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Employment and breastfeeding

posted Mar 26, 2015, 4:53 AM by Melissa Bugeja   [ updated Apr 10, 2015, 2:15 AM ]

Now more than ever before, mothers continue working after giving birth whether it is because they wish to or because they have to.   As a breastfeeding mother, this will seem like an insurmountable problem which will give breastfeeding a deadline.  This need not be so! Having some strategies at hand plus basic knowledge on breastfeeding is all you need to make working and breastfeeding a success story..

Strategies to manage breastfeeding and work

Knowing how much maternity leave you are entitled to is the starting point.  In Malta we are entitled to 18 weeks of fully paid maternity leave.  We are also entitled to an extra full year of unpaid leave (both partners),this is a bit tricky though since most businesses are small and will not be able to afford to keep your place for a year.  However, you would be able to ask for an extra 2-6 months off unpaid (depending on the organisations' size).

 My story: When I was pregnant I decided to breastfeed for 6 months so I applied for my maternity leave plus an extra 3 months unpaid leave.  That made sure that my son had my constant presence till the time I planned to wean. However once on maternity leave I decided to continue breastfeeding till my son was 1 year old, so I contacted my employer and told him that I needed to express milk for my son once back to work and that I needed a place where I could do this.  He readily accepted and provided all the necessary space.  In the end I breastfed my son till 4 years of age.

Working from home is a good option for mothers.  At an age were everything is done electronically, this can be a good bargain for you and your employer; or maybe you would like to start your own company... 


Going back to work part time or using flexible hours help because you are away for less time with your child and there is a good possibility that you would not need to express any milk either.

EMB's Story: I breastfed my boy and started going part time work when he was 7 months. Just before he started going to nursery and me back to work, we started giving him fruit and veg purees, baby rice and some water, like that he was covered for those 4.5 hours without breast milk. I was breastfeeding him just before taking him to nursery, giving them the purees to feed him, and breast feed as soon as l was picking him up. While I did try expressing at night, l found it to much time consuming. This way worked for us better and we nursed till 22 months old:) 

Expressing milk at the work place is possible.  All you need is a private space with an electrical outlet to do this and a fridge for the milk and pump.  Considering the length of our maternity leave, leaving your baby in the care of a family member or nursery at approximately 4 months old is not really bad.  The amount of milk you would need to express will depend on how much the baby takes and the length of time you will be away from him.

Christine Zammit's story: Well basically I managed quite well with Breast feeding and continuing to work. I returned to work when Luca was 4 months old and had started to express at around 3 months. I used to BF him before going to work, then he took the expressed milk and then normal feeds follow when I return back home. I never expressed milk at work: we do have the facilities ie clean quiet rooms etc but since I don't work long hours I never felt the need to express at work. When I return at home then I express two 6 once bottles since God Bless I have quite a good flow. At 1 year of age I stopped expressing milk- Luca had started eating well and was also getting used to cow's milk so I BF before going to work and then after I come. He is now 1 year 2 months and we seem to have no intension to stop BF yet .

On average, a baby between 4-6 months of age will consume between 90-120 ml or 3 to 4 oz.  Once solid food is introduced the amount of milk needed will gradually start to diminish.  When you are pumping to replace a feed you can pump the whole feed at a go.  That being said it will depend on your breast storage capacity.  Breast Storage capacity is the maximum amount of milk available in your breasts during the time of day when your breasts are at their fullest.  This is based on the amount of room in your milk-making glands, not breast size and it varies among mothers and in the same mother from baby to baby (Nancy Mohrbacher).

Another option worth mentioning, if your baby has started taking solids, you can find a day care centre near your workplace and go to nurse him there during your lunch break.  It is a good way to keep contact with your baby and a good way to avoid expressing milk if that is what you wish to do.

Ilona Petrovska's story: When I was pregnant I did some research and decided to give my best shot at BF.  I knew I would be going back to work when my daughter was going to be 4 months old but thought I would figure something out nearer to the time.  I started working 4 hours a day and expressed milk in the morning for my little one's use.  I Bf my daughter till she was nearly 2 years old!


