Breast feeding
The breast feeding characterizes the capacity which have the Mammifère S to nourish their offspring thanks to the Lait that the females produce.
Overall picture
Developed during each pregnancy in the mother, the device of lactation becomes operational with the birth, the secretion and the ejection of progressively occurring milk, under the stimulation of the Sein by tétées of the baby or a regular expression of milk. Lactation is maintained during time as a long time as stimulation is effective.
The colostrum of the first days, then mature milk meet directly and in an economic way (easy digestion, optimal contribution of energy) the needs for the newborn to complete its neurological development and to build immunizing defenses against the ambient conditions.
In the breast-feeding, the nourrissage is generally direct (tétée with the center); in certain circumstances, the mother's milk can be drawn mechanically (manual expression, breast-pump), transported, stored (with personal capacity or by a milk bank) and managed with the baby by various means (probe, device of assistance to lactation, spoon, cup, feeding-bottle,…). The recourse to a nurse, another mother directly giving her mother's milk to the child, fell in disuse.
The membership of human of the class of the mammals higher and the constitutional immaturity of small than the birth which results from it, imply a specific food during the first months of the life; such as it is, only the milk of the mankind meets the needs for the human baby. Failing this, it is necessary to replace it by a substitute of the mother's milk, generally a compound formed containing cow's milk modified (from 0 to 6 months: preparation for infant, 6 months with 1 year: milk of continuation). According to WHO (the World Health Organization), the diversification of the food (solid introduction of food) is desirable only after age the 6 months.
Physiology of lactation
The device of lactation
The basic internal structure of the center, made up from 15 to 25 channels milk (or lactiferous, of English lactiferous ) emerging on the surface of the nipple by independent pores, is present at the rudimentary state in the two sexes, of the embryonic age at the adulthood.At the pubescent woman, the gland mammaire develops under the hormonal influence: steroids ovariens, Prolactin, Growth hormone, glyco-corticoids, etc The estrogen S develop the milk channels and the Progestérone develops the glandular buds, the future producing cells, the acini.
In the expectant mother, the estrogens induce a lengthening of the milk channels, the progesterone, prolactin and the hormone placental lactogene the multiplication and the development of the acini. The progesterone inhibits prolactin, preventing the secretion of milk.
At the end of the pregnancy, the milk branches are largely furnished with acini (a acinus, acini), on the whole between 6 000 and 200 000 microscopic units, laid out by bunches from 10 to 100 and thus constituting lobules or units ducto-lobulaires from 0,1 to 1 mm diameter each one. From 20 to 40 of these lobules are gathered in branches around one of the milk channels, thus forming a lobe. There are as many lobes as of channels milk (between 15 and 25), each one emerging separately in the nipple.
With the childbirth, the fall of the blood rate of estrogens and progesterones are accompanied by a massive release of prolactin for the manufacture of milk in the acini. As a long time as the mother nurses, the acini continue to develop. After weaning, the acini disappear and the milk channels are atrophied.
The branches again refill acini during the following pregnancy.
Process of lactation
The Acinus is the basic unit of production of the mother's milk. It is a hollow sphere with microscopic dimensions connected to a small milk channel. It is papered of only one layer of producing cells. One calls “light” of the acinus the cavity in which milk is secreted.The wall external of the cells of the acinus is in contact with many capillary. After the birth and with tétées of the baby, under the impulse of the hormone of lactation, prolactin, the blood flow is increased in priority in the zone of the center. The increase in pressure in these capillaries allows the passage, of the wall of the capillaries towards the cells of the acinus, of all the elements necessary to the manufacture of milk. Each cell treats this raw material. Part of the components of milk results directly from filtration from blood, the other is synthesized by the cells of the acinus. Milk is thus secreted drop by drop in the light of the acinus.
Toujours following the birth and under the effect of the suction of the center by the baby, under the effect of the Oxytocin - the same hormone which governs the contractions during the childbirth - the cells myoépithéliales, which are microscopic muscle fibers wrapping the acinus, are setting in motion and contract, pressing the acinus to empty it. The secreted milk drops are now expelled towards the milk channel. Oxytocin causes the contraction of muscle fibers throughout the milk channels which pulsate milk towards the exit by a peristaltic movement. It is the reflex of ejection.
In the mom, it is expressed in the form of a tension directed of the interior of the center towards the point. When the baby begins one tétée, the reflex of ejection appears only at the end of a few moments, the time of the startup of the muscular contractions.
Before the exit in the nipple, the milk channels present a widening out, the milk sine. These small tanks have a relatively modest size at the human one and do not represent that a milk starter in tétée of which the essence is provided in the course of suction by the reflex of ejection of the mother.
