Lectures on lactation and breastfeeding

2021-01-30 12:00 AM

Abstinence begins as early as 3 months, producing colostrum. Colostrum is rich in protein, lactose and immune globulin. Colostrum persists until lactation, that is, a few days later.

Breast milk is the most valuable food source for children, no artificial milk can replace breastmilk.

Physiological lactation

Breast glands during puberty

The first mammary gland to appear in the fetus is not affected by hormones until puberty is the sparse duct network connecting the nipple. By puberty, under the influence of ovarian hormones, the tube network proliferates, branching into the fat organization, at the end of the tube appear small buds that will be the source of the secretory organization.

During each menstrual cycle

In the proliferation stage, under the influence of estradiol, the muscle-epithelial cells surrounding the ends of the ducts proliferate. Associate holding country.

In the secretory stage, progesterone differentiates the terminal ducts of milk, stopping cell proliferation.

In pregnancy, the mammary glands achieve their full development

Breast parenchyma proliferation. The epithelial buds change into lobules, secretory columnar cells surrounded by a layer of muscle-epithelial cells. The ducts are long and branched. Prismatic blood vessels.

The origin of this development is the influence of the honors. The estrogens and progesterone’s of the vegetable cake play a fundamental role. Estrogen develops the ducts of milk, making the lobules sensitive to other hormones. Progesterone causes the growth of lobules.

Abstinence begins as early as 3 months, producing colostrum. Colostrum is rich in protein, lactose and immune globulin. Colostrum persists until lactation, that is, a few days later. During the hours after giving birth, babies suckle colostrum. It is colostrum that helps children from hypoglycemia, from infection and has certain physiological roles in the digestive tract.

At the end of pregnancy, under the influence of estrogen and progesterone, the mammary gland has been fully prepared, ready for action. During pregnancy, the mammary glands are not fully functional because progesterone inhibits prolactin, which occurs in the pituitary and mammary glands.

The loss of milk occurs 3 - 4 days after birth in the calves, 2-3 days in the womb. The phenomenon of milk loss is due to the level of prolactin in the blood suddenly increased and the synthesis of more milk.

Lactation is maintained initially by sucking on the nipple. Nerve reflex sucking action stimulates the hypothalamus to release prolactin. Every time you suckle, prolactin levels in the blood peak. Thereafter, lactation is maintained with almost all of the milk present in the lobules each time the baby is breastfed. The lobules produce milk only when the milk in the lobule is removed. By this point, the level of prolactin in the blood gradually decreases to the normal level as during the menstrual cycle. The secretion of gonadal hormones reappears gradually and menstruation returns. It has been found that in women who breastfeed for two years or more:

After 1 year, 80% of these women still do not have their period again.

After 2 years, still 20% of women who have not had their period again

Every time a baby sucks on the nipple, a nerve reflex will appear to lead to the posterior pituitary gland and release oxytocin. It is oxytocin that shrinks epithelial muscle cells in the milk ducts and expels the milk. Oxytocin is also released every time the mother sees the baby or hears the baby cry (a conditioned reflex). In addition, oxytocin also causes the uterus to contract.


Breastfeeding is always encouraged for many reasons:

Breast milk is the best source of food for babies, especially colostrum in the early days.

Breast-feeding is the basis for developing mother-and-child affection, creating affection and embracing mother and child.

Breastfeeding is also a method of contraception in the first few months after.

Begin to breastfeed

Breastfeed as soon as possible. The mother can breastfeed her baby right after giving birth. Breastfeeding may be slower if the health of the mother or baby is not very good (the mother must have a cesarean section; the baby is in active recovery ...). Early breastfeeding has helped babies use colostrum, which is a very suitable physiological milk for babies. In addition, the suckling has stimulated the mammary glands to secrete milk quickly and much. Early breastfeeding is a very favourable time for a mother to interact with her baby. Early breastfeeding also helps the uterus to contract well, limit bleeding.

Number of feedings

It is the child who adjusts to the number of feeds per day. During the first few days, the number of feedings increased, from 7 to 9 times. Breastfeed your baby with both breasts, each feed should not exceed 15 minutes. Breastfeeding times are 2 to 3 hours apart, but it's best to feed each time your baby asks for it. There is no need to wake the baby to breastfeed at certain hours, nor should the baby breastfeed too quickly. After a few days, the baby's hunger itself regulates the number of feedings and the interval between feeds. Night-feeding is avoided to allow the mother to rest. To check whether the baby is nursing enough, the baby is weighed. Weighing once a day is enough. If the baby's weight is steadily increasing, it is evidence that the child is well nourished, well-fed.

Some hygiene rules that apply to breastfeeding mothers

Cleaning in place: Every day to wash the breasts with soap, wash hands before feeding, rinse the nipples with cooked water to cool before and after feeding. need to express a few drops of milk before feeding. After feeding, the nipples should be protected, covered with a clean, dry bucket cloth. Do not use nylon or synthetic fibre bras because it can cause nipple ulcers.

Breastfeeding position: The mother can breastfeed in a sitting or lying position. When breastfeeding, let the baby close the areola.

Maternal Diet: Energy needs increase by 25% compared to normal, about 500 calories. Note for mothers to drink plenty of water, eat more protein (meat, fish, eggs, milk ...). Besides, mothers should use more calcium and iron. Mothers should eat many meals a day. Do not use stimulants such as alcohol, beer, tea, coffee, cigarettes ...

Cases are not allowed to breastfeed

There are not many contraindications to breastfeeding. In some diseases, patients are not allowed to breastfeed their babies, such as heart disease, active tuberculosis, HIV infection, and mental illness and inability to care for their children.

