Breast Care and Breast & Bottle Feeding
Definition of terms
1. define the following terms:
1.1 Breast
- the mammary gland is located anterior to the
pectoral muscle. It is a milk producing gland. It is
composed largely of fat. Within the mammary
gland is a complex network of branching ducts.
These ducts exit from sac-like structures called
lobules, which can produce milk in females. The
ducts exit the breast at the nipple.
1.2 Nipples
- is composed of smooth muscles capable of
erection on manual or sucking stimulation. On
stimulation, it transmits sensations to the
posterior pituitary gland to release oxytocin,
which then acts to constrict milk glands and push
milk forward into the ducts that lead to the nipple
1.3 Areola
- the skin surrounding the nipples that is darkly
pigmented to about 4 cm. This area appears
rough on the surface because it contains many
sebaceous glands called Montgomery tubercles
1.4 Breast care
- care given to the breast by the mother during her
prenatal period, intranatal period and postnatal
period. It is the activity to prepare and clean the
breasts during pregnancy and lactation for
breastfeeding. This also helps in maintaining
hygiene and prevent cross infection during
feeding.
2. discuss the anatomy and physiology of the breast
Breasts
Paired mammary glands that lie over the muscles of
anterior chest wall, anterior to the pectoralis major and
serratus anterior muscles.
Function
a. To produce and store milk that provides
nourishment for newborns
b. Aid in sexual stimulation
External Breast Anatomy & Physiology
a. Nipple
- Pigmented projection at the center of
each breast that contains tiny openings of
lactiferous ducts
- Allows passage of milk from the breast
b. Areola
- Darkly pigmented area surrounding the
nipple of the mammary gland (generally
1 to 2 cm radius)
- Contains sebaceous glands
(Montgomery glands)
- Hair follicles commonly appear around
the areola
c. Lymph Nodes
- Drain impurities from the breasts
- Anterior nodes: drain anterior chest wall
and breasts
- Posterior nodes: drain posterior chest
wall and part of the arms
- Lateral nodes: drain most of the arms
- Central nodes: receives drainage from
the anterior, posterior, and lateral nodes
Internal Breast Anatomy & Physiology
a. Glandular Tissue
- Constitutes the functional part of the breast,
allowing for milk production
- Arranged in 15 to 20 lobes that radiate in a
circular fashion from the nipple and contain
the alveoli
1. Alveoli (Acini Cells)
- balloon-like structures lined with milk-
secreting cuboidal cells, or lactocytes,
that are surrounded by a net of
contractile myoepithelial cells
2. Mammary Ducts
- Ducts conveying the milk secreted by
the loves of the breast to and through
the nipples
3. Lactiferous Sinus (ampullae)
- Reservoir for storing milk until
stimulated to be released from the
nipple
- Located behind the nipple
b. Fibrous Tissue
- Provides support for the glandular tissue
1. Cooper’s Ligaments
- Extends vertically from the breast
surface to attach on the chest wall
muscles
c. Fatty Tissue
- Glandular tissue is embedded in the fatty
tissue
 - Provides most of the substance to the breast,
determining the size and shape of the breast
3. enumerate the importance of breast care
● To maintain proper hygiene
- Breast care ensures that the breasts are clean to
minimize infection and enhance the overall health.
● Prevents and manages complications that can
occur during breastfeeding
- Breastfeeding problems such as infections or
painful lumps, breast engorgement, and sore
nipples can be prevented or managed by breast
care. For example, if a mother is experiencing
engorgement, she should apply cold packs on the
breast for 20 minutes to reduce the swelling and
allow the ducts to open. Also, a mother
experiencing painful lumps can apply moist or dry
heat compresses to the breast for 10 minutes,
three times a day and massage the breast in a
warm shower.
● Promotes comfort
- Proper breast care prevents or reduces pain during
breastfeeding. It also aids in adjusting to the
change in breast size to prevent sagging.
● Prepares the breast for breastfeeding
- Breast care helps in allowing the baby to latch
properly and to prevent milk blockage.
● Helps in maintaining the safety of the newborn
during breastfeeding
- Breast care can prevent the baby from developing
complications due to breastfeeding.
4. explain the principle involved in breast care
● Anatomy and Physiology: Involves the anatomy of
the breast and uses parts of the body in performing
breast care
● Body Mechanics: Involves the proper position or
posture in performing breast care
● Microbiology: Cleaning the breast kills pathogenic
microorganisms to prevent infections and to
promote personal hygiene
● Physics: Involves friction in cleaning the breast.
Involves gravity to prevent the breast from sagging
● Time and Energy: Preparation of necessary
materials in performing breast care in order to
conserve time and energy.
● Epidemiology: Involves in knowing the factors
determining and influencing the frequency and
distribution of diseases, injury, and other health-
related events.
● Sociology: Helps establish trust and rapport
gaining the client's cooperation.
5. state the guidelines in breast care
● For Breastfeeding Women
Instruct mother to wash areola and nipples
with water, without soap or a washcloth to
avoid washing away natural oils and
keratin.
Advise the mother with sore or irritated
nipples to apply ice compress just before
breast feeding. This numbs and firms the
nipple making them less sensitive and
easier for the infant to grasp.
Suggest that lubricating the nipple with a
few drops of expressed breast milk before
feeding may help prevent tenderness.
Recommend placing breast pads over the
nipples to collect colostrum or milk which
commonly leaks during the first few
breastfeeding weeks. Advise replacing
pads often to guard against infections.
Inform the mother that breast milk comes
in 2 – 5 days after delivery and is
accompanied by a slight temperature
elevation and breast changes – increase in
size, warmth and firmness.
Tell mother that a well fitting support bra
may help control engorgement.
Advise mother with engorged breast to
apply warm compress,massage the
breast, take a warm shower or express
some milk before feeding. This dilates the
milk ducts, promotes let down and makes
thenipples more pliable.
● For non-breastfeeding Women
Instruct the mother to clean her breast
using the same technique as the breast
feeding mother. Add that she may use
soap however.
Advise her to wear a support bra to help
minimize engorgement and to decrease
nipple stimulation.
Advise her to avoid stimulating the nipples
or manually expressing her milk to
minimize further milk production. Instead
provide medication as ordered, ice packs
or a breast binder.
Types of Breasts:

