfeeding May 2017
 Benefits to the mom

1. Breastfeeding can
reduce this by 20,000
per year

2. Cancer of the ovaries

3. Excessive bleeding during child birth

4. Can help you lose pregnancy weight.

Breastfeeding May 2017
Helping the modern mothers achieve
breastfeeding goals
• Health Bill - 2016
Comprehensive lactation Programme for corporates Includes:
• Privacy for milk expression
• Flexible working hours/breaks
• Education
• Support

• Insurance policies to include breastfeeding support.

Breastfeeding May 2017

Benefits of lactation Programme for corporates (1)

Reduces medical cost and health

insurance claim for the employees
X3 and their infants

Reduces turn over

X90% Return to work after child birth- 90%

Reduces number of 1day absences.

X50%

Breastfeeding May 2017

 Is there a problem?
Rates of exclusive breast-feeding in Kenya KDHS
2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
at birth 0-1mo 2-3mo 4-5mo
Exclusive BF No exclusive BF

Breastfeeding May 2017

Towards successful breastfeeding

• Be prepared
• When
• What (moms’ feeds, baby’s feeds)
• How (Technique)

Breastfeeding May 2017

Common problems – be proactive
•I don’t have sufficient
breast milk
•I have breast pain
•I gained a lot of
weight during after
delivery
•Baby is crying a lot-
not getting enough

Breastfeeding May 2017

The Breast

• Nipple
• contains 15-25 ducts,
opening of each of the
tubuloalveolar glands
• Richly innervated with
sensory nerve endings
• Smooth muscle fibre
• Sebaceous and sweat
glands
• Highly elastic
• Tail of Spence – mammary
glandular that projects to
the axilla – connect to a
normal ductal system
Breastfeeding May 2017
Breast anatomy
Areolar :
• Montgomery
glands –
secrete a
lubricant for
the nipple an
the areolar
• Highly elastic

Glandular
tissue
• Size of breast
does not
predict milk
Breastfeeding May 2017
production
Breast milk
• stage I : From 16 weeks – mother can express colostrum . Milk
production inhibited by high level of progesterone and estrogen
• Stage II: Production of copious milk at delivery - - due to drop in
progesterone levels – level drop in the first 4 days postpartum. – by 5th
day the mammary epithelium is transformed to produce volumes of milk

onset of stage II also marks increase

in lactose and citrate concentration in
breastmilk.
 High levels of prolactin first 3-4 day
& milk production not dependent
on suckling
Next 10days composition of
milk changes to mature milk .
Stage III: mature breastmilk

Breastfeeding May 2017

 Physiology of
breastfeeding

Plus auditory,
visual

Breastfeeding May 2017

Essential of Effective lactation

•Suckling

•Emptying of the breast (accumulation of milk

in the breast inhibits milk production)

•Adequate precursors of nutrients

Maternal nutrition, age, body
composition and parity are secondary
factors
Breastfeeding May 2017
Correct breastfeeding technique

•Mothers position

•Baby position

•Holding the breast

•Attaching the breast into baby’s mouth

Breastfeeding May 2017

Mothers position

• Mother must be comfortable

Breastfeeding May 2017

Baby correct position

• baby’s nose at the level of the

breast
• baby close to the mother
• head and the trunk in a straight line
• mom support child’s whole body
Breastfeeding May 2017
Attaching baby’s mouth to the breast

Holding the breast

Opening the mouth
Introducing the breast into the infant mouth
Breastfeeding May 2017
Breastfeeding May 2017
Signs of good attachment
• chin touching breast,
• mouth open,
• more areola above
nipple,
• lower lip turned out,
Effective suckling.
• baby takes slow deep
suckles sometimes
pausing and you may be
able to see or hear baby
swallowing.
• Suckling is comfortable
and pain free for mom.
Breastfeeding May 2017
Correct
attachment ?

