What is Breastfeeding?
Breastfeeding is providing breast milk as the primary source of nutrition directly from the mother's breast. The baby latches onto the nipple and suckles, taking in the nutrients, antibodies, and immune factors in breast milk. Major health bodies recommend exclusive breastfeeding for about the first 6 months, with continued breastfeeding alongside complementary foods for 2 years or beyond as mutually desired (AAP; WHO).
Physiology of Breastfeeding
- Acinar cells (alveolar cells) form breast milk.
- Progesterone levels fall after the placenta is delivered, which stimulates prolactin.
- Prolactin stimulates milk production.
- In the fourth month of pregnancy, the acinar cells start producing colostrum, which is full of nutrients for the newborn.
- Colostrum production continues for the first 3 to 4 days after birth.
- Transitional breast milk replaces colostrum on the 2nd to 4th day.
- True or mature breast milk is produced on the 10th day.
- Milk flows through its reservoirs, the lactiferous sinuses, located behind the nipple.
- Foremilk is the constantly forming milk.
- When the infant sucks at the breast, oxytocin is released and the collecting sinuses of the mammary glands contract.
- Milk is forced forward through the nipples, the action called the letdown reflex.
- The letdown reflex can be triggered by thinking about the baby or hearing a baby cry.
- After letdown, new milk (hindmilk) forms, with higher fat than foremilk.
- Hindmilk makes the infant grow more rapidly than foremilk.
- Oxytocin also contracts the uterus, so the mother feels a small tugging or cramping in the lower pelvis during the first few days of breastfeeding.
Advantages of Breastfeeding
Breastfeeding should fit the preference of both the mother and the baby, so both can enjoy it and gain the benefits.
Advantages for the Infant
- Breast milk contains immunoglobulin A, which binds viruses and bacteria so they are not absorbed from the gastrointestinal tract.
- Lactoferrin from breast milk interferes with the growth of pathogens.
- Lysozyme, an enzyme in breast milk, destroys bacteria by lysing their cell membranes.
- Leukocytes in breast milk protect against common respiratory infections.
- Macrophages that produce interferons protect against common viruses.
- Lactobacillus bifidus in breast milk prevents colonization of pathogenic bacteria in the gastrointestinal tract, reducing the incidence of diarrhea.
- Breast milk contains the ideal composition of electrolytes and minerals for infant growth.
- It is high in lactose, which provides ready glucose for rapid brain growth.
- It contains linoleic acid, an essential fatty acid for skin integrity.
- Nutrient levels meet the infant's needs and spare the kidneys from a high renal solute load of unused nutrients.
- Breast milk is free from allergens, unlike cow's milk.
- Calcium is regulated better in breastfed newborns.
- Breastfeeding prevents excessive weight gain in infants.
Advantages for the Mother
- Breastfeeding helps prevent breast cancer.
- Oxytocin aids uterine involution by helping the uterus contract.
- Feeding and preparation time is greatly reduced.
- The bond between mother and baby is strengthened.
Common Concerns in Breastfeeding
Some mothers love breastfeeding; others hesitate, usually because of specific concerns about the process.
| Issue | Intervention |
|---|---|
| The mother worries about the amount of milk taken by the baby because she cannot see it. | The nurse should assure the mother that to be certain that an adequate amount is taken by the baby; she must observe whether the baby appears content between feedings and is wetting the diapers. |
| The infant does not suck well because of the possible effect of analgesia during birth. | The nurse should guide the mother in adjusting the feeding pattern of the infant to meet its needs, and assure her that the effect of analgesia is temporary. |
| The infant also cannot suck well when it is not hungry or was exhausted by crying from hunger. | |
| The mother is worried because the infant’s stools are loose and thin, but these are normal because stools are normally lighter and looser for breastfed babies. | Explain the normal stool pattern and transitions to the mother and also examine the infant’s stools. |
| The father feels shut out of the mother-baby relationship, so he does not participate in infant feeding . | Advise the father to look for other ways to bond with the infant aside from feeding . |
| The mother has sore nipples because the nipples were kept wet, so the infant cannot grip the entire areola properly. | Assist the mother by helping the infant grasp the nipple correctly and advise the mother to expose the nipple to air between feedings. |
| Advise the mother that she can apply aloe vera or vitamin E to help heal the tissue. | |
| The engorgement of the mother’s breasts causes a lymphatic filling as milk production begins. | Encourage the infant to suck and advise the mother to apply warm packs to breasts. |
| Instruct the mother to take a warm shower before breastfeeding the infant to soften the breast tissue. | |
| The mother does not want to breastfeed in public because some people make them uncomfortable. | Encourage the woman to use discretion to avoid confrontation. |
Given the benefits to both infant and mother, promote breastfeeding and coach mothers through the early concerns so every newborn gets a strong start.
Frequently Asked Questions
How long should a baby be breastfed? Major health bodies recommend exclusive breastfeeding for about the first 6 months, then continued breastfeeding with complementary foods for 2 years or beyond as mutually desired (AAP; WHO).
What is colostrum? The first milk, produced from about the fourth month of pregnancy and continuing 3 to 4 days after birth. It is dense in nutrients and immune factors. Transitional milk replaces it around day 2 to 4, and mature milk arrives by about day 10.
What is the letdown reflex? When the infant suckles, oxytocin contracts the collecting sinuses and forces milk forward through the nipple. It can also be triggered by thinking about the baby or hearing one cry.
What is the difference between foremilk and hindmilk? Foremilk is the milk constantly forming between feeds. Hindmilk, released after letdown, has higher fat and supports faster infant growth.
How can a mother tell the baby is getting enough milk? She cannot see the volume, so reassure her to watch for a content baby between feedings and adequate wet diapers rather than measuring intake.
How do you manage sore nipples and engorgement? For sore nipples, help the infant grasp the whole areola and expose the nipples to air between feeds. For engorgement, encourage the infant to suck, apply warm packs, and take a warm shower before feeding to soften the tissue.