Common Breast Problems:

● Breast Lumps
● Breast Pains or Tenderness
● Nipple Discharge
● Inverted Nipple
● Breast Skin Changes
 Assisting in Breastfeeding
Definition of terms:
1. define the following terms:
1.1. Breastfeeding - the feeding of babies and young
children with milk from a woman's breast
1.2. Lactation - the secretion of milk by the mammary
glands.
1.3. Colostrum - a breast fluid produced by humans,
cows, and other mammals before breast milk is
released.
1.4. Burping - the release of gas bubbles up the
esophagus and out of the mouth. These gas
bubbles can also be released out the other end of
your little bundle, resulting in a different noise and
smell.
1.5. Latch-on - refers to how the baby fastens onto the
breast while breastfeeding. A good latch
promotes high milk flow and minimizes nipple
discomfort for the mother, whereas poor latch
results in poor milk transfer to the baby and can
quickly lead to sore and cracked nipples.
1.6. Breast pump - a mechanical device that lactating
women use to extract milk from their breasts.
They may be manual devices powered by hand
or foot movements or electrical devices powered
by batteries or electricity from the grid.
1.7. Prolactin - a hormone that tells the body to make
breast milk when a person is pregnant or breast-
feeding. Production of prolactin takes place in the
pituitary gland. For most men and women who
are not pregnant or breast-feeding, there are only
low levels of prolactin in the body
1.8. Oxytocin-The release of the hormone oxytocin
leads to the milk ejection or let-down reflex.
Oxytocin stimulates the muscles surrounding the
breast to squeeze out the milk. It promotes the
movement of milk into the breast, allowing it to be
excreted by the nipple.
2. explain the physiology of lactation
The physiological basis of lactation is divided into 4
phases
A. Mammogenesis (Preparation of Breasts)
At peak development during gestation and early lactation,
the mammary gland consists of ductular and secretory
alveolar epithelial cells (parenchyma) embraced in a
heterogeneous matrix of cells (stroma), which includes
myoepithelial cells, adipocytes and fibroblasts. In
addition, leukocytes, cells associated with the vascular
system, and neurons are found in the mammary gland.
Mammary growth is the major determinant of bovine milk
yield capacity; the number of mammary alveolar cells
directly influences milk yield. Estimates of the correlation
coefficient (r) between milk yield and mammary alveolar
epithelial cell numbers range between 0.50 and 0.85.
Conversely, increased proportions of fibroblasts and
adipocytes in the mammary gland are associated with
reduced milk yield in cows. Growth of the mammary gland
(mammogenesis) takes place during various reproductive
epochs beginning in the prenatal period to early lactation.
Mammary development during fetal and pre-pubertal
stages is not necessarily under hormonal control. During
puberty, pregnancy, and lactation, however, growth and
development are largely under the influence of hormonal
changes. Most structural development of the mammary
gland takes place during pregnancy.
B. Lactogenesis (Induction of Milk Synthesis)
Near the time of parturition, milk secretion is initiated.
Lactogenesis is a process of differentiate whereby the
mammary gland alveolar cells acquire the ability to
secrete milk; it is conveniently defined as a two-stage
mechanism.
The first stage of lactogenesis consists of partial
enzymatic and cytological differentiation of the alveolar
cells and coincides with limited milk secretion before
parturition. It occurs by mid pregnancy and mammary
gland becomes competent to secrete milk. High
circulating levels of progesterone and estrogen hold the
secretion of milk in check.
The second stage begins with the copious secretion of
all milk components shortly before parturition and extends
throughout several days postpartum in most species. The
onset of copious milk secretion at parturition to meet the
nutritional requirements of relatively well-developed
neonates is a feature of lactation in all placental
mammals.
 C. Galactokinesis (Ejection of Milk)
Discharge of milk from the mammary glands depends not
only on the suction exerted by the baby during suckling
but also on contractile mechanism which expresses the
milk from the alveoli into the ducts.
● Hairy. It’s totally normal to have hair growing
around your nipples, and some people have more
hair than others.

