HEALTH FEATURE ARCHIVE

Breastfeeding: Helpful Tips

The following information is written for women who are breastfeeding, or are pregnant and considering breastfeeding their baby.

• How breast milk is made: anatomy of the breast
• The role of hormones
• Tips for making it work
• Getting enough milk

How breast milk is made: anatomy of the breast

Knowing how the breast is made and how it works to produce milk is helpful in understanding the breastfeeding process. The breast actually begins developing in the first few weeks of gestation, before birth. But the mammary gland, the gland that produces milk, does not become fully functional until lactation begins. When a woman's breasts become swollen during pregnancy, this is a sign that the mammary gland is getting ready to work. The breast itself is a gland that is composed of several parts, including glandular tissue, connective tissue, blood, lymph, nerves, and fatty tissue. Fatty tissue is what mostly affects the size of a woman's breast. Breast size does not have an effect on the amount of milk or the quality of milk a woman produces.

Anatomy of the Breast

Milk is secreted from the alveoli cells. When the alveoli cells are stimulated by a hormone, they contract and push the milk into the ductules and down into larger mammary ducts. These mammary ducts are underneath the nipple and areola and widen to collect the milk. These widened ducts are called milk or lactiferous sinuses. When the baby's gums press on the areola and nipple, it is the lactiferous sinuses that are being compressed, squeezing the milk into the baby's mouth. The nipple tissue protrudes and becomes firmer with stimulation, which makes it more flexible and easier for the baby to grasp in the mouth. In the diagram, you can see that each mammary gland forms a lobe in the breast. Each lobe consists of a single branch of alveoli, milk ducts, and a lactiferous sinus that narrows into an opening in the nipple. Each breast has about 15 to 25 lobes.

The role of hormones

Hormones play a key role in breastfeeding. The increase of estrogen during pregnancy stimulates the ductules to grow. After delivery, estrogen levels drop and remain low in the first several months of breastfeeding. The increase of progesterone during pregnancy also causes the alveoli and lobes to grow. Prolactin, also called the "mothering hormone," is another hormone that is increased during pregnancy and adds to the growth of breast tissue. Prolactin levels also rise during feedings as the nipple is stimulated. As prolactin is released from the brain into the mother's bloodstream during breastfeeding, alveolar cells respond by making milk. Oxytocin is the other hormone that plays a vital role because it is necessary for the let-down, or milk-ejection reflex to occur. It stimulates the alveoli cells to contract so the milk can be pushed down into the ducts. Oxytocin also contracts the muscle of the uterus during and after birth, which helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth. The release of both prolactin and oxytocin may be responsible in part for a mother's intense feeling of needing to be with her baby.

Tips for Making It Work

Breastfeeding can be a wonderful experience for baby and mom. It's important not to get frustrated if you are having problems. What works for one mother and baby may not work for another, so just focus on finding a comfortable routine and positions for you and your baby. Here are some tips for making it work:

1. Get an early start. You should start nursing as early as you can after delivery (within an hour or two if it is possible), when the infant is awake and the sucking instinct is strong. Even though your milk won't come in for a few days, your breasts contain a special thick, yellowish fluid called colostrum, which helps protect your infant from disease. Don't discard it.



2. Use proper positioning for baby's mouth and when holding baby. The baby's mouth should be wide open. You can tickle your baby's lips with your nipple to get him/her to open wide. Place the nipple in the baby's mouth as far back as possible, and pull his/her body close to you so his/her tummy is facing and touching your tummy. Be sure the baby's lips and gums are around the areola (the darker-colored area surrounding the nipple). The baby should never be latched onto the nipple only. This reduces soreness for you. If your baby is latched on correctly, his/her lips will be turned out, not pulled in over the gums. You may see your baby's jaw move back and forth and hear low-pitched swallowing noises. Your baby's nose will touch against your breast, but he/she is getting enough air. REMEMBER: IF IT HURTS, IT'S WRONG. Take the baby off of your nipple and try again. Break your baby's suction to your breast by gently placing your finger in the corner of his/her mouth.

HOW TO BRING BABY TO BREAST:


1. Tickle baby's lips to open.


2. When open wide, bring baby to breast so mouth is around both the nipple and areola and baby's tummy is facing your tummy.