Ins and Outs of expressing at work

When you need to express milk at work, you will need:
  • a clean, quiet, private room with an electrical outlet to express milk
  • a fridge where to store the milk
  • your breast pump and containers for the milk 
  • small cooler to carry your milk back home
Taking into consideration the possibility that as a mother you would be working 8 hours a day and are leaving behind a 4 month old baby, you will usually need to take 2-3 x 20 minute breaks to pump milk (the amount of breaks will depend not just on the amount of milk you need but also on how long you normally take to collect said amount).  It is best to pump at the time your infant normally nurses and so if at 1000 hrs you usually nurse your infant you should pump at this time. However it is not essential to do so. Normally your breasts will have given you all the milk possible in 20 minutes - more than that might actually hurt your nipples.

If you do not feel quite comfortable especially the first few days at work you might want to consider bringing a book or some music to help you relax and take your mind away from the pumping.  A picture of your infant might help trigger the let down reflex quicker.

Once you have expressed your first bottle, store in the fridge.  If it is not full you can add to it at your next pumping session.  The pump, simply take out the motor part of it and store the rest of it in the fridge along with the milk.  In the evening while you are at home give it a good wash and sterilise it.


Other Resources:
Maternity Leave by the Maltese Government
Employee's guide to breastfeeding and working by US department of health and human services

Skin to skin or kangaroo care

posted Mar 26, 2015, 4:52 AM by Melissa Bugeja   [ updated Apr 10, 2015, 2:25 AM ]

Skin to skin also known as kangaroo care was used mostly for premature infants.  However, a multitude of studies have now shown that skin to skin for term healthy infants is just as beneficial.

Skin to skin, meaning having your naked baby put on your naked chest with a blanket on top of you both to keep you warm if need be, has been shown to help with stabilising breathing, temperature, heart beat and also blood sugar levels.  It is also said (although evidence is not conclusive) that it can help increase the milk volume.

When it comes to breastfeeding, if baby is put skin to skin soon after birth for an hour or more, he is more likely to latch on better without any help.  This of course leads to less possibility of developing other common problems like blocked ducts and mastitis.

When your child is premature, skin to skin has also been shown to reduce the amount of time in the hospital and helps prevent neonatal deaths due to premature complications.  Even when very small and mechanically ventilated, they can still be held skin to skin safely!  You can remain skin to skin for as long as you wish (preferably for a minimum of 2 hours) unless the infant becomes physiologically unstable.

Jill Bergman

Separation from mother is highly stressful, and  is enough to make a baby unstable(2;5).
 He feels unsafe, his brain send “danger”signals to the body.  
His brain releases the stress hormone cortisol which increases the heart rate and breathing in a basic 
“fight or flight” instinct(5-7). Somatostatin (which counteracts the growth hormone) is also released and 
acts in the gut to decrease absorption of food and thus inhibit growth(8;9). These stress hormones will stay
 in the body while the baby is separated from Mum.   When returned to Mum, the stress hormones still take
 30 minutes or even an hour to wash out of his system.

All of this intense protest activity uses up vital calories which should be used for growth(12). If the baby’s protest signals are not heeded, the baby may go into an energy-conserving defense mode which lowers heart rate and temperature for prolonged survival(5). This state of “freeze” may look like the baby is asleep, but recent neuroscience research has shown that baby can be  firing avoidance pathways in the brain. A final stage of defense is called “dissociation” in which the baby essentially “tunes out”(7). The ominous part is that the brain of the baby is wiring emotional pathways, adapting to cope with “a dangerous world, where nobody loves me”. This can cause lasting emotional complications which can have major effects later in life for the emotional and mental health of the baby. Adult mental health is based on infant mental health, but now we know that this starts really early, even in the first hour after birth(5).
In summary, separation of the newborn baby from the mother is the primary cause of stress. This can show itself in increased heart rate, blood pressure and decreased oxygen saturation in the blood. This often causes a cascade of problems and complications requiring ever more intervention from the neonatal health system.
Most of this could be avoided by the mind-blowingly simple practice of putting every newborn baby naked onto Mum’s bare chest, drying him and covering both of them. All of the observations and tests can be done while leaving the newborn in his SAFE place. This alternative to separation-stress is called “skin-to-skin contact”(4).



