Download 2-breast feeding

Breast feeding
Lactation is an important physiological event of
puerperium.
The primary function of breast feeding is to provide
nutrition for the new baby
The secondary functions are:
Protection against infant infections & various diseases.
Inhibition of ovarian activity.
Encouragement of uterine involution.
Physiology of lactation
The breast development occur during puberty
mainly& each breast compose of 20 lobules arranged
radialy from the nipple. Each lobule compose of
glandular tissue & ductal system which is branching &
then unite to form a single duct which open on the
nipple.
The glandular tissue compose of alveoli. The duct
& the alveoli are surrounded by myoepithelial
contractile cells.
During pregnancy there is hypertrophy of the
alveoli & ductal system of the breast. This hypertrophy
is due to the effect of estrogen , progesteron
,prolactin, growth hormone & adrenal steroid.
Milk production
Secretion of milk & colostrum begin in the 2nd
trimester but it is minimal due to the inhibitory effect of
estrogen.
Establishment of lactation include 2 similar but
independent mechanisms:
 The release of prolactin which acts upon the glandular
cells of the breast to stimulate milk secretion.
 The releases of oxytocin which acts upon the
myoepithelial cells to induce milk ejection reflex.
The release of both hormones is stimulated by an
afferent neorological stimuli from the nipple( which
become very sensitive to tactile stimuli immediately
after delivery) to the hypothalamus.
Milk secreation
Prolactin is a long chain polypeptide released from
the lactotrophs in the anterior pituitary stimulated by
the nipple stimulation during suckling.
Its level is dependent on the strength, frequency &
duration of suckling stimuli
Its peak level is reached after 30-45 minutes after
suckling & return to basal level after 2 hours.
Prolactin secretion is under the neuro-endocrine
control of a prolactin inhibitory factors from
hypothalamus which is dopamine ,so its secretion is
inhibited by dopamine agonist which is bromocriptine.
Prolactin will act on the secretary cells of the breast to
stimulate the synthesis of milk proteins (casein,
lactoglobulin& lacalbumin) , lactose & lipids.
Milk ejection reflex
This reflex Is mediated by the release of oxytocin from
the posterior pituitary & it will stimulate contraction of
the myoepithelial cells which ware situated round the
milk secreting glands & wall of the ducts longitudinally.
So the contractions of these smooth muscle will cause
:
 Expelling of milk from the gland.
 Dilatation of the ducts & encouraging free flow of the
milk.
Oxytocin secretion is stimulated by tactile
stimulation of the areola by suckling & also by sensory
input such as the mother seeing or hearing her baby
crying, while prolactin is stimulated by tactile
stimulation of the areola.
Oxytocin have a very short halve life in the
circulation & released from the pituitary in a pulsatile
manner.
The milk ejection reflex may be inhibited by
emotional stress.
Composition of colostrum & breast milk
From the 1st 2 days after delivery colostrum is
secreted & on the 3rd & 4th days the secretion is
changed to normal breast milk.
Colostrum is a yellow fluid containing large fat
globules & has a high mineral, moderate proteins &
relatively low sugar content
It has a high content of Ab spatially secretary Ig A
which has an important role against infections
When the secretion changes from colostrum to milk
,its color changes to bluish white.
Advantage of breast feeding
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Breast milk is a natural food for the human infant.
Inexpensive
Always at appropriate temp.
Protect against infections.
Contribute to the development of infant – mother
attachment.
Protection against diseases as juvenile DM ,
inflammatory diseases or atopic illnesses as asthma
or eczema.
Improved neurological development.
Breast feeding decrease the incidence of breast
cancer in premenopausal women .
Suppression of ovarian activity.
Problems during breast feeding
It may be related to the infant or the mother
Causes related to the infant

Disease of the infant such as pneomonia or other inf.

Disproportion between the size of the nipple & the baby’s
mouth but this can be remedied as the baby grows.

Cleft lip & cleft palate or micrognethia .

Nasal obstruction
Causes related to the mother

Retracted nipple.

Cracked or sore nipple which is mainly due to incorrect
fixation of the baby (which may be due to breast
engorgement caused by infrequent feeding )or due to fungal
skin infection
Cracked or
Sore nipple
Incorrect fixation
Infrequent feeding
Breast engorgement
Treatment is:
1.
Encourage frequent feeding &if the breast is so tens
& engorged allow manual milk expression or
expression by pump.
2.
Educate the mother about correct positio & fixation
of the baby to the breast.
3.
Lubricate the nipple by the terminal milk drops which
are rich in fatty material.
4.
Treatment of fungal infection if present.
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Breast engorgement that usually occur on the 3rd or
4th day after delivery & the breast become painful,
tender ,swollen , red & shiny. This is usually relieved
by frequent feeding
Drugs during lactation
Drugs should be avoided during lactation unless
there is definite clinical indication because some of the
drug or its degradation product is likely to be secreted
in the milk..
Secretion of drugs in the milk depend on its molecular
wt. ,size, its binding protein , solubility in water or lipid.
The effect of the drug depend on whether it appear in
the milk in its active or inactive metabolite, the rout of
administration , the drug half life.
Other factor to be determined is whether the infant gut
can absorb the drug or the drug can be detoxified or
excreted.
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Some steps can be taken to minimize the potential
effect of maternal medication on the infant as:
The long acting form of the drug should be avoided
The drug is given immediately after feeding so the
peak level in maternal blood will subside by the next
fed
The infant should be watched carefully for possible
adverse effect such as change in feeding habits ,
sleeping pattern if the mother taking anti epileptic
drugs, skin rash or other unusual signs as bleeding
tendency in infant of a mother taking anticoagulant
drugs.
Protection against infections
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The breast milk contain lactoferrin which bind to iron &
because E.coli require iron for growth ,multiplication of the
organism is inhibited
Breast feeding encourage the colonization of the gut by a non
pathogenic flora which will competitively inhibit pathogenic
strains.
Breast milk contain a bactericidal enzymes as lysozymes.
Ig A which is a secretary Ig secreted by the lymphoid tissue of
the gut (Peyer’s patches) & transferred to the breast milk & is
not absorbed from the infant gut but remain to attach to
specific pathogen.
Breast milk contain a living cells as polymorphs ,lymphocytes
& plasma cells which may be active against invading
pathogens.
Suppression of ovarian function
This secondary function of lactation which is called
lactational amenorrhea is caused by a suckling
induced effect or change in the hypothalamus
sensitivity to the feedback effect of ovarian steroid
During lactation the hypothalamus becomes more
sensitive to the negative feedback effect & less
sensitive to the positive feedback effect of estrogen
This mean when the pituitary secret enough FSH &
LH to initiate follicular development ,the consequent
estrogen secretion will inhibit G n release & follicle will
fail to mature.
during the 1st 6 moths of life the failure rate of
exclusive breast feeding as contraceptive is 1-2% but
increase to 10% after 6 months.