See also: Mother's milk
The first milk secreted by the mother after the childbirth is called the colostrum. It is a thick and coloured milk, almost orange. The colostrum immediately meets the essential needs of the baby who has just been born. It brings under a low volume and in the good proportions all the complex elements which the newborn needs.
The colostrum naturally not very abundant, between 20 to 50 ml by is tétée at the beginning, a quantity which increases quickly. It is appropriate for the very small stomach of the newborn. It is very quite comparable, does not cause an overload renal and produced little not digested waste.
The colostrum is abundant in alive cells and Anticorps which protects the baby against the microbial aggressions from the ambient conditions. It contains many Protéines (23 g/l), of directly assimilable sugars (Oligosaccharide S), of Vitamine S, Rock salt and Amino-acid free (20%).
After the first days, consistency is fluxed, volume increases slightly, the proportion of the components changes. It is milk colostral, a mixture of colostrum and mature milk. At the end of 2 to 3 days, at the time of what is called the “milk rise”, the volume of produced milk increases abruptly. Milk becomes whiter. At the end of approximately 3 weeks, it is the mature milk, which often takes a bluish aspect, almost translucent (what does not mean fall of the food values). With the age of the baby, milk continues to increase in volume. The composition corresponds to the age and the needs for the baby.
The major components of the mother's milk are: water (87,5% approx.), the Glucids (7% approx.), the Lipids (4% approx.), the Protids (1% approx.), micronutriments (0,5% approx.).
But these proportions and these components are brought to change constantly according to the needs and of the age of the baby, of the hour of tétée or the beginnings and ends of tété.
The mother's milk undergoes a big change between the colostrum first days and mature milk around 3 weeks.
The content of the various components of the mother's milk is also specific to the species and directly proportional at the speed of growth of the newborn and the weight of the brain.
At the human one which has a slow growth (140 days to double weight) and an enormous brain (1 200 G), the profile of milk is weak in protids and lipids, but has a glucid high rate necessary to the construction of the brain.
The profile of composition of the mother's milk is relatively stable all over the world and varies only in one small proportion according to the lifestyle and of the food of the mother.
From specificity of its composition, and contrary with the cow's milk, human milk is preserved relatively well.
Good information on breast feeding and the mother's milk as well as a good knowledge of its body help a future mother with guiding well her breast feeding and the father of the baby to including/understanding the process of lactation well.
There currently exists of many information sources (Internet, books, booklets, meetings, councils telephone, etc) which make it possible to the future parents to be familiarized with a practice for which it is necessary a minimum of references for them.
Several myths run as for the concrete preparation that a woman must undertake before being able to nurse correctly. Actually, the centres do not need any preparation: neither cream, neither massage, nor changes in the lifestyle of the woman. The process of lactation will begin without external intervention and any problem. The main issue encountered in the beginnings of breast feeding comes from the mesinformation (myths, nonfounded beliefs) current in the mediums where the breast-feeding was forsaken with the profit of the industrial preparations.
A good positioning of the baby who tète is a factor of success of breast feeding because it allows an adequate suction necessary to a correct nourrissage. Many difficulties of startup of breast feeding come from a bad positioning of the baby causing an inadequate suction.
In a position of safety, the back of the baby rests against the front armlever of the mother, her head is mobile in the hollow of its elbow, its shoulder is in the axis of the ear and the hip.
The end of the nose and the point of the chin are both in equal contact with the center.
When the baby tète, his chin must be against the center and the baby owes téter firmly the whole of the areola and the nipple. If the nose of the baby is inserted in the center whereas the chin is detached, it is necessary to bring the body closer to the baby towards oneself. If the chin of the baby does not touch the center, the baby should be gone up a little higher.
Except at the premature ones whose head must be constant, it is necessary to avoid holding the head of the baby with the hand or pushing its head to help it to take the center. That would block its nape of the neck and would cause at his place a reflex of retreat.
The galactagogue food is the food which supports lactation, in the event of milk fall due to tiredness for example. It is recommended to eat varied and balanced.
Contrary certain food decrease lactation. To avoid parsley, mint, and sage.
The device of the mouth of the baby and that of the maternal center are complementary.
The areola of the center granulous and is lubricated (tubers of Montgomery). The higher gums of the newborn have blisters which hang the back of the areola. Thanks to the reflex of extrusion, the nipple and the areola are plated against the palate of the baby who can extract milk from all his forces without to damage fabrics of the center. The language undulates from the front to the back to mass the center and to lead milk to squirt.
The muscles of the cheeks of the new-born babies are reinforced by pads of suction, the balls of Bichat which ensure the side stability of the nipple and improve the effectiveness of suction.