Other Resources:

Kangaroo Mother Care by Nils & Jill Bergman
FAQ Skin to Skin by LLL Canada

Expressing and storing milk

posted Mar 26, 2015, 4:51 AM by Melissa Bugeja   [ updated Apr 10, 2015, 2:54 AM ]

While it is not necessary to introduce a bottle to breastfed infants, many mothers choose to do so mostly to be able and leave their children with a care giver when they need to go out alone.  

It is thought that unless you introduce a bottle before 3 months of age, your infant will refuse it.  While this can happen, the main reason is mostly that between 3-4 months of age they go through a developmental milestone and need extra comfort at the breast.  However some infants can be choosy and you might need to try various different brands of teats to find one that is acceptable for your little one.

Many are surprised by the small amount of milk they express especially in the beginning.  It is taken for granted that if you have a good milk supply, you will express loads of milk.  This is normally not the case and especially if you need to express milk from the very first day of life of your little one; because colostrum is very thick.  The most important thing to remember when starting to express milk is that the amount of milk you pump is not an indication of how much milk your baby receives directly.  Babies are more efficient than pumps and can transfer more milk than a pump.

There are different kinds of breast pumps available today or you might want to hand express your milk.  Once you decide on the best way to express milk, all you need is to find that quiet time and start.  Many women complain that not a drop of milk came out when they started pumping.  The reasons can vary but generally speaking unless you are relaxed, no milk will come out and at first your breasts need to get used to the different sucking pressure of the pump/hand.

Many women find the following aids helpful to pumping:

  • Applying a warm compress befrehand
  • Breast massage during pumping
  • Having the baby close by or a picture of him
  • Pumping often

NOTE: The hereunder guidelines apply for mothers who have healthy full-term babies (check with the hospital personnel for guidelines pertaining to storage and handling of breastmilk for pre-term or ill babies).

Milk can be stored in clean glass or plastic containers.

When storing milk label with the full date to use the oldest milk first.  Stored milk will separate; this is normal and swirling it gently will mix it up again. You can combine milk expressed at different times within a single day.

Breast milk in Malta can be left out at room temperature for not more than 1 hour (in Winter).  In a good cooler with ice packs in, it can be stored for up to 6 hours.  Milk can be left at the back of the fridge, where it is coldest, for up to 3 days and frozen in a fridge freezer (i.e. the fridge & freezer having separate doors) for up to 3 months.  It is important to note that when reading articles on storage of milk from other countries the storage time is longer.  However the shorter storage time ensures that milk is fresher and has not lost much of its immunological properties.

Handling and Thawing Milk 

Frozen milk is best left to be thawed overnight in a refrigerator - this usually takes approximately 12 hours.  If you need a quicker method, it is best to put it under a tap of running water or in a small basin that is gradually warmed up.  Once thawed, breast milk can not be refrozen and must be used within 24 hours.  

Breast milk should be heated up to room temperature so as not to kill important immunological properties.  This could be done by putting it in a basin of warm water.  Heated milk can not be reheated.  It is important to remember never to heat milk directly on the stove or in the microwave.

It is best to store milk in small portions (2-4 oz/ 60-125 ml) to avoid waste.  It also thaws and warms quicker.

Extensive research has not yet been done to determine if it is safe to give a baby milk that was left over from a previous feeding or milk that was previously warmed, but not used. However, most lactation experts agree that milk that is not finished at one feeding may be offered at one more feeding before needing to be discarded. Human milk has antibacterial and antimicrobial properties that result in slower spoilage as compared to other foods. (Becky Flora IBCLC)

Can Breast milk turn sour?

