Question

Describe how the process works physiologically, proper positioning, and feeding schedule for a newborn

Answer 1

1) Ans)There are two hormones that directly affect breastfeeding: prolactin and oxytocin. A number of other hormones, such as oestrogen, are involved indirectly in lactation When a baby suckles at the breast, sensory impulses pass from the nipple to the brain. In response, the anterior lobe of the pituitary gland secretes prolactin and the posterior lobe secretes oxytocin.

Prolactin

Prolactin is necessary for the secretion of milk by the cells of the alveoli. The level of prolactin in the blood increases markedly during pregnancy, and stimulates the growth and development of the mammary tissue, in preparation for the production of milk . However, milk is not secreted then, because progesterone and oestrogen, the hormones of pregnancy, block this action of prolactin. After delivery, levels of progesterone and oestrogen fall rapidly, prolactin is no longer blocked, and milk secretion begins.

When a baby suckles, the level of prolactin in the blood increases, and stimulates production of milk by the alveoli The prolactin level is highest about 30 minutes after the beginning of the feed, so its most important effect is to make milk for the next feed . During the first few weeks, the more a baby suckles and stimulates the nipple, the more prolactin is produced, and the more milk is produced. This effect is particularly important at the time when lactation is becoming established. Although prolactin is still necessary for milk production, after a few weeks there is not a close relationship between the amount of prolactin and the amount of milk produced. However, if the mother stops breastfeeding, milk secretion may stop too – then the milk will dry up.

Oxytocin

Oxytocin makes the myoepithelial cells around the alveoli contract. This makes the milk, which has collected in the alveoli, flow along and fill the ducts . Sometimes the milk is ejected in fine streams.

The oxytocin reflex is also sometimes called the “letdown reflex” or the “milk ejection reflex”. Oxytocin is produced more quickly than prolactin. It makes the milk that is already in the breast flow for the current feed, and helps the baby to get the milk easily.

Oxytocin starts working when a mother expects a feed as well as when the baby is suckling. The reflex becomes conditioned to the mother's sensations and feelings, such as touching, smelling or seeing her baby, or hearing her baby cry, or thinking lovingly about him or her. If a mother is in severe pain or emotionally upset, the oxytocin reflex may become inhibited, and her milk may suddenly stop flowing well. If she receives support, is helped to feel comfortable and lets the baby continue to breastfeed, the milk will flow again.

It is important to understand the oxytocin reflex, because it explains why the mother and baby should be kept together and why they should have skin-to-skin contact.

Oxytocin makes a mother's uterus contract after delivery and helps to reduce bleeding. The contractions can cause severe uterine pain when a baby suckles during the first few days.

Positioning:

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,or 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

Position of the baby

The baby can breastfeed in several different positions in relation to the mother: across her chest and abdomen, under her arm, or alongside her body.

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. 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.

Breastfeeding pattern

Schedule:

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 24-hour intake of milk varies between mother-infant pairs from 440–1220 ml, averaging about 800 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. They do not empty the breast, but remove only 63–72% of available milk. 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 .