The breast is made of a network of ducts, fatty and glandular tissue containing small ducts and alveoli. The milk is produced within the alveoli. Recent research has shown the ducts to be quite close to the surface, about 2mm in diameter and easily compressed (Ramsay, et al, 2005).
Milk is produced by the glandular tissue contained within the fatty and fibrous supporting tissue of the breast. Prolactin is the hormone responsible for milk production. Small nerves in the areola, the coloured area surrounding the nipple, are stimulated as the baby suckles the nipple. This causes the release of the hormone prolactin which stimulates milk production.
The ‘let-down reflex’ gets the milk from the breast tissue to the nipple for the baby to drink. Nipple stimulation signals the brain to trigger the release of oxytocin. This hormone causes cells surrounding the alveoli in the glandular tissue to contract and release milk into the ducts. The milk is transported through the ducts to openings in the nipple. Oxytocin also stimulates the uterus and it is quite common to have uterine cramps and increased blood flow during or following breastfeeding in the first days and weeks after giving birth.
Babies suckle in a two phase pattern. As the baby starts to feed, they suckle in a shallow and fast suck pattern. This progresses to a deeper suck and swallow action as let-down occurs. The stimulation of the nipple triggers further oxytocin and prolactin to be released so further milk is produced and let down. In this way the more the baby suckles, the more milk you make, so supply usually equals demand.
How Breastfeeding Works
Breastfeeding is not easy! It is a learned skill and often does not come naturally. Women in previous generations learned to breastfeed by growing up watching the women in their family breastfeed. Now days, the first time women are exposed to breastfeeding is when they first try it themselves. 49% of women have trouble breastfeeding on the day of delivery. Luckily, this reduces to 15% a week later (Dewey et al, 2003). Many factors influence breastfeeding and attachment early on. Poor attachment and difficulty feeding is more likely if this is your first baby, have had a caesarean or have flat or inverted nipples (Dewey et al, 2003).
The position you hold the baby in, how the baby reacts, and your level of anxiety all affect to how feeding goes. Problems with breastfeeding can range from difficulty or painful attachment to engorgement, blocked ducts, and mastitis.
When feeding your baby, it is important to maintain a good posture. Good posture positions your nipples straight ahead, which is easier for the baby to attach to. Bring the baby to your nipple height and prop up their weight with pillows or a ‘breastfriend’ support. You should not feel you are taking the weight of the baby in your arms, rather, you are guiding the baby into the correct position. It is tempting to lean forward and drop your nipple into the baby’s mouth. This is more difficult for the baby to attach to and feed from and can result in neck and back pain for you (just what a new mother does not need).
The baby should have good hold of your areola and the nipple well within his mouth. The baby draws the nipple and breast tissue into his mouth a long way. His tongue comes forward over the gums and the bottom lip rolls out. It should feel comfortable if the baby is well attached. Poor attachment is painful due to abnormal pressure on the nipple which can cause cracking of open areas.
It is important to drain the whole breast when feeding. However, it isn’t always that easy. Ideally, as you feed the baby, his suckling action will drain the whole breast. Holding the baby in the usual cradle hold and the under the arm ‘football’ hold help fully drain the breast. You can also try side lying which is a nice position when you are exhausted as you can both drift off to sleep.
It is a good idea to feel your breasts for lumps after each feed. Your breasts should be soft and relatively smooth. Regular checks allow you to ‘get to know’ your breasts and notice lumpy areas sooner rather than later.
Avoid Breastfeeding Problems
Milk flow can be restricted by a poorly fitting bra, poor positioning of you or the baby, compression from your fingers holding your breast too firmly, or even sleeping on your stomach. A bump to the breast or the baby pulling at your breast can cause bruising and swelling which may restrict milk flow. Incomplete drainage from hurried feeds or too long between feeds can allow milk to collect and set in the ducts.
Picking a well fitting maternity bra is important. Maternity bras that have cups that don’t completely drop down when you feed, but leave a triangle of fabric around the breast, can compress the breast and restrict milk flow. You may need a couple of different sized bras for days when you are fuller than others.
Positioning yourself and the baby during feeding is essential. You spend so long feeding throughout the day you need to do it in good posture for two reasons. First, it helps protect you from neck and back pain due to prolonged poor positions, a very common complaint for new mothers. Second, poor positioning especially leaning down towards the baby can kink the easily compressed ducts in your breast , block milk flow, and result in incomplete emptying of the breast. Using a commercial breast feeding pillow such as the ‘Breastfriend’ or a few pillows to lift the baby up to your level helps maintain a good breastfeeding position. This reduces the load on your neck and back and positions your nipple straight ahead which is easier for the baby to attach to. Some women are lucky and only need to feed in the ‘cradle hold’ position to drain their breast. Other women need to use a number of positions for effective drainage including the ‘football hold’ or side lying.
When feeding avoid pressing too firmly on your breast with your fingers when positioning your nipple. Lifting the baby up to your breast rather than leaning down to the baby helps reduce the need to direct the nipple towards the baby’s mouth. If you still feel the need to direct your nipple, use only very gentle pressure.
From there Joshua moved down to Geelong for 3 years at Geelong Hospital working in intensive care, surgical, respiratory and orthopaedic physiotherapy.
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