An effective suction starts and strongly activates the lactation of the mother on the whole of tétée. It is the guarantee that the baby will be well nourished.
It is necessary to let the baby quietly take the center well opposite, stops large open, the quite drawn language, adhesive the center until the back of the areola. One sees more areola above the mouth of the baby than in lower part.
When the baby swallows mother's milk, it carries out movements of swallowing which the mother can distinguish from a simple suçotage.
The baby must be able téter each center between 10 and 20 minutes to go until the end of the cycle of lactation. Tétées last on average from 5 to 45 minutes following the age and the hunger of the infant. Milk changes composition throughout tétée and becomes increasingly rich in lipids.
One advises to give the two centres to the beginning to stimulate lactation but it should well be emptied each center so that the baby can benefit from the fatty milk of end from tétée. A baby who wets 5-6 layers per day is a baby who has a good suction. The saddles of yellow color are gilded and liquids. If they become greenish it is that the baby does not drink enough milk, in this case it is necessary to increase the number of tétées and to make sure that the baby takes the center well.
The lactation of the mother is set up thanks to tétées complete, frequent and exclusive ones.
These tétées are held, at least in the first weeks, along the twenty-four hours of the day. The number of tétées goes from 8 to the 12 tétées first weeks (even more).
This rate/rhythm is necessary to the mother to stabilize the rate of prolactin in blood and to allow an adjustment of fast and effective lactation.
The tétées frequent ones set up a relation followed and individual mother-child and allow a repeated body contact, beneficial with the internal security of the baby.
An exclusive breast feeding with the milk of mother makes it possible to make profit the child from exceptional qualities of the mother's milk.
The suction of tétines (lollipops) or the addition of substitutes of the mother's milk (feeding-bottles additional) disturbs the lactation of the mother and is likely to make lose with the baby his capacity to stimulate the maternal center and, a fortiori, that to be nourished correctly by tétées of mother's milk.
They can induce an involuntary weaning.
In the event of absence of the mother one will prefer to give to drinking with the cup, with a spoon or Softcup of medela to avoid a confusion center-tétine which would involve a bad suction of the infant.
WHO, as well as the High ranking authority Health - HAS- (ex-ANAES) , recommend an exclusive breast feeding until the 6 months age, follow-up of a continuation of this one, parallel to a diversified food, until the 2 years age and beyond.
Multiple particular cases of breast feeding exist, one can even say that each breast feeding is a particular case.
The course of the infantile nutrition, breast feeding-weaning-diversification is specific to each individual and fact part of his history.
In the infantile nutrition, the possibility of breast feeding is an opened option, variable, and this process gains with being guided and controlled thanks to good information and an attentive follow-up.
A Cesarean, births multiple, a premature baby, a more or less serious affection in the mother or the child, each case have precise indications as regards breast feeding.
The development of techniques making it possible to give the mother's milk indirectly widened the possibilities for the mother of making profit her child from the mother's milk even in typical locations.
Adequate practices of extraction (manual or with mechanical or electric breast-pump), of transport, storage and conservation of the mother's milk as well as the indirect methods of administration of milk to the baby (nourrissage by probe, device of assistance to breast feeding, packs, spoon, feeding-bottle…) are described currently perfectly and transmissible. The control of these techniques is relatively recent (end of the 20th century) and general public is not yet well-known.
Breast feeding is a prolongation of the pregnancy.
This one can be stopped voluntarily, on medical indication in certain very rare particular cases (cancer, seroposivity, drug-addiction of the mother, galactosemy of the infant) or by choice when the environment lends itself to it (Drinking water and infantile Lait available at an accessible cost).
An indication of weaning should be given only if the advantages of breast feeding do not represent a profit higher than the use of a substitute.
The recourse to substitutes making often difficult the possibility of returning to a breast-feeding thereafter, the decision of weaning must be taken in all full knowledge of the facts.
For the indications relating to (Drugs and breast feeding) the consumption of poisons, heavy pathologies, the rare diseases, the complex cases, there exist medical databases (LLL, for example) making it possible to give adequate indications for the nutrition of the baby and the conditions of the continuation, of the temporary or final adoption of the breast-feeding. Contact licks it league if your doctor says to you that the treatment that it gives you is incompatible with breast feeding, it exists in the majority of the cases of other substances compatible with breast feeding that many doctors do not know.
In an unfavorable environment, in the event of major environmental problem, of bad health of the mother, in particular the AIDS, the recommendations of the the World Health Organization must be taken into account, general qualities of protection of the breast-feeding remainder generally effective for the child, even under limiting conditions, and significantly contributing cause a drop in infantile mortality and morbidity.