Human milk rarely spoils and when it does it has a distinctive sour taste and odour.  That being said some mothers do find their milk is not fresh any more and smells soapy.  If you continue to find such milk, check again the handling and storage guidelines.  If these are being met you might be one of those few mothers who are thought to produce an excess of an enzyme called lipase which helps breakdown of fats in human milk.  Most babies will not mind a mild change in taste and the milk is not harmful, but the stronger the taste the more likely that baby will reject it (Kellymom).

One way to keep milk from spoiling so quickly is to halt the breakdown of fats by scalding the milk just prior to storing it. This is done as soon after expression as possible and over a stove eye. Scalding the milk involves allowing small bubbles to appear on its surface but removing it from the heat before an actual boil occurs. The milk should then be stored immediately either in the refrigerator or freezer (Becky Flora IBCLC).


Other Resources:

My Power went out and I have milk in the freezer by Kellymom

What are the LLLI guidelines for storing my pumped milk by LLLI

Storage and handling of Breastmilk by Becky Flora IBCLC

Hand Expression of Breast Milk by Stanford University

My Expressed milk doesn't smell fresh what can I do? by Kellymom

Mothers & medications

posted Mar 26, 2015, 4:49 AM by Melissa Bugeja   [ updated Apr 10, 2015, 2:59 AM ]

Sears wrote: What goes into your body also goes into your milk.  That is the complete truth but fortunately for us most medications are safe to take while breastfeeding.  

There are of course those few that are not and if the inevitable happens and there are no alternatives to take, quiz yourself and your doctor before deciding on taking the medication.
  • How sick are you?
  • Do you really need this drug or can you use a natural alternative?
  • Will it effect the baby and/or lactation?
It is also important to weigh the potential risk temporary weaning can cause:
  • The risk of the baby refusing to go back to the breast
  • The risk of damaging your milk supply
And so, it is of the utmost importance to inform your doctor that not only you are breastfeeding, but you are ready to explore alternative treatment rather than weaning.  Many a time, doctors suggest weaning because they do not have enough information about a particular medication.  They would consult the package insert from pharmaceutical manufacturers, which almost always across the board say that the medication is not suitable for pregnant or lactating mothers.  The warning statements are designed to protect themselves from lawsuit because in general manufacturers have done no studies on breastfeeding women( even if studies have been done by others this is not listed).

It is good to search for a second opinion and also consult with your baby's paediatrician who would be more aware of what effects certain medications will have on babies and young children.  You can also ask help to a Breastfeeding Counsellor or Lactating Consultant should you not be able to find the information you are looking for.  You can also urge your doctor to find more information about the medication.  

Other Resources:

Breastfeeding Network - UK online information network and helpline
The Breastfeeding Book - Martha Sears R.N & William Sears M.D
Medications & Mothers' Milk - Thomas Hale PhD

Weaning: the baby-led approach

posted Mar 26, 2015, 4:48 AM by Melissa Bugeja   [ updated Apr 10, 2015, 3:00 AM ]

When do I start solid food to my baby is a question raised by many.  However, if you follow some basic steps, it is easy to know when is best to introduce solids as not all babies develop the same.

 

Solid foods should preferably not be introduced before the baby is 6 months of age.  The reason behind this is that the gut of a baby is not mature enough to handle these foods before this age.  Also the oral-motor development readiness usually begins between 6 and 8 months.

 

Signs of Readiness

·        The ability to sit up unaided i.e not just sit for a moment and topple over

·        The ability to pick bits of food in a pincer grip i.e between thumb and forefinger and put it in his mouth

·        Looking interestingly and/or crying at your own food

·        More frequent feedings that are not linked to illness, teething or change in routine and that persist over several days.

How do I introduce solids is another question many parents ask.  The basic principles of nutrition for babies are no different than us adults.  So whole vegetables and fruits steamed or mashed, whole-grain cereals and so on, as opposed to refined and processed foods such as commercial baby foods, which can be highly processed and are often less nutritious than whole unprocessed foods are the ideal.

