LEARNING CONTENT

INTRODUCTION: It is universally agreed that breast milk is the preferred method of feeding a newborn, because it provides numerous health benefits to both the mother and the infant; it remains the ideal nutritional source for infants through the first year of life (Kleinmann, 2004). Nurses are prime people to teach women about the benefits of breast-feeding and provide anticipatory guidance for problems that may occur. ADVANTAGES OF BREASTFEEDING TO THE MOTHER Breastfeeding may serve a protective function in preventing breast cancer.

The release of oxytocin from the posterior pituitary gland aids in uterine involution (the reduction in size of the uterus after childbirth). Oxytocin is released whenever a mechanical stimulus is initiated by the sucking mechanism of the infant.
Successful breast-feeding can have an empowering effect, because it is a skill only a woman can master Breast-feeding reduces the cost of feeding and preparation time.

Breast-feeding provides an excellent opportunity to enhance a true mutual bond between mother and child. ADVANTAGES OF BREASTFEEDING TO THE BABY

Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, keeping them from being absorbed from the gastrointestinal tract (stomach) into the infant. Lactoferrin, is an iron-binding protein in breast milk that interferes with the growth of pathogenic bacteria. The enzyme lysozyme in breast milk apparently actively destroys bacteria by lysing (dissolving) their cell membranes, possibly increasing the effectiveness of antibodies. Leukocytes in breast milk provide protection against common respiratory infectious invaders. Macrophages, responsible for producing interferon (a protein that protects against viruses), interfere with virus growth. The bifidus factor is a specific growth-promoting factor for the beneficial bacteria Lactobacillus bifidus. The presence of L. bifidus in breast milk interferes with the colonization of pathogenic bacteria in the gastrointestinal tract, reducing the incidence of diarrhea.

Breast milk contains the ideal electrolyte and mineral composition for human infant growth. It is high in lactose, an easily digested sugar that provides ready glucose for rapid brain growth. The protein in breast milk is easily digested, and the ratio of cysteine to methionine (two amino acids) in breast milk favors rapid brain growth in the early months. It contains

nitrogen in compounds other than protein, so that an infant can receive cell-building materials from sources other than just protein.
Breast milk contains more linoleic acid, an essential fatty acid for skin integrity and less sodium, potassium, calcium and phosphorus than do

many formulas. Breast milk also has a better balance of trace elements, such as zinc. These levels of nutrients are enough to supply the infants needs, yet they spare the infants kidneys from having to process a high renal solute load of unused nutrients.

Breast-fed newborns appear to be able to regulate their calcium/phosphorus levels better than infants who are bottle fed. Decreased calcium levels in a newborn can lead to tetany (muscle spasms). LACTATION AND PROPER POSITIONING TECHNIQUES IN BREASTFEEDING - Breast milk looks like nonfat milk. It is thin and almost blue-tinged in appearance. Before breastfeeding, mothers must wash their hands to be sure they are free of pathogens picked up from handling perineal pads or other sources. Washing her breasts is not necessary unless she notices caked colostrums (first breast fluid characterized as a thin yellowish fluid secreted by the breasts during the second trimester onwards but most evident in the first 2 to 3 days after birth and before the onset of true lactation) on the nipples.
Lying on her side with a pillow under her head is a good position to assume when she is first attempting to breastfeed. This relieves fatigue because it allows the infant to rest on the bed. Another position that the mother can utilize is sitting position with a pillow under the baby. Using a football hold with the baby supported on a pillow also may be helpful, especially if the mother had a cesarean birth.
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- Brushing the infants cheek with a breast nipple stimulates a newborns rooting reflex. The baby then turns toward the breast. Do not try to initiate a rooting reflex by pressing a babys face against the mothers breast; this will cause the child to turn away from the mother and toward your hand.

