Oxford Handbook of Midwifery (139 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

BOOK: Oxford Handbook of Midwifery
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  • Enzymes
    : breast milk contains at least 70 enzymes.
    3
    They contribute to digestion and development. Possibly the two most important are amylase and lipase. Their presence in breast milk compensates for the limited pancreatic amylase and lipase activity in the newborn and therefore aids digestion.
    For a comprehensive breakdown of the composition of breast milk, see Henschel and Inch
    2
    and Coad.
    4
    Immunological properties of breast milk
    Human milk also has a non-nutritive protective role for the infant and also for protecting the breasts from infection. Important constituents are as follows.
  • Immunoglobulins
    : IgA, IgG, IgM, IgD, and IgE, which are active against specific organisms, e.g.
    Salmonella
    species and poliovirus.
  • Cells
    : B lymphocytes, T lymphocytes, macrophages, and neutrophils. The actions of these cells include:
    • Production of antibodies against specific microbes
    • Killing of infected cells
    • Production of lysozyme and activation of the immune system
    • Phagocytosis of bacteria.
  • Lacto bifidus factor
    : promotes an acidic environment suitable for the growth of
    Lactobacillus bifidus
    and inhibits the growth of pathogenic organisms.
  • Lactoferrin
    : reduces iron availability for bacterial growth, by binding to iron. It also acts as a bacteriostatic agent.
  • Binding proteins
    : increase the absorption of nutrients, therefore reducing those available to be utilized by bacteria.
  • Complement, lipids, fibronectin, G-interferon, mucins, oligosaccharides, bile salt-stimulated lipase, epidermal growth factor, and many more.
    4
    The immunological properties of breast milk are increased with better
    maternal nutrition.
    5
    1. Jessen RG (ed.) (1995).
      Handbook of Milk Composition.
      London: Academic Press Inc.
    2. Henschel D, Inch S (1996).
      Breastfeeding Guide for Midwives
      . Hale: Books for Midwives Press.
      3
      Lawson M (1992). Non-nutritional factors of human breastmilk.
      Modern Midwife
      2
      (6), 18–21.
      4
      Coad J (2001).
      Anatomy and Physiology for Midwives
      . Edinburgh: Mosby.
    5
    Chang SJ (1990). Antimicrobial proteins of maternal and cord sera and human milk in relation to maternal nutritional status.
    American Journal of Clinical Nutrition
    51,
    183–7.
    CHAPTER 24
    Breastfeeding
    660‌‌
    Advantages of breastfeeding
    An ever-increasing amount of quality research has demonstrated the advantages of breastfeeding for both infant and mother.
    1
    Advantages for the infant:
    • Optimal nutrition
    • Reduced risk of mortality from necrotizing enterocolitis and sudden infant death
    • Reduced infection: gastrointestinal, respiratory, urinary tract, ear, meningitis, intractable diarrhoea
    • Reduced atopic disease: eczema, asthma
    • Optimal brain development
    • Reduced risk of autoimmune disease
    • Enhanced immunity
    • Reduction in childhood obesity. Advantages for the mother:
    • Convenience, cost, and lack of contamination
    • Reduced risk of maternal breast and ovarian cancer
    • Reduced risk of hip fractures in women over 65
    • Losing pregnancy weight gain if feeding for 6 months or longer, b see also Health risks associated with formula feeding, p. 728. For the infant breastfeeding also may have positive effects on:
    • Interpersonal relationships and sleep patterns
      2
    • Reduced crying if they stay close to the mothers and breastfeed from birth.
      3
    1. Coad J (2009).
      Anatomy and Physiology for Midwives
      , 2nd edn. Edinburgh: Mosby.
    2. Renfrew M, Fisher C, Arms S (2000).
      The New Bestfeeding: Getting Breastfeeding Right for you, The Illustrated Guide
      . California: Celestial Arts.
    3. Christensson K, Winberg J (1995). Separation distress call in the human neonate in the absence of maternal body contact.
      Acta Pediatrica
      84
      , 468–73.