Finely pureed foods are often uninteresting to the baby. These where introduced recently, when it was recommended for babies to wean them around 3-4 months of age.  At that age nearly liquid texture is important as they are unable to cope with firmer foods.  However, at 6 months, most babies are able to eat lightly mashed or soft foods.

Simple weaning foods

·        Grated fruits & vegetables or steamed to a soft texture

·        Strips of toasted whole-grain bread

·        Frozen peas

·        Stewed or roasted beef or chicken soft enough to gum easily –shredded if necessary

·        Cubes of cheese

·        Whole-grain cereals such as oats (not instant oatmeal however)

Liquids

A baby taking solids will need more liquid, while breastmilk continues to be very important- in fact breastmilk should remain the main source of food till your baby hits 1 year of age- extra water will be needed.

 

Vegetarian and Vegan Diets

If raising your children vegetarians, it is helpful to remember to watch out for any allergic reaction to soy as this is a common allergen.  Also watch out for wheat gluten used in some meat substitutes.  Legumes are however low-allergenic food.

Vegan families on the other hand, may need to supplement their baby with vitamin B12 if their child is not given any dairy products and eggs.  It might also be helpful to monitor the baby’s intake of iron, zinc and vitamin D.

Allergenic Foods

Some foods are known to be highly allergenic.  Families with known history of allergy should particularly be careful to delay introducing these foods until the child is over 2 years of age, when their systems may be able to handle them. Common allergens include:

·        Nuts

·        Wheat

·        Cow’s milk

·        Eggs

·        Peanuts (other nuts are actually legumes not nuts)

·        Citrus fruits & berries

·        Tomatoes

·        Corn

·        Soy

Tips for feeding solids

·        Breastfeed first – breastmilk is still the baby’s main source of nutrition throughout the entire first year. Breastfeeding before giving solids ensures your baby is getting enough nutrition.  Starting solids is mainly a time when baby is getting used to new textures, tastes, chewing and putting food in his own mouth.

·        Start slow – introduce new foods one at a time, in small quantities (about a teaspoon each time) and allow a week or so before trying something new to allow time to observe for any potential allergic reactions.

·        Timing – some babies explore food better at a quiet time of the day like mid morning.  Experiment to see what baby prefers

·        Don’t force – if baby not interested try again another day

·        Stay with the baby – Constant supervision to watch out for trouble in swallowing or choking is essential. Besides eating is a social activity and closeness to a parent is as important to a young baby as it is to us.

Resources: Dr Jack Newman Starting Solid food

                Gill Rapley Guidelines for implementing a baby-led approach to the introduction of solid food

                World Health Organisation Infant Nutrition Guide

Positioning and latching

posted Mar 26, 2015, 4:46 AM by Melissa Bugeja   [ updated Apr 10, 2015, 3:02 AM ]

Positioning
An important lesson every mother must learn when just starting to breastfeed is that you must be comfortable and relaxed before you attempt to go any further.  Breastfeeding newborns usually takes a lot of time so being comfortable will help your baby to be comfortable and being relaxed will get the milk ejection reflex to occur and the baby to latch on easily.
Once your body is comfortable and relaxed it is time to position your baby.  In whichever position you choose to nurse, there are three rules of thumb to keep in mind:
  1. The baby must be tummy to tummy
  2. The baby's nose must be in line with you nipple
  3. The baby must have the head lined up with the body
The Cradle hold is the “classic” breastfeeding position.  The mother will be either sitting or semi reclining and the baby lies tummy to tummy with her while resting his head in the crook of his mother’s arm.  If needed the mother may place a pillow in her lap to support the baby’s body. 
The Cross-cradle hold is similar to the cradle hold except that instead of the head resting in the crook of the mother’s arm, the mother’s opposite hand supports the baby.
The Football hold gets its name from the sense of tucking something under your arm.  The mother tucks the baby under her arm and supports the back of the head and neck to bring the baby to the breast.  The baby’s body may rest on a pillow to raise him to the needed height.
The Side-lying hold is the most restful position especially at night time if co-sleeping.  When the mother lies down on her side, her baby can also lie on his side facing her and feed.  The baby’s head can rest flat on the bed or on the mother’s arm.  The baby’s body should be tucked close to his mother so as not to arch his back. A small pillow placed at the baby’s back and another between the mother’s knees might be helpful.
Latching
Another important lesson every mother need to learn is how to latch the baby effectively.  If the connection between baby and breast is poor, the baby is less likely to get enough milk and you are more likely to feel pain.
Once you are in position, your baby will most likely seek the nipple himself.  However if your baby is sleepy or quiet, you may lightly brush your nipple to his lips or even express a few drops of milk on his lips to tempt your reluctant baby.
The baby’s mouth should be wide open- like a yawn- before you try to bring him onto the breast.  Tickling his lips with the nipple often encourages your baby to open wide.  If the mouth is not open wide, your baby may not be able to grasp enough of the areola to form a proper teat in which case, it may rub painfully against the hard palate when the baby suckles.
Lastly, guide the baby’s head forward onto the breast.  Most babies dislike having the back of their head pushed firmly to guide them to the breast.  So use just enough guidance to help the baby along.

 
Signs of a good latch
• The baby’s mouth is open very wide
• The lips are flanged out like the mouth of a fish
• The cheeks are plumped out 
• There is no lip-smacking or sucking noises 
• The muscles in front of the baby’s ears can be seen to ripple in pulses as the baby suckles
If the latch is not right, gently detach the baby by inserting your little finger into the corner of the baby’s mouth and pulling down lightly on the baby’s chin and try latching him on again.  You might need to latch on several times in the beginning but the process will become more natural by time.

References: Kelly Bonyata www.kellymom.com
                    Martha Sears R.N & William Sears M.D The Breastfeeding Book
                    Jan Riordan Breastfeeding and the Human Lactation
                    

Breastfeeding basics

posted Mar 26, 2015, 4:45 AM by Melissa Bugeja

Breastfeeding can seem daunting to some women.  One of the main reasons is that we are afraid of what we can not see.  How do you know that your infant is nursing well? Is he crying due to hunger or sickness?

Hereunder I am introducing you to ways of recognising these general concerns:


Feeding Cues

There are various ways to know when your infant is hungry.  Crying is a desperate hunger cue.  Instead look out for the earlier hunger cues.

·         Rooting
·         Wriggling
·         Sucking on fingers or anything that comes near the mouth
·         Fussing/Restless

Signs of good milk transfer

Because you can not see what baby is drinking, many of us tend to worry that our baby is not drinking enough.  This is especially true in the first few days of life when baby needs to drink very often.  If your baby is showing the hereunder signs, that is a great indication of good milk transfer:

·         Baby is alert when not sleeping, shows feeding cues, appears satiated

·         Baby is producing the expected urine and bowel movements

·         Signs of let down observed

·         Baby’s skin when gently pinched returns to normal when released – doesn’t tent

Expected Urine Output

One way to know that your baby is drinking enough is by noting the urine output as mentioned above.  It is recognised that for each day of life your baby should have a minimum of one wet nappy.  In other words this means, that the minimum number of wet nappies should be as follows:

1 day old = 1 nappy

2 days old = 2 nappies

3 days old = 3 nappies

4 days old = 4 nappies

5 days old = 5 nappies

6 days old and beyond = 6 nappies

On the other hand, bowel movements are less predictable.  However, the colour of the bowel movement should change accordingly:

First few days after birth – sticky & blackish called meconium

It than changes slowly to a green and then more yellowish colour, until the baby starts producing “mature” bowel movements.

