DR.VEERENDRAKUMAR C.M.

MD.,DNB.
Associate Professor
VIMS,BELLARY
 PERFECT GI FT TO MANKI ND

 PLACENTA-  COLOSTRUM-

INTRAUTERINE EXTRAGESTATE
FETUS FETUS
Why e mphas i z e on br e as t
f e e di ng ?

 WHEN INDIAN WOMEN BREAST

FEED WITHOUT EXCEPTION!

 25% DO NOT INITIATE WITHIN 24 Hrs

 50% DISCARD COLOSTRUM

 75% GIVE PRELACTEAL FEEDS

 MANY WOMEN BELIEVE THEY DO NOT

HAVE SUFFICIENT MILK &INDULGE IN

TOP MILK FEEDING

BREAST FEEDI NG pr omot i on

 PRIMARY RESPONSIBILITY LIES

WITH OBSTETRICIAN & NOT
THE PEDIATRICIAN !

 WOMAN BELIEVES MORE IN HER

OBSTETRICIAN & WE SHOULD
NEVER FAIL HER IN EXCLUSIVE
BREAST FEEDING
 It is a natural instinct , women take to
breast feeding easily

BUT

even with minor problem readily switch on

to TOP feeding .
Ear l y Di s c ont i nuat i on

 Most women who stop breastfeeding

prematurely do so in the first ten days.

 To improve the duration of breastfeeding

physicians must provide support during this
critical early period.
“ Not e nough mi l k”

 Colostrum
 The newborn who cries loudly &
sucks hard is getting enough to eat
 Elimination pattern after day 5
 5 voids
 2-3 stools
anat omy
 BREAST ENGORGEMENT

 SORE/ CRACKED NIPPLE

 INSUFFICIENT / NO MILK

 RETRACTED NIPPLE/ inverted nipple

BREAST ENGORGEMENT
ENGORGED LYMPHATIC & VENOUS CHANNELS AROUND
THE ALVEOLI

INCREASED ALVEOLAR PRESSURE

FLATTENS EPITHELIUM &BLOCKS THE DUCTS

BREAST HARD & PAINFUL

BABY STRUGGLES & TRAUMATIZES
THE NIPPLES

NO FURTHER BREAST FEEDING

MASTITIS

BREAST ABSCESS
 ANTENATAL BREAST EXAMINATION

TEACH MOTHER HOW TO MANUALLY

EXPRESS THE MILK

BEFORE & AFTER FEED EXPRESS THE MILK &

RENDER THE BREAST SOFT

CORRECT POSITIONING
Manual e xpr e s s i on
Manual e xpr e s s i on
 BREAST SUPPORTING

 ANALGESICS

 ICE BAG
SORE NIPPLE

 PORTAL OF ENTRY
FOR PATHOGENIC
ORGANISMS.

 ANTENATAL
EXAMINATON &
TREATMENT AVOIDS
COMPLICATIONS
 EARLY SORE NIPPLE ALWAYS DUE
TO INCORRECT POSITIONING.

 AVOID CRUST FORMATION

 LOCAL HYGEINE

 EXPOSE TO AIR ,application of breast milk

or lanolin , USE NIPPLE SHIELD
Re t r ac t e d & i nve r t e d
ni ppl e
RETRACTED NI PPLE

 GENTLE MANUAL
TEASING.

 REVERSE
SYRINGING
EFFECTIVE

 AGAIN
ANTENATALLY CAN
BE CORRECTED .
MASTI TI S & ABSCESS
MASTI TI S & ABSCESS

 BABY SOURCE OF INFECTION.

 MORE LIKELY IN FISSURED NIPPLE.

 STAPHYLOCOCCUS COMMONEST.

 ANTIBIOTICS & CONTINUED BREAST

FEEDING.
 DON’T WAIT TILL FLUCTUATION
APPEARS.

 FAILURE TO RESPOND-SURGICAL
MANAGEMENT.

 RECENTLY -USG GUIDED NEEDLE

ASPIRATION
I NSUFFI CI ENT MI LK &
LACTATI ON FAI LURE
 A MYTH OR REALITY?

 NO PARALLELS IN OTHER 4000

SPECIES.

 THE PRICE WE PAY FOR

CIVILIZATION ?
Enhanc i ng f ac t or s

 SUCKLING
 SENSORY IMPULSES FROM NIPPLE
 EMPTYING OF BREAST
 NIGHT FEEDS
 THINKING /SOUND/SIGHT OF BABY
 CONFIDENCE
 PROLACTIN & OXYTOCIN
Hi nde r i ng f ac t or s

 PRELACTEALS, BOTTLE FEEDING.

 INCORRECT POSITIONING.

 PAINFUL BREAST CONDITIONS.

 WORRY, STRESS , EMBARASSMENT.

 DOUBT, NO SELF CONFIDENCE.

LACTATI ON FAI LURE

PRIMARY HYPOPROLACTINEMIA

SHEEHAN’S SYNDROME

RETENTION OF PLACENTA

HYPOPLASTIC BREASTS

WRONG MANAGEMENT
HOW TO OVERCOME?

 ANTENATAL PREPARATION

 MATERNAL MOTIVATION

 EARLY INITIATION

 ROOMING IN

 UNRESTRICTED DEMAND
FEEDING BOTH DAY,NIGHT
 BAN PRE LACTEAL FEEDS

 LOOK FOR LOCAL OR SYSTEMIC

ILLNESS

 EXCESSIVE CRY NOT ALWAYS DUE

TO INADEQUATE MILK

OBSERVE MOTHER-INFANT
COUPLE FOR PROPER TECHNIQUE
Lat chi ng
ROLE OF GALACTOGOGUE

 PLACEBOS TABLETS, TONICS

 AYURVEDIC PREPARATIONS

 DOPAMINE AGONISTS

 BABY SUCKLING BREAST IN

CORRECT POSITION
CONTRA I NDI CATI ONS

 HIV .CMV, HBV INFECTION

 ACTIVE TUBERCULOSIS

 HERPETIC LESIONS ON BREAST