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Poor attachment

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Expressing breastmilk Cup feeding

Breastfeeding May 2017

Takes 15minutes
Getting sufficient breastmilk
• Correct breastfeeding technique
• Relaxed mom
• Frequent draining of the breastmilk
• Breastfeeding
• If not possible – express breastmilk

Not by drinking or Help in

eating excess fully weight
reduction
Breastfeeding May 2017
 Cues for feeding in baby watching:
Baby Cue Stage of Readiness to Feed
• Wiggling, moving arms or Early
legs

• Rooting, fingers to mouth Early

• Fussing, squeaky noises Mid

• Restless, crying intermittently Mid

• Full cry, aversive screaming

pitch, color turns red
Late
Breastfeeding May 2017
Breastfeeding for HIV mothers
• Mother to make informed decision
• Start on the ARVs early ( before 3 months gestation)
• Fully supported for ARV adherence (mothers lifelong
treatment and baby prophylaxis).
• Baby prophylaxis to be continued for one week after
stopping breastfeeding.
• Transmission of HIV increases if mom stops ARVs
abruptly

Breastfeeding May 2017

Breastfeeding for HIV mothers
•Overall transmission of HIV
4% •Breastfeeding duration for 12months

• Transmission of HIV
3.5% • Breastfeeding duration for 6months

• ARVs started by 15weeks gestation

0.5-1.9%

Breastfeeding May 2017

10 steps of successful breastfeeding

1. Have a written breastfeeding policy that is routinely communicated to all

healthcare staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of
breastfeeding.
4. Help mothers initiate breastfeeding within 30minutes of birth.
5. Show mothers how to breastfeed and how to maintain lactation even if
they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk unless
medically indicated.
7. Practice rooming in-that is allow mothers and infants to remain together
24hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers(also called dummies or soothers) to
breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer
mothers to them on discharge from hospital or clinic.

Breastfeeding May 2017

4 key points on positioning

• Baby's head and body are in line

• Baby held close to mother’s body
• Baby's whole body supported
• Baby approaches breast nose to nipple.

Breastfeeding May 2017

Feeding positions

• Cradle position
• Cross-cradle position(across the lap)
• The football
• Side-lying position
Mothers can try different positions before discharge
Mothers who had vaginal deliveries report less fatigue if they
breastfeed in the side-lying position rather than the sitting position

Breastfeeding May 2017

Cradle position

• Mother’s same-sided arm supports the infant at the breast on which

the infant is nursing.
• The infant’s head is cradled near the mother’s elbow while the arm
supports the infant along the back ,facing the mother , chest-to-
chest.

Breastfeeding May 2017

Madonna (cradle position)

Breastfeeding May 2017

Side-lying Position

• The mother lies on her side facing the infant who is also lying on his
or her side
• Infant faces the mother with the mouth at the level of the nipple
• Caution-infant should not be surrounded by loose clothing or
bedding and careful precautions should be made if the mother is
drowsy to prevent entrapment or suffocation

Breastfeeding May 2017

Side-lying position

Breastfeeding May 2017

Football /clutch Hold

• The infant’s feet and body are tucked under her arm and the infants
head is held in her hand facing the breast.
• It can be difficult in this position to determine whether the infant’s
mouth is open wide enough and whether lower lip is flanged

Breastfeeding May 2017

Football or clutch hold

Breastfeeding May 2017

Cross-cradle or Transitional hold
• This hold uses the opposite arm to support the
infant with the back of the head(below the occiput)
and neck held in the mother’s hand.
• The hand closest to the breast supports and
positions the breast as needed
• Ideal for early breastfeeding
• Excellent support and the ability to present the
breast in a moulded fashion with a free hand.
• Easier to assess a wide gap of the mouth and
appropriate lip flange

Breastfeeding May 2017

Cross-cradle or modified clutch hold

Breastfeeding May 2017

Poor positioning

• Baby’s neck and head twisted to feed

• Baby not held close
• Baby supported by head and neck only
• Baby approaches breast, lower lip/chin to nipple

Breastfeeding May 2017

Attachment (Latch-on)

• More areola is seen above baby's top lip

• Baby's mouth wide open opposite mother’s nipple
• Lower lip turned outwards
• Baby's chin touches or is close to the breast
• Neck slightly extended with head shoulders and hip in alignment
• Support the breast with a c-grip or u-grip

Breastfeeding May 2017

Latching on

Mouth gaped open Grasping breast

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Poor attachment

• More areola seen below bottom lip

• Baby’s mouth not open wide
• Lips pointing forward or turned in
• Baby’s chin not touching breast

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 4/3

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 4/2

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 4/4

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 4/5

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 4/6

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 4/7

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 Dealing with Flat and inverted nipples
Flat Show the mother how to make the nipple stand out
nipples by pinching it between her thumb and the index
finger

Inverted
nipple

Also Pump the breast before nursing

If engorge touch the breast with wet cold cloth briefly
Breastfeeding May 2017
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