Growth Spurts

Babies go through certain phases where they go through growth spurts.  Growth spurts are phases where your baby seems never to be satisfied and is all the time hungry due to physical and/or developmental advancement.  This is normal and you should not worry that you do not have enough milk.  Growth spurts normally last between 2-3 days.  Average ages that babies go through a growth spurt are:

 

·         During the first few days at home

·         Around 7 -10 days old

·         Around 2-3 weeks old

·         Around 4-6 weeks old

·         Around 3 months old

·         Around 4 months old

·         Around 6 months old

·         Around 9 months old


Signs of sickness

A baby can't tell you it is feeling sick.  If you are experiencing any of the following, it is best to check your baby with a pediatrician or family doctor.

·         Have a temperature (more than 37 degrees Celsius)

·         Is in distress – crying a lot for no apparent reason, won’t comfort at the breast.

·         Is in pain – signs of distress as well as arching back or drawing feet to abdomen, crying that is different than the norm (different pitch), withdrawing (being still, avoiding eye contact)

 

Signs of dehydration

Dehydration is very serious in babies as it can mean the life or death of said infant.  Signs of dehydration would be:

·         Reduced urine output

·         Listlessness or lethargy

·         Clammy skin

·         Paleness

·         Decreased tears

·         Sunken looking eyes

·         Dry lips and mouth interior

·         Fever

·         Increased pulse rate

References: Jan Riordan Breastfeeding and the Human Lactation

                    Martha Sears R.N & William Sears M.D The Breastfeeding book

                    Dr Jack Newman Is my baby getting enough milk



Breast anatomy and milk making

posted Oct 14, 2009, 11:16 PM by Melissa Bugeja   [ updated Apr 10, 2015, 3:04 AM ]

Having an understanding of how your breasts work and make milk, will make you appreciate more the art of breastfeeding.

                                                How does the breast work?

 The lactation system inside the breast resembles a treeThe glandular tissues which make the milk are the leaves.   The ducts are the branches from which the milk travels. These ducts then flow into the larger tree trunk or milk sinuses which empty into the nipple through approximately twenty openings. The nipple appears as a short cylindrical protrusion through which the milk flows out of the breast and is surrounded by a patch of coloured and sometimes wrinkled skin called the areola. The milk sinuses are located beneath the areola. To empty the milk effectively, the baby’s gums must be positioned over them. When sucking only on the nipple, only a little milk is drawn out and the nipple gets irritated. In fact it is said that Babies feed on areolas not nipples (Sears).
  The baby’s sucking stimulates nerves in the nipples that send messages to the pituitary gland to the brain to secrete the hormone prolactin, which encourages continued milk production.  As the baby continues to suck, the sensors in the nipple signal the pituitary gland the release of another hormone, oxytocin.  This causes the tissue around each of the many milk glands to contract, squeezing a large supply of milk through the milk ducts into the sinuses and out of the nipple.  This is called the milk- ejection reflex (Sears).


 How is the milk made?

The making of milk begins mid pregnancy, when the body under the influence of the hormone prolactin starts the process to produce colostrum.  About three days postpartum, the milk starts coming in and at this stage women commonly feel fullness in their breasts which can lead to engorgement.  Around 9 days postpartum the last stage of milk making is reached and this ends whenever mother and baby decide to finish breastfeeding.  This is the stage of supply and demand.  It means that the amount of milk produced is dictated by how much milk is removed from the breast and therefore the more a breast is emptied, the more milk will be produced and that is how mothers with twins and triplets produce enough milk for all their children.

References: Martha Sears R.N & William Sears M.D The Breastfeeding Book
                    Carol L Wagner Human Milk and Lactation
                   Auerbach & Riordan Clinical Lactation: A Visual Guide

Immunology and breast milk

posted Oct 14, 2009, 11:11 PM by Melissa Bugeja   [ updated Mar 26, 2015, 4:43 AM ]

When a baby is born her immune system is very immature.  In fact the immune system of a baby is not at its full strength before the child is 5 years old.  And while not the norm, it is why UNICEF and WHO both advise breastfeeding to carry on for 2 years and beyond.

All human babies receive some coverage in advance of birth. During pregnancy, the mother passes antibodies to her fetus through the placenta. These proteins circulate in the infant’s blood for weeks to months after birth, neutralizing microbes or marking them for destruction by phagocytes-immune cells that consume and break down bacteria, viruses and cellular debris. But breast-fed infants gain extra protection from antibodies, other proteins and immune cells in human milk. - Jack Newman


Breastmilk is full of antibodies (immunoglobulins)  and other cells (white blood cells) that have been shown they help protect the infant from various infections and disease; including ear infections, upper and lower respiratory tract infections, allergies, intestinal disorders, colds, viruses, staph, strep and e coli infections, diabetes, meningitis, pneumonia, urinary tract infections, salmonella and many, many more.

The antibodies, made by our bodies are very specific molecules that fight against illnesses.  These antibodies are than delivered to the baby through breastmilk.  So that your infant will now have immunity of all the diseases you have been yourself exposed to.  Not only that, but if your baby gets in contact with something which you have not been exposed to, at the next feeding he will transmit it to you while nursing and your body will in turn produce antibodies which of course are than delivered back to the baby. - And that is why we refer to breast milk as liquid gold - because our awesome system is impossible to beat!

One of the most important antibody produced by breastmilk is secretory IgA.  The secretory IgA molecules passed to the nursing baby protect against infection agents that the infant is most likely to get in contact with during the first weeks of life.  The antibodies  delivered to the infant ignore useful bacteria normally found in the gut. This flora serves to crowd out the growth of harmful organisms, thus providing another measure of resistance. -Secretory IgA molecules further keep an infant from harm in that, unlike most other antibodies, they ward off disease without causing inflammation-a process in which various chemicals destroy microbes but potentially hurt healthy tissue. In an infant’s developing gut, the mucosal membrane is extremely delicate, and an excess of these chemicals can do considerable damage. Interestingly, secretory IgA can probably protect mucosal surfaces other than those in the gut. - Jack Newman

Human milk is a complex fluid that contains more than 200 recognized constituents (see Blanc, 1981). The number of recognized constituents has increased as analytic techniques have been improved. 

Classes of Constituents in Human Milk

Protein and Nonprotein Nitrogen Compounds

Carbohydrates

Proteins

Lactose

Caseins

Oligosaccharides

α-Lactalbumin

Bifidus factors

Lactoferrin

Glycopeptides

Secretory IgA and other immunoglobulins

Lipids

β-Lactoglobulin

Triglycerides

Lysozyme

Fatty acids

Enzymes

Phospholipids

Hormones

Sterols and hydrocarbons

Growth factors

Fat-soluble vitamins

Nonprotein Nitrogen Compounds

A and carotene

Urea

D

Creatine

E

Creatinine

K

Uric acid

Minerals

Glucosamine

Macronutrient Elements

α-Amino nitrogen

Calcium

Nucleic acids

Phosphorus

Nucleotides

Magnesium

Polyamines

Potassium

Water-Soluble Vitamins

Sodium

Thiamin

Chlorine

Riboflavin

Sulfur

Niacin

Trace Elements

Pantothenic acid

Iodine

Biotin

Iron

Folate

Copper

Vitamin B6

Zinc

Vitamin B12

Manganese

Vitamin C

Selenium

Inositol

Chromium

Choline

Cobalt

Cells

 

Leukocytes

 

Epithelial cells

 

and properties can be found in several recent review articles and books (e.g., Blanc, 1981; Carlson, 1985; Gaull et al., 1982; Goldman et al., 1987; Goldman and Goldblum, 1990; Hamosh and Goldman, 1986; Jensen, 1989; Jensen and Neville, 1985; Koldovskỳ, 1989; Lönnerdal, 1985a, 1986a; Picciano, 1984a, 1985; Ruegg and Blanc, 1982).

Nutrition during Lactation - Institute of Medicine


Other Resources:

Immunological Protection by Kahtryn Orlinsky


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