Some common problems with breastfeeding

Burning pain in the nipples

The nipple is dominated by a rich sensory neural network, so it is very sensitive to sensory stimuli, pressure. When the baby sucks the breast, it creates a great pull and for a long time two nipples. After 6 or 7 degrees of feeding, the nipples may be sore each time the baby sucks on the nipple. The pain gradually increased with breastfeeding for 3 or 4 days, then gradually got used to. It is a normal phenomenon that needs an explanation for the mother to understand and be patient. In many cases, it is mistaken for a cracked nipple. The mother does not need to do anything special, if any, it is just massaging the nipples. The risk of this phenomenon is that the mother is afraid when breastfeeding, which can lead to breast engorgement and poor milk production. All these phenomena fall into the spiral of pathology.

Nipple receding

A nipple depression is not a contraindication to breastfeeding because the baby's areola latches on the breast. After some suckling, the baby's sucking power can pull out the nipples perfectly. If it is still difficult, the mother can help the baby by expressing some milk and pulling out the nipples before feeding the baby.

Breast milk flowing on its own when not feeding

This is a common phenomenon in the first weeks. One breast will flow by itself when the baby is sucking on the other breast, and the two breasts will flow by itself when the mother hears the baby crying or without cause. No special treatment is required, just place a cotton pad on the nipple to absorb the leaking milk and change it whenever it gets wet.

Little milk

Little or no milk loss is rare. It is more common in the case of the hypothalamus, pituitary gland. Not to be confused with cases of low milk loss due to slow breastfeeding or not wanting to breastfeed.

A little secondary milk after having had a milk drop is very common. It is related to the mother's fatigue, being emotional (the baby is sick), changing the rhythm of life (changing accommodation, going to work), the low secondary milk that usually does not last long if the mother is not in a hurry to transfer it. bottle-feeding. Bottle-feeding can easily make babies lose their breastfeeding habits and lose their milk-forming reflex. The physician needs:

Explain the phenomenon to the mother, comforting the mother that the milk will come so she can feel secure.

Advise the mother to breastfeed more and limit the number of bottle-feeding times to the maximum.

After feeding, expressing the breast to stimulate new milk production.

Ask the mother to rest more, drink more juice, milk.

It is possible for mothers to take Galaclogil (3 tablespoons per day), Primperan (metoclopramide, 10 mg, 3 times per day).

Cracked nipples

Or it happens in the first two weeks of breastfeeding. About 25% of breastfeeding women have cracked nipples. The advantageous factor is that the baby sucks for a long time and wears a nylon bra

Symptoms of a cracked nipple:

Painful nipples when babies suckle.

Nipples have small cracks and cracks on the surface.

In the end, it is possible to try sores on the nipples or at the base of the nipples. The entire nipple is red, burning with blood every time the baby is breastfed.


Leave your breasts exposed to the air, if possible, in direct sunlight.

Apply grass fat-containing vitamins A and E, apply eosin 1% solution.

Pause feeding on the affected side for 6 to 12 hours and express breastmilk by hand, not using a straw, while continuing to breastfeed on the other side.

If the lesions do not help, need to find the cause of the thrush caused by thrush in children. If yes, treatment for both mother and child.

Breast erection

Breast erections may flex at any time during lactation. Most common in the first week, however. Minerals 15% of lactating women have erectile breasts. The advantageous factors are that the baby breastfeeds sparingly, breastfed weakly (underweight or weak), the mother has pain during breastfeeding, cracked nipples when the mother wakes. Clinical manifestations include total erection, tightness, pain, sometimes fever (around 38 ° C). Treatment is to massage, compress the breast, continue to breastfeed. May appoint intramuscular oxytocin (4 units divided by 2 primers per day). Must treat well breast erection to avoid mastitis and breast abscess.


Approximately 5% of breastfeeding women develop mastitis. If the nipple fracture and erectile dysfunction are well treated, the mastitis will decrease. The pathogen is staphylococcus, streptococcus or Gram-negative bacteria penetrates through the nipple injury to cause disease. The lymphatic system of the breast ensures the body's resistance. Milk is not infected, so it is still possible to breastfeed.

Clinical manifestations are high fever (up to 40 ° C), chills. The affected breast is swollen, tight and painful. On the breast, one can see a red area localized to a plaque or a red area that is very painful to touch and touch. Examination of armpit with round, painful, mobile axillary lymph nodes.

Patients need bed rest, hot compresses on the spot, pain relief (paracetamol 3g for 24 hours). Increase breastfeeding on the affected side (10-12 times in 24 hours). After feeding, milk must be expressed, and oxytocin can be used intramuscularly. If the symptoms disappear after 24 hours, antibiotics should be given.

Inflammation of the ducts

Usually ducts inflammation occurs after mastitis and lymphadenitis. The patient has a high fever, the breast has stiff and painful nuclei, the armpit has painful lymph nodes. Milking on a cotton pad observed small yellowish flakes, indicating pus in the milk (Budin sign).

Let the sick person rest in bed. Do not breastfeed on the injured side, discard milk. This milk should be tested for pathogenic bacteria. Indications for use of antibiotics that work on staphylococci such as Rovamyxin for 15 days, in combination with anti-inflammatory drugs. Under the effects of treatment, ducts inflammation can heal or progress to an abscess

Breast abscess

This is the most serious complication, which is the result of inflammation of the ducts that are not well treated. Patients with high fever, swollen breasts, hot, red, painful. Treatment is by injecting drainage of pus. During the abscess, not breastfeeding but to discard milk.


Breastfeeding should last from 18 to 24 months. At this time, the child has eaten many other foods. The number of feedings decreased gradually. Reducing the number of feedings until the feed stops completely will deplete the milk.