The stop of the breast-feeding before the end of the period of diversification, or the fact of giving up it as of the beginning, require the recourse to substitutes of the mother's milk (infantile Lait powder mixed with mineral Water, given with a Biberon). From 0 to 6 months, with preparations for infants, from 6 to 12 months, with milks of continuation.
The breast-feeding, biological and natural fact, knew during the history the recourse to the nurses in the cases of death postpartum of the mother, as it was frequent lasting of the centuries, or whenever the mother did not have sufficient milk to nourish the child. But, starting from the end of the 16th century, the practice of breast feeding mercenary was diffused in the aristocracy initially, then in the middle-class, in order to free itself from this constraint. Until the 18th century, this practice was generalized and the women of easy craftsmen being able to allow itself to rent the services of a nurse had recourse there. The nurses were in general women of the least easy popular classes. The return to the breast-feeding took place only at the beginning of the 19th century; when Madam d' Épinay claimed to nurse itself his/her children, this idea was considered extravagant by people of its medium.
It is towards the end of the 20th century, in the 1980, qu years' one sees appearing and developing associations of assistance with the mothers and protection measures of the breast-feeding.
This moment marks a turning for the infantile nutrition.
For several decades, the childbirth generalized in health care institutions and the development of industrial infantile food carried by publicity had put at evil the practice breast-feeding initially in the industrialized countries, then in the countries in the process of development.
The developments in the technologies of assistance to breast feeding, a general way as in the particular cases, the access of the public to information of quality, the training of the health professionals and the development of the information networks and mutual aid, the public health measures making promotion and protecting the breast-feeding did not only involve one inversion of the tendency in favor of the breast-feeding.
These evolutions improved also the conditions of breast feeding and thus made this practice more comfortable for the mother, as well from a social point of view as body.
In certain companies, the promotion of the breast-feeding, whereas the bottle-feeding does not pose serious problems (maternized milk and healthy mineral water available to reasonable cost, medical departments in the vicinity), is sometimes perceived like a social pressure and either like a choice.
However this phenomenon is not quantified in France and seems minority since 75% of the women would like to nurse during at least a few weeks.
The breast-feeding is protected by international recommendations from the UNICEF and WHO whose certain elements were transcribed in European directives.
The international Code of marketing of the substitutes of the mother's milk was stated in 1981 by the World Health Organization). It regulates the marketing of milks for infants, feeding-bottles, tétines and food for infants.
It prohibits in particular publicity and promotion near the public, the promotion and distribution of gifts and samples in the departments of health as well as the promotion of unsuited products.
The application by departments of health of the " Ten recommendations for the success of breast feeding maternel" stated in 1989 in Joint statement OMS/UNICEF on Protection, the encouragement and the support of the breast-feeding, allows to obtain the label " Friendly hospital of Bébés".
One can note:
A recent study shows that breast feeding does not have or little effect on the Intelligence quotient of the child.
One can note:
With Sumer, in Mésopotamie, the Code of Hammourabi (-1850) regulated already the practice of the nurses to which one cut a Sein if they were not obeying.
In the Cabal, breast feeding is a metaphor used to indicate the mode of relation between the divine emanations (sefirot) and the human one, an intimate contact which cannot be formulated in terms of knowledge.
In the Islamic religion, two children nourished consequently nurse become automatically “foster brothers” and cannot marry between them.
Human milk
Colostrum with mature milk
Composition of human milk
Practical of breast feeding
Preparation with breast feeding
Position of the baby
Galactagogue food
Mechanism and checking of suction
Tétée does not consist in “emptying” the center, but stimulating it. The suction of the baby creates in the mother a reflex of manufacture/ejection which provides to the request the mother's milk with the baby. It is the baby who, by his action of suction, creates milk in his mother. This is why it is necessary to avoid all awkwardnesses or intrusions which could disturb the mechanism of lactation caused by tétées repeated of the baby.
Rate/rhythm of breast feeding
Particular cases
Indications
Context
Protection of breast feeding
Effects
In the child
In the mother
For the community
A study of Doctor Pierre Bitoun carried out in 1994 estimated that in France a generalized breast feeding would make it possible to reduce by 1,071 billion francs the health costs supported by the health insurance, the only preventive effect of breast feeding on the otitises, the diarrheas and the rhinopharyngites.
Practical aspects
Constraining aspects
Others
In the old Egypt, the goddess Isis is represented, sometimes in goddess-cow nourishing the king of her milk, sometimes out of goddess-tree tightening the center of regenerating water to the late king, sometimes as a goddess-mother nursing the king-child.
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