Breastfeeding and

Lactation Management
Exclusive Breastfeeding
 Infant receives only breastmilk without any additional foods or water or other
fluids (with the exception of vitamins and medicines if needed),
recommended during the first 6 months of life.
Lactation Management
 The general care of a mother-infant nursing couple during the mother’s
prenatal, immediate postpartum, and postnatal periods. It deals with
educating and providing knowledge and information to pregnant and lactating
mothers on the advantages of breastfeeding, the risks associated with
breastmilk substitutes and milk products not suitable as breastmilk
substitutes such as,but not limited to condensed milk, and evaporated milk,
the monitoring of breastfeeding mothers by health workers and breastfeeding
peer conunselors for service patgients to ensure compliance with the DOH,
WHO, and the UNICEF on the implementation of breastfeeding policies, the
physiology of lactation, the establishment and maintenance of lactation, the
proper care of the breasts and nipples, and such other matters that would
contribute to successful breastfeeding.
Infant and Young Child Feeding (IYCF)
(WHO) Key Facts:
 Every infant and child has the right to good nutrition according to
the “Convention on the Rights of the Child”
 Undernutrition is associated with 45% of child deaths.
 About 40% of infants 0-6 months old are exclusively breastfed.
 Over 82,000 children’s lives could be saved every year among
children under 5 years, if all children 0-23 months were optimally
breastfed. Breastfeeding improves IQ, school attendance, and is
associated with higher income in adult life.
 Improving child development and reducing health costs through
breastfeeding results in economic gains for individual families as
well as at the national level.
10 Facts of Breastfeeding (WHO)
Breastfeeding is one of the most effective ways to ensure child health and survival.
1. Breastfeeding for the first six months is crucial
Who recommends that:
1. Mothers initiate breastfeeding within one hour after birth
2. Infants should be exclusively breastfed for the first six months of life to
achieve optimal growth, development and health, and thereafter, to meet
their evolving nutritional requirements, infants should receive nutritionally
adequate and safe complementary foods, while continuing to be breastfed;
and
3. Breastfeeding should continue up to two years and beyond.

2. Breastfeeding protects infants from childhood illnesses

Breast milk is the ideal food for newborns and infants. It gives infants all the
nutrients they need for healthy development. It is safe and contains antibodies
that help protect infants from common childhood illnesses such as diarrhea and
pneumonia, the two primary causes of child mortality worldwide. Breast milk is
readily available and affordable, which helps to ensure that infants get adequate
nutrition.
3. Breastfeeding also benefits mother
Exclusive breastfeeding is associated with a natural method of birth control (98%
protection in the first six months after birth). It reduces risks of breast and ovarian
cancer, type II diabetes, and poetpartum depression.

4. Breastfeeding has long term benefits for children

Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of
good health. Adolescents and adults who were breastfed as babies are less likely to be
overweight or obese. They are less likely to have type-II diabetes and perform better in
intelligence tests.

5. Infant formula does not contain the antibodies found in breastmilk

The long-term benefits of breastfeeding for mothers and children cannot be replicated
with infant formula.

6. Transmission of HIV through breastfeeding can be reduced with drugs

Antiretroviral drugs (ARV) can be given to either the mother or HIV-exposed infant to
reduce the risk of transmission. Togather, breastfeeding and antiretroviral drugs have the
potential to significantly improve infant’s chances of surviving while remaining HIV
uninfected.
7. Marketing of breastmilk substitutes are highly monitored
An international code was adopted in 1981 to regulate the Marketing of breast-milk
substitutes. It calls for:
• All formula labels and information to state the benefits of breastfeeding and
the health risks of substitute
• No promotion of breastmilk substitute
• No free samples of substitute to be given to pregnant women, mothers or
their families; and
• No distribution of free subsidized substitutes to health workers or facilities
• .
8. Supports for mother is essential
To provide this support and improve care for mothers and newborns, most
countries have implemented the WHO-UNICEF Baby-friendly Hospital Initiative,
which sets standards for quality care.

9. Mother should continue breastfeeding at work

10. Solid foods should be phased in at 6 months

Laws in the Philippines
 EO 51 Milk Code of 1986- National code of Marketing of
Breastmilk Substitutes, Breastmilk Supplement and
Other Related Products
 R.A. 7600 Rooming-in and Breastfeeding Act (1992)-n it
is a law providing incentives to all government and
private health institutions with rooming-in and
breastfeeding practices.
 R.A. 10028 The Expanded Breastfeeding Promotion Act
(2009) – an act expanding the promotion of
breastfeeding, amending for the purpose R.A. 7600,
otherwise known as the Rooming-in and Breastfeeding
Act of 1992
Anatomy and Physiology of the Breast
• Lobes and lobules- internally the mammary gland is
composed of 15-25 lobes that radiates around the
nipple. Each lobe consists of about 20-40 lobules, a
smaller milk duct that contains 10-100 support
alveoli.
• Glandular Tissue- responsible for milk production
and transportation which is composed of:
1. Alveoli- epithelial grape-like cluster of cells
where milk is produced.
2. Ductules- branch-like tubules extending
from the clusters of alveoli and empties to
larger ducts called lactiferous ducts.
3. Lactiferous ducts- widen underneath the
areola and nipple to become lactiferous
sinuses
4. Lactiferous sinuses- collect milk from
lactiferous ducts and narrows to an opening
in the nipple.
• Connective Tissue- supports the breast.
• Cooper’s ligaments– are fibrous bands that attach the breast to the chest
wall and keep the breast fom sagging.
• Blood- nourishes breast tissue and supplies the nutrients to the breast
needed for milk production
• Nerves- make the breast sensitive to touch, hence allowing the baby’s suck
to stimulate the release of hormones that trigger the let-down reflex or milk
ejection reflex.
• Lymph nodes- removes waste products
• Adipose Tissue (fat)- protects the breast from injury.
Externally the breast is composed of:
• Areola- pigmented area at the center of each breast.
• Nipple- protruding area at the center of each breast.
The function of producing milk is regulated by hormones. During pregnancy
levels of estrogen and progesterone rises to sustain pregnancy.
 Estrogen- causes the breast size to increase in size through the
accumulation of adipose tissues.
 Progesterone- stimulates the growth and maturation of the duct system.
Another hormone important for the implementation of mammary gland
function is the presence of prolactin and oxytocin.
 Prolactin- responsible for milk production. Breastfeeding caused
continues production of prolactin with concentration highest during night
feeds. Prolactin is involved in the suppression of ovulation.
 Oxytocin- triggers the let-down or milk ejection reflex. Oxytocin release
during breastfeeding causes mild but often painful contractions during
the first few weeks of lactation. This also serves to assist the uterus in
clotting the placental attachment point postpartum.
Types of Breastmilk
-Colostrum
Thick and yellow in color, rich in protein, antibodies, vitamins and
minerals that develops during pregnancy and lasts a few days after the
baby is born.

-Transitional Milk
is a thin and white, and contains high quantities of fat, calories, protein,
lactose and vitamins approximately 2-4 days after the baby is born,
replaces colostrum.

-Mature Milk
Primarily consists of water, and often appears bluish in color at the
beginning of feeding (foremilk), and turns white toward the end of the
feeding (hindmilk) as the milk’s fat content increases.
Properties and Components of
breastmilk
Human Milk varies in its composition:
1) With the time of day ex. the fat content is lowest in the
morning and highest in the afternoon
2) With the stage of lactation ex. the fat and protein
content of colostrum is higher than in mature milk
3) In response to maternal nutrition ex. although the total
amount of fat is not influenced by diet, the type of fat
will be influenced by what the mother eats.
4) Bacause of individual variation
Fats and Fatty Acids- for the human infant, with his unique and rapidly growing brain, it is the fat
and not the protein in human milk that has particular [Link] provide the baby 50% of his
caloric requirements.
Carbohydrate- the carbohydrate component of breast milk is provided chiefly by lactose, which
provides the baby with about 40% of his caloric requirements.
Protein- Human milk contains less protein than any other mammalian milk and this accounts in part
for its more transparent appearance. Allergic problems occurs less frequently in breastfed babies
than in artificially fed babies.
Vitamins- all vitamins required for good nutrition and health are supplied in breastmilk.
Fat-soluble vitamins- Vit A, D, E,and K
Vit A- is present in the human milk as retinol, retinyl esters and beta carotene. Colostrum has
twice the amount present in mature milk and it is this that gives the colostrum it’s yellow color.
Vit D- plays an important role in the metabolism of calcium and phosphorus in the body and
prevents osteomalacia in adults and rickets in children and is not strictly a vitamin but a
hormone triggered by the ultraviolet light.
Vit E- although it is present in human milk it’s role is uncertain. It appears to prevent the
oxidization of polyunsaturated fatty acids and may prevent certain types of anemia to which
preterm infants are susceptible.
Vit k- is essential for the synthesis of blood-clotting factors. It is present in human milk and
absorbed efficiently.
 Water-soluble vitamins- unless the mother’s diet is seriously deficient, mother’s breastmilk will
contain adequate levels of all the vitamins.
 Minerals and trace elements
 Iron – normal term babies are usually born with a high haemoglobin level, which
decreases rapidly after birth. The iron recovered from the haemoglobin breakdown is re-
utilized They also have ample iron stores, sufficient for at least 4-6months. Although the
amount of iron are less than those found in formula, the bioavailability of iron in
breastmilk is very much higher. 70 % of iron from breastmilk is absorbed, whereas only
10% is absorbed from a formula.

 Zinc- a deficiency of this essential trace mineral may result in failure to thrive and
typical skin lesion. Although there is more zinc in formula the bioavailability is greater in
human milk. Breastfed babies maintain high plasma zinc values compared with formula
fed infants, even when the concentration of zinc is three times that of human milk.

 Calcium- is more efficiently absorbed from human milk than from breastmilk substitutes
because of high calcium, phosphorus ratio. Infant formulas, which are based on cow’s
milk, inevitably have a higher phosphorus content than human milk, and thishas been
reported to increase the risk of neonatal tetany.
 Other Minerals
 Human milk has significantly lower levels of calcium, phosphorus, sodium, and potassium
than formula. Copper, cobalt, and selenium are present at higher levels. The higher
bioavailability of this minerals ensures that then infant’s needs are met while also
imposing a lower solute load on the neonatal kidney than do breastmilk substitutes.
 Anti-infective Factors
 Leucocytes- during the first 10 days, there are more white cells/ml in breastmilk than there
are in blood. Macrophages and neutrophils are among the most common leucocytes in
human milk and they surround and destroy harmful bacteria by their phagocytic activity.
 Immunoglobulins- five types of immunoglobulin have been identified in human milk: IgA,
IgG, IgE, IgM, and IgD. Of these the most important is IgA, which appears to be both
synthesized and stored in the breast.
 Lysozyme- kills bacteria by disrupting their cell walls. The concentration of lysosome
increases with prolonged lactation.
 Bifidus factors- in human milk promotes the growth of Gram-positive bacilli in the gut flora,
particularly lactobacillus bifidus, which discourages the multiplication of pathogens.
 Hormones and growth factors- Epidermal growth factor and insulin-like growth factor
stimulate the baby’s digestive tract to mature more quickly and strengthen the barrier
properties of the gastrointestinal epithelium.
 Management of Breastfeeding
 Antenatal Preparation
 Breast and nipples are altered by pregnancy. The mother should be given breastfeeding education and
information during prenatal visits.
 The first feed
 Breastfeeding is initiated within 1 hour after delivery. Early feeding contributes to the success of breastfeeding .
 The next feed
 All mothers should be offered help with the next feed. Once the baby is feeding satisfactorily, the mothers
should receive breastfeeding education.
 Positioning and Proper attachment
 Signs the baby is well attached:
 The chin touches the mother’s breast
 The mouth is wide open
 The cheeks is round and full, not sucked in or dimpled
 The sucks become slower and longer
 The mother can see some of her breast above the baby’s top lip
 The mother feel a strong, drawing sensation
Breast Problems
 Sore and damaged nipples- the cause is almost always trauma from the baby’s mouth and tongue,
which results from incorrect attachment of the baby to the breast. Other causes of soreness may occur
due to infection with Candida Albicans. The nipple and areola are often inlfamed and shiny, and the pain
persists throughout the feed. The baby may show signs of oral or anal thrush. Both mother and baby
should receive concurrent fungicidal treatment.
 Dermatitis- sensitivity may develop to topical applications such as creams, ointments or sprays (including
those used to treat thrush).
 Anatomical Variations
 Long Nipples- can lead to poor feeding because the baby is ab le to latc h on to the nipple without
drawing breast tissue into his mouth.
 Short nipples- should not cause problems as the baby has to form teat from both the breast and
nipple.
 Abnormally large nipples- if the baby is small, his mouth may not be able to get beyond the nipple
and onto the breast. Lactation could be initiated by expressing, either by hand or by pump. As the
baby grows and the breast and nipple become more protractile, breastfeeding may become possible.
 Inverted and flat nipples- if the nipple is inverted it may be necessary to initiate lactation by
expressing and delay attempting to attach the baby to the breast until lactation is established.
 Problems with Breastfeeding
 Engorgement- this condition occurs around the 3rd-4th day postpartum. The breasts are hard
often edematous, painful and sometimes flushed. It may occur if feeds are delayed or restricted
or if the baby is unable to feed efficiently because he is not correctly attached to the breast.
 Deep breast Pain- this is likely to be due to raised intraductal pressure caused by inefficient milk
removal thus breastfeeding technique can improve this condition. Very rarely, it may be the
result of ductal thrush infection.
 Mastitis- means inflammation of the breast. A wedge-shaped area of redness and swelling appears
in the breast with flu-like symptoms, including shivering attacks or rigors that may occur. It is the
result of milk stasis not infection.
 Non-infective (acute intramammary)mastitis- results from milk stasis. It may occur in the early
days as a result of unresolved engorgement or at anytime when there is poor feeding techniques
which causes an inefficient milk removal by the baby.
 Infective Mastitis- when there is damaged to the epithelium bacteria enters the underlying
tissues and causes infection.
 Breast Abscess- a fluctuant swelling develops in a previously inflamed area. Pus may be
discharged from the nipple. Sinple needle aspiration may be effective, or incision and drainage
may be necessary.
 Blocked ducts- lumpy areas in a lactating mother’s breasts.
“Walang kapantay
ang gatas ni
Nanay” by:
Cabinos, Nelyn
Dioquino, Carine Joy
Guarino, Cheenie Belle
Serrato, Princess