    CONTRAINDICATIONS TO BREASTFEEDING
    661‌‌
    Contraindications to breastfeeding
  • Drugs
    . Most drugs will pass into breast milk in a greater or lesser degree. The majority of drugs can be taken safely, but there some are drugs where breastfeeding is contraindicated.
  • Cancer
    . Anticancer treatments are normally highly toxic and will make it impossible to breastfeed without harming the baby. The mother could, if she wishes, express and discard her milk for the duration of treatment and resume breastfeeding later. If the mother has had a mastectomy, she may successfully breastfeed from the other breast.
    If the mother has had a lumpectomy, she should seek advice from her surgeon as she may be able to feed from the treated breast.
  • Breast surgery
    . Breast reduction and augmentation are not contraindications to breastfeeding, but this depends upon the surgical techniques used. Advice should be sought from the surgeon. Following unilateral mastectomy it is perfectly possible to breastfeed using the other breast.
  • Breast injury
    . Serious damage caused by burns and accidents may have caused scarring that makes breastfeeding impossible.
  • HIV infection
    . HIV may be transmitted in breast milk.
    • Current WHO recommendations are that when breast milk substitutes are acceptable, feasible, affordable, sustainable, and safe, then mothers should be advised not to breastfeed. Therefore in the UK mothers would be advised against breastfeeding.
      1
    • In developing countries, or in countries, where artificial feeding is a significant cause of infant mortality, exclusive breastfeeding may be less of a risk.
      1
      Department of Health (2004).
      HIV and Infant Feeding. Guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS.
      London: DH. Available at: M www.dh.gov.uk/en/
      Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4089892 (accessed November 2009).
      CHAPTER 24
      Breastfeeding
      662‌‌
      Management of breastfeeding
      Initiation of breastfeeding
      ‘
      All mothers should be given their baby to hold with skin-to-skin contact in an unhurried environment for an unlimited period as soon as possible after delivery. All mothers should be offered help to initiate a first breastfeed when their baby shows signs of readiness to feed
      ’.
      1
      The need to suckle is common to all mammalian young and the human baby is no different. If the mother and baby are given a peaceful, unhurried environment and the baby is placed on the mother’s abdomen following delivery, it will crawl to the breast and initiate suckling.
      2
      A number of studies have shown that satisfying the infant’s early urge to suckle positively influences the success and duration of breastfeeding.
      3,4
      Skin-to-skin contact
      • Initiate as soon as possible after birth.
      • Place the naked, dried baby against their mother’s skin.
      • Place a blanket around them both to ensure neither becomes cold.
      • Very small babies may also need a hat.
      • If the mother so wishes, place the baby inside her nightgown.
      • Provide a calm, unhurried atmosphere.
      • Ensure that the mother and baby are uninterrupted during this time.
      • Skin-to-skin contact should last until after the first breastfeed or until the mother chooses to end it.
        1
        The midwife is responsible for ensuring that the mother and infant have a successful first feed. It is also their responsibility to provide information about breastfeeding, although the timing of this should be decided on an individual basis.
        Positioning and attachment
        Before commencing a feed, the comfort of the mother should be ensured.
        Talk the mother through the process as far as possible, to help develop her confidence and ability in breastfeeding. For the infant to suckle suc-
        cessfully at the breast, two processes need to be correct. These are posi- tioning and attachment.
        Positioning of the baby at the breast
        Correct positioning is the secret of successful breastfeeding. Good posi- tioning will enable the baby to achieve and maintain attachment at the breast. This, in turn, will enable the baby to feed effectively for as long as he or she needs. Good positioning is fundamental to successful breast- feeding and the prevention of problems. The mother should position the baby at the breast although some mothers may need guidance.
        Principles of effective positioning
      • The baby’s head and body should be in a straight line.
      • The mother should hold the baby’s body close to hers. ‘Tummy to mummy’ may not be the appropriate position for all babies, as this will depend upon the shape and size of the mother’s breasts.
      • The baby should face the breast with the nose opposite the nipple.
      MANAGEMENT OF BREASTFEEDING
      663

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