D. Galactopoiesis (Maintenance of Lactation)

Prolactin appears to be the single most important
galactopoietic hormone. Continuous suckling is essential
for removal of milk from glands, also release prolactin.
Secretion is the continuous process unless suppressed
by congestion or emotional disturbances.

3. enumerate the advantages of breastfeeding

B est for Babies
R educes the incidences of allergies
E conomical ● Protruding. Protruding nipples tend to point
A ntibodies outwards and are often raised by a few
S tool inoffensive millimetres, particularly noticeable, it can cause
T emperature is always ideal discomfort in your clothing .
F resh
E asy once established
E motional bonding
D igested easily
I mmediately available
N utrionally optimal
G astroentiritis greatly reduced

4. state the types of the nipple

● Bumpy. Small bumps around the areola, called
Montgomery glands, are more noticeable on
some nipples.

● Puffy (Cone Shape). Both the areola and the

nipple make up a raised mound

● Inverted. Inverted nipples retract inward instead

of standing out like erect nipples.

.
● Supernumerary. This is just a fancy way of
saying you have an extra nipple — which, in case
you’re wondering, is completely normal.

● Flat. Flat nipples remain at the level of the

areolae, though they may stand up with
stimulation.

● Unilateral inverted. These nipples like to mix it

up, as one is inverted and the other is everted.
5. discuss breastfeeding according to:
5.1 importance
A. For the baby
● Breast milk helps keep your baby healthy.
It supplies all the necessary nutrients in the proper
proportions.
It protects against allergies, sickness, and obesity.
It protects against diseases, like diabetes and
cancer.
It protects against infections, like ear infections.
It is easily digested – no constipation, diarrhea or
upset stomach.
Babies have healthier weights as they grow.
Breastfed babies score higher on IQ tests.
● Breast milk is always ready and good for the
environment.
It is available wherever and whenever your baby
needs it.
It is always at the right temperature, clean and free.
No bottles to clean.
Breastfeeding has no waste, so it is good for the
environment
B. For mothers who breastfeed:
● Have a reduced risk of Type 2 Diabetes and certain
cancers such as breast cancer
● May find it easier to return to what they weighed
before they got pregnant
● Strengthen the bond with their children
5.2 indication
a) Exclusive breastfeeding (newborn to 6 months/ to
2yrs)
b) Nipples are intact (no redness, cracking, scabs, or
bleeding), and nipple tenderness is minimal.
c) Breasts are full, soft, and without engorgement,
with no redness and minimal tenderness to
palpation.
d) Infants born weighing less than 1500 g (very low
birth weight).
e) Infants born at less than 32 weeks of gestation
(preterm).
f) Newborn infants who are at risk of hypoglycaemia
by virtue of impaired metabolic adaptation or
increased glucose demand (such as those who are
preterm, small for gestational age or who have
experienced significant intrapartum
hypoxic/ischaemic stress, those who are ill.
5.3 contraindications
a) Infants with classic galactosemia: a special
galactose-free formula is needed.
b) Infants with maple syrup urine disease: a special
formula free of leucine, isoleucine and valine is
needed.
c) Infants with phenylketonuria: a special
phenylalanine-free formula is needed (some
breastfeeding is possible, under careful
monitoring).
d) Severe illