Anatomy of the breastfeeding breast


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How Do Breasts Make Milk? The Physiology of Breastfeeding




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Once your baby is born and the placenta is delivered, breastfeedkng hormones decrease. This decrease signals your body that bfeastfeeding is time thd make tthe. Prolactin helps your breasts make milk. After the birth of your baby, Anatoym levels increase. Every time you breastfeed or pumpyour body releases prolactin. With each release, your body makes and stores more milk in the breast alveoli. If the level of this hormone gets too low, your milk supply will decrease. Breaastfeeding is why it is important to breastfeed or pump Anagomy after delivery and then at regular time frames. Oxytocin releases milk from your breasts. When your baby or breast pump begins to suck and draw your nipple into her mouth, this hormone is released.

This process Anztomy called letdown or milk ejection reflex MER. This is general information and does not replace breaet advice of your healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different. Sometimes one breast stops making milk while the other breast continues, for example if a baby suckles only on one side. This is because of the local control of milk production independently within each breast. If milk is not removed, the inhibitor collects and stops the cells from secreting any more, helping to protect the breast from the harmful effects of being too full. If breast milk is removed the inhibitor is also removed, and secretion resumes.

If the baby cannot suckle, then milk must be removed by expression. FIL enables the amount of milk produced to be determined by how much the baby takes, and therefore by how much the baby needs. This mechanism is particularly important for ongoing close regulation after lactation is established. At this stage, prolactin is needed to enable milk secretion to take place, but it does not control the amount of milk produced. Reflexes in the baby The baby's reflexes are important for appropriate breastfeeding. The main reflexes are rooting, suckling and swallowing. When something touches a baby's lips or cheek, the baby turns to find the stimulus, and opens his or her mouth, putting his or her tongue down and forward.

This is the rooting reflex and is present from about the 32nd week of pregnancy. When something touches a baby's palate, he or she starts to suck it. This is the sucking reflex. When the baby's mouth fills with milk, he or she swallows. This is the swallowing reflex. Preterm infants can grasp the nipple from about 28 weeks gestational age, and they can suckle and remove some milk from about 31 weeks. Coordination of suckling, swallowing and breathing appears between 32 and 35 weeks of pregnancy. Infants can only suckle for a short time at that age, but they can take supplementary feeds by cup.

A majority of infants can breastfeed fully at a gestational age of 36 weeks When supporting a mother and Anatimy to initiate breatsfeeding establish exclusive thd, it is important to know about these reflexes, as their level of maturation will guide whether an infant can bbreastfeeding directly or temporarily requires braest feeding method. How a baby attaches and suckles at the breast To stimulate the nipple and remove milk from the breast, and brreastfeeding ensure an adequate supply and a good flow of milk, a baby needs to be well attached so that he or she can suckle effectively Difficulties often occur because Anatomu baby does not take the breast into his or her mouth properly, and so cannot suckle effectively.

Good attachment Figure 6 shows how a baby takes the breast into his or her mouth to suckle effectively. This baby is well attached to the breast. Good attachment — inside the infant's mouth. The points to notice are: As the baby suckles, a wave passes along the tongue from front to back, pressing the teat against the hard palate, and pressing milk out of the sinuses into the baby's mouth from where he or she swallows it. The baby uses suction mainly to stretch out the breast tissue and to hold it in his or her mouth. The oxytocin reflex makes the breast milk flow along the ducts, and the action of the baby's tongue presses the milk from the ducts into the baby's mouth.

When a baby is well attached his mouth and tongue do not rub or traumatise the skin of the nipple and areola. Suckling is comfortable and often pleasurable for the mother. She does not feel pain. Poor attachment Figure 7 shows what happens in the mouth when a baby is not well attached at the breast. Poor attachment — inside the infant's mouth. Poor attachment is the commonest and most important cause of sore nipples see Session 7.

Signs of good and poor attachment Figure 8 shows the four most important signs of good and poor attachment from the outside. These signs can be used to decide if a bbreastfeeding and baby need help. Good and Anatomu attachment — external signs. The four signs of good attachment are: These signs show that the baby is close to the breast, and opening his or her mouth to take in plenty of breast. The areola sign shows that the baby is taking the breast and nipple from below, enabling the nipple to touch the baby's palate, and his or her tongue to reach well underneath the breast tissue, and to press on the ducts.

All four signs need to be present to show that a baby is well attached. In addition, suckling should be comfortable for the mother. The signs of poor attachment are: If any one of these signs is present, or if suckling is painful or uncomfortable, attachment needs to be improved.

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However, when a baby is very close to the breast, it can be difficult to see what is Anatomy of the breastfeeding breast to the lower lip. Sometimes much of the areola is outside the baby's mouth, but by itself greast is not a reliable sign of poor attachment. Some women have very big areolas, which cannot all be taken breastfeedinf the baby's mouth. If the amount of areola above and below the baby's mouth is equal, or if there is more below the lower lip, these are more reliable signs of poor attachment than the total amount outside. Effective suckling If beastfeeding baby is well attached at the breast, then he or she can suckle effectively. Signs of effective suckling indicate that milk is flowing into the baby's mouth.