3. When baby is latched on well, his/her nose and chin touch your breast.



PROPER POSITION OF BABY'S MOUTH AROUND NIPPLE:

Note that baby's lips are around the nipple AND the areola, and the nose and chin are touching the breast. Baby's lips are turned out or "flanged," not tucked in.

Breastfeeding Positions Here are several positions in which you can hold your baby while breastfeeding. You can try all of them and choose the one(s) that you and your baby feel most comfortable in. No matter which one you choose, make sure your infant's tummy is facing your tummy. This helps him/her to properly "latch on" to the nipple. Try using pillows under your arms, elbows, neck or back, or under the baby for support.
1. Cradle (Easy and commonly used position.)
2. Cross Cradle, Modified Clutch or Transitional (Gives baby extra head support, may help them stay on the breast. Good for premature babies or babies with a weak suck or who are having problems latching on.)
3. Clutch or "Football" (Allows mother to better see and control baby's head. Good for mothers with large breasts or inverted nipples which sink in instead of protruding out or laying flat)
4. Side-Lying (Allows mother to rest or sleep while baby nurses. Good for mothers who had a Cesarean section. Puts no pressure on the incision.)
5. Slide-Over (Can help encourage a baby who refuses one breast to nurse on the less-preferred one.)

3. Nurse on demand. Newborns need to nurse often. Breastfeed at least every 2 hours and when they show signs of hunger, such as being more alert or active, mouthing (putting hands or fists to mouth and making sucking motion with mouth), or rooting (turning head in search of nipple). Crying is a late sign of hunger. Nurse about 10 to 15 minutes on each breast. Breastfed babies can eat more often than bottle-fed babies. This is because breast milk is easier to digest than formula.

4. Feed your baby only breast milk. Nursing babies don't need water, sugar water or formula. Breastfeed exclusively for about the first six months. Giving other liquids reduces the baby's intake of vitamins from breast milk.

5. Delay artificial nipples (bottle nipples and pacifiers). A newborn needs time to learn how to breastfeed. It is best to wait until the newborn develops a good sucking pattern before giving her or him a pacifier. Artificial nipples require a different sucking action than real ones. Sucking at a bottle can also confuse some babies when they are first learning how to breastfeed. If, after birth, your baby needs to be taken away from you for a length of time and has to be given formula, ask the nurse to use a syringe or cup when feeding him/her to avoid nipple confusion.



6. Breastfeed your sick baby during and after illness. Oftentimes sick babies will refuse to eat but will continue to breastfeed. Breast milk will give your baby needed nutrients and prevent dehydration.



7. Air dry your nipples. Right after birth, until your nipples toughen, air-dry them after each nursing to keep them from cracking. Cracking can lead to infection. If your nipples do crack, coat them with breast milk or other natural moisturizers (like Vitamin E oil and lanolin) to help them heal. It isn't necessary to use soap on your nipples, and it may remove helpful natural oils that are secreted by the montgomery glands, which are in the areola. Soap can cause drying and cracking and make the nipple more prone to soreness.



8. Watch for infection. Signs of breast infection include fever, irritation, and painful lumps and redness in the breast. You need to see a health care provider right away if you have any of these symptoms.



9. Expect engorgement. A new mother produces lots of milk, making her breasts big, hard and painful for a few days. This is called engorgement. When this happens, she should feed the baby often. Her body will, over time, adjust and produce only the amount of milk her baby needs. To relieve engorgement, you can put warm, wet washcloths on your breasts and take warm baths to relieve the pain. If the engorgement is severe, placing ice packs on the breasts between nursings may help. Talk with a health care provider if you have problems with breast engorgement.



10. Eat right and get enough rest. A nursing mother needs a healthy diet that includes 500 extra calories a day (about 2700 calories total) and 6 to 8 glasses of fluids. This will help her make plenty of good milk for her baby. She also needs to rest as much as she can. This will help prevent breast infections, which are worsened by fatigue.
    
    Women on strict vegetarian diets may need to increase their vitamin B12 intake and should talk with their health care provider. Infants breastfed by women on this type of diet can show signs of not getting enough vitamin B12.