If a woman has large breasts, the infant may have trouble breathing while

nursing because tissue presses against the nose. The mother can prevent this happening by grasping the areolar margin of her breast between her thumb and forefinger, holding the bulk of the breast supported while her infant feeds. This also makes the nipple more protruberant. - Frequent feeding is advantageous to sustain a milk supply, because the more often the breasts are emptied, the more efficiently they will fill and continue to maintain a good supply of milk. - Help the infant break away from the breast when they are finished feeding. Insert a finger in the corner of the infants mouth or pull down the infants chin to release suction. Otherwise, the baby may pull too hard on the nipple, causing crack or soreness. PROMOTING ADEQUATE SUCKING Often, a newborn being breast-fed drops off to sleep during the first few feedings. To stimulate both milk production effectively and ensure adequate fluid intake, help the mother attempt to keep the infant awake, urging him/her to suck. To accomplish this, stroking the back of the newborn, changing their position during feeding, rubbing their arms and chest, changing their diaper, gently tickling the bottom of a babys feet are ways on waking the infant effective. If the infant is not sucking well, the mother can use breast massage after a feeding to empty her breasts manually. This helps ensure good milk production for the time when the infant is ready to suck. TECHNIQUES FOR BURPING THE BREAST-FED BABY Some infants seem to swallow little air when they are breast-fed, whereas

others swallow a great deal. As a rule, it is helpful to bubble (burp) newborns after they have emptied the first breast and again after the total feeding. Placing the baby over one shoulder and gently patting or stroking the back is an acceptable position. However, this position is not always satisfactory for a small infant, who has poor head control.

Holding the baby in a sitting position on the lap, then leaning the child

forward against one hand, with the index finger and thumb supporting the head, is often the best position to use. This position provides head support but leaves the other hand free to pat the babys back. Laying the baby prone across the lap is another alternative position. PREVENTING OR RELIEVING ENGORGEMENT The primary method for relieving engorgement is emptying the breasts of milk by having the infant suck as much as before.

If an infant cannot grasp a nipple strongly because of engorgement, warm

packs applied to both breasts for a few minutes before feeding, combined with massage to begin milk flow, often facilitates drainage and promotes breast softness so the infant can suck. Manual expression or the use of a breast pump to complete emptying of the breasts after the baby has nursed can help maintain or promote a good milk supply during the period of engorgement. Assure the mother that symptoms of engorgement are healthy; it is an

indication that her breasts are producing milk. Engorgement is only temporary and should begin to subside 24 hours after it first becomes apparent. PROMOTE HEALING OF SORE NIPPLES Painful nipples result from the strong sucking action of a newborn. This may be worsened by the following factors: 1. Improper positioning of an infant (failure to grasp the areola as well as the nipple) 2. Forcefully pulling an infant from the breast 3. Allowing an infant to suck too long at a breast after the breast is emptied 4. Permitting a nipple to remain wet from leaking milk To help prevent soreness, encourage the mother to position her baby slightly differently for each feeding. This helps prevent the same area of the areola from receiving the majority of pressure. Expose nipples to air by leaving her bra unsnapped for 10 to 15 minutes

after feeding. Discourage the use of plastic liners that come with nursing bras; it is preferable to have air always circulating around the breasts. Applying vitamin E lotion after air exposure may toughen the nipples and prevent further irritation.

Advise mothers not to use a hand pump with sore nipples, because the

pressure may cause fissures to worsen. An electric or battery-operated pump usually can be used; these devices exert less pressure on the nipples. WEANING Weaning is defined as accustoming the infant to discontinue breast feeding by substitution of other nourishment. At any age, breast-feeding should be discontinued gradually to prevent

engorgement and pain in the mothers breast while still providing satisfaction for the infant. To do this, the mother could first omit one breast- feeding a day, substituting a bottle-feeding or milk from a glass or cup. Then she could omit two breast-feedings, then three, and so on, until the child is feeding entirely from a bottle, glass, or cup. If weaned before 12 months, infants should be weaned to formula, not whole milk, so that they continue to receive the added vitamins and low solute load of commercial formulas. REFERENCES: Maternal and Child Health Nursing: Care of the Childbearing

and Childrearing Family, 5th edition, by Pillitteri, Adele, et al. Tabers Cyclopedic Medical Dictionary, 18th edition, by Thomas, Clayton L., et al Principles of Anatomy and Physiology, 9th edition, by Tortora, Gerard J., et al