The ths takes slow, deep suckles followed by a visible or audible swallow about once per second. Sometimes the baby pauses for a few seconds, allowing rhe ducts to fill up with milk again. When the baby starts suckling again, he or she may suckle quickly a few times, stimulating milk flow, and then the slow deep suckles begin. The baby's cheeks remain rounded during the feed. Breastfeedint the end of a feed, suckling usually slows down, with fewer deep suckles and longer pauses between them. This is the time when thf volume of milk is less, but as it is fat-rich hindmilk, fhe is important for the feed to continue.

When the baby is satisfied, he or she usually releases the breast spontaneously. The nipple may look stretched out for a second or two, but it quickly returns to its resting form. Signs of ineffective suckling A baby who is poorly attached is likely to suckle ineffectively. He or she may suckle quickly all the time, without swallowing, and the cheeks may be drawn in as he or she suckles showing that milk is not flowing well into the baby's mouth. When the baby stops feeding, the nipple may stay stretched out, and look squashed from side to side, with a pressure line across the tip, showing that the nipple is being damaged by incorrect suction.

Consequences of ineffective suckling When a baby suckles ineffectively, transfer of milk from mother to baby is inefficient. These difficulties are discussed further in Session 7. Causes of poor attachment Use of a feeding bottle before breastfeeding is well established can cause poor attachment, because the mechanism of suckling with a bottle is different. Functional difficulties such as flat and inverted nipples, or a very small or weak infant, are also causes of poor attachment. However, the most important causes are inexperience of the mother and lack of skilled help from the health workers who attend her. Many mothers need skilled help in the early days to ensure that the baby attaches well and can suckle effectively.

Health workers need to have the necessary skills to give this help. Positioning the mother and baby for good attachment To be well attached at the breast, a baby and his or her mother need to be appropriately positioned. There are several different positions for them both, but some key points need to be followed in any position. Position of the mother The mother can be sitting or lying down see Figure 9or standing, if she wishes. However, she needs to be relaxed and comfortable, and without strain, particularly of her back. If she is sitting, her back needs to be supported, and she should be able to hold the baby at her breast without leaning forward.

Baby well positioned at the breast. Position of the baby The baby can breastfeed in several different positions in relation to the mother: Whatever the position of the mother, and the baby's general position in relation to her, there are four key points about the position of the baby's body that are important to observe. The baby's body should be straight, not bent or twisted. The baby's head can be slightly extended at the neck, which helps his or her chin to be close in to the breast. He or she should be facing the breast.

The nipples usually point slightly downwards, so the baby should not be flat against the mother's chest or abdomen, but turned slightly on his or her back able to see the mother's face. The baby's body should be close to the mother which enables the baby to be close to the breast, and to take a large mouthful. His or her whole body should be supported.

Breast the breastfeeding Anatomy of

The baby may be supported on the bed or a pillow, or the mother's lap or arm. She should not support only the baby's head and neck. She should not grasp the baby's bottom, as this can pull him or her too far out to the side, and make it difficult for the baby to get his or her chin and tongue under the areola. These points about positioning are especially important for young infants during the first two months of life. Breastfeeding pattern To ensure adequate milk production and flow for 6 months of exclusive breastfeeding, a baby needs to feed as often and for as long as he or she wants, both day and night This is called demand feeding, unrestricted feeding, or baby-led feeding.

Babies feed with different frequencies, and take different amounts of milk at each feed. The hour intake of milk varies between mother-infant pairs from — ml, averaging about ml per day throughout the first 6 months Infants who are feeding on demand according to their appetite obtain what they need for satisfactory growth. More milk can always be removed, showing that the infant stops feeding because of satiety, not because the breast is empty. However, breasts seem to vary in their capacity for storing milk. Infants of women with low storage capacity may need to feed more often to remove the milk and ensure adequate daily intake and production It is thus important not to restrict the duration or the frequency of feeds — provided the baby is well attached to the breast.

Nipple damage is caused by poor attachment and not by prolonged feeds. The mother learns to respond to her baby's cues of hunger and readiness to feed, such as restlessness, rooting searching with his mouth, or sucking hands, before the baby starts to cry. The baby should be allowed to continue suckling on the breast until he or she spontaneously releases the nipple. After a short rest, the baby can be offered the other side, which he or she may or may not want. Prolonged, frequent feeds can be a sign of ineffective suckling and inefficient transfer of milk to the baby. This is usually due to poor attachment, which may also lead to sore nipples.

If the attachment is improved, transfer of milk becomes more efficient, and the feeds may become shorter or less frequent. At the same time, the risk of nipple damage is reduced. Bulletin of the World Health Organization. PMC ] [ PubMed: Schanler R, guest editor. The Pediatric Clinics of North America. Breastfeeding and human lactation. Jones and Bartlett; The biological specificity of breast milk.


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