Patient Education
Breast milk is the best food for babies as it meets all the requirements. It comes with the right nutrients, ready any time the baby wants at the right temperature with no need for sterilization of equipment or preparation. It is the precious gift any mother can give it to their babies. There is enough evidence to suggest Breast milk offers short term and long term benefits both in the developing and developed world.
Breast milk contains all the nutrients which are required for normal growth and development. All babies can easily digest and absorb Breast milk. There is enough evidence to suggest it decreases the risk of necrotizing enterocolitis(NEC) in Preterm babies. Breastfed babies have lower rates of diarrhea, respiratory tract illness, acute and recurrent otitis media, and urinary tract infection. Breastmilk also protects babies against allergic diseases and reduces sudden infant death syndrome (SIDS).
Breastfed babies have a lower risk of obesity, cancer, coronary heart disease, inflammatory bowel disease, and Diabetes mellitus. Breastfed babies have lower chances of malocclusion. Breastfed babies have better cognition, Intelligence quotient(IQ) and visual function as Breastmilk is rich in docosahexaenoic acid (DHA). Breastfed babies have a lower risk of behavior problems later in life.
Breastfeeding improves bonding, helps in uterine involution, reduces postpartum hemorrhage. It also protects against pregnancy, breast cancer, and ovarian cancer. It also helps the mother to lose weight. Breastfeeding is convenient, time-saving and economical to mothers.
The Breastmilk is a complex fluid that comprises many chemical and cellular components.
Breast milk is 70% whey and 30% casein. The predominant whey proteins are alpha-lactalbumin, lactoferrin, lysozyme, and IgA.
Lactose and oligosaccharides are the main carbohydrates present in breastmilk.
Breast milk fat is rich in polyunsaturated fatty acids and is the major energy source. The hindmilk fat is 1.5 to 3 times more than foremilk fat. DHA (docosahexaenoic acid) is of the omega-3 type of Long-chain polyunsaturated fatty acid(LCPUFA) which has anti-inflammatory properties and present in the brain and retina thereby helps in neurodevelopment and visual acuity. Breast milk also contains Vitamins, minerals, growth factors, enzymes and hormones
Colostrum: It is secreted during 3-4 days after delivery. It is produced small in quantity, 15-20 ml during day 1, yellow and thick and it is rich in antibodies, macrophages, and Vitamins.
Transitional milk: Milk secreted after 3-4 days until 2 weeks.
Mature Milk: It follows transitional milk.
Foremilk: secreted at the beginning of breastfeeding and is rich in proteins, sugar, vitamins, minerals, and water that relieves the baby’s thirst.
Hindmilk: secreted during the later part of breastfeeding and is rich in fat which provides energy and gives a sense of satiety.
All hospitals should have a written policy on Ten Steps to Successful Breastfeeding developed by WHO and UNICEF as criteria for a Baby-Friendly Hospital.
All mothers should be prepared and counseled during the antenatal period regarding the benefits of breastfeeding and how to initiate and manage to breastfeed.
Help all mothers to breastfeed within one hour after birth.
Encourage breastfeeding on demand
Exclusive breastfeeding for 6 months
Long term benefits depend on the duration of Breastfeeding.
Figure : Breast Feeding
Mothers should be shown in different breastfeeding positions and how to hold a baby during breastfeeding. Mothers should be taught how to recognize Good Latching and poor Latching. Effective milk transfer requires good coordination of suckling and swallowing.
Minimum Breastfeeding frequency is at least eight times in 24 hours. The mother should try to demand feed and taught to recognize signs of hunger and satiety and cues for readiness to Breastfeeding. The mother should offer both breasts at each feeding and make sure the breast is completely emptied so that baby can get the benefits of both Foremilk and Hindmilk.
Sometimes mothers need to express their milk when the baby is not ready and unwell and breastfeeding is not completely established. Mother can either express the milk by hand or using a breast pump (Manual or electrical). The mother needs to be demonstrated the different steps involved and how to use a breast pump.
The expressed milk can be stored at room temperature for 4 hours, in a fridge for 24 hours, and a freezer at -2°C for 3 to 6 months.
Breastfeeding problems are commonly seen in clinical practice and most of the problems can be easily prevented by simple advice. Mother can have a sore nipple, inverted nipple, and a flat nipple. The sore nipple is more common when latching is not adequate. If the breast is not emptied fully then the mother can have breast engorgement and breast abscess. Candida infection of the nipple and oral thrush in babies are commonly seen in clinical practice. Early recognition and referral to a lactation consultant is very important in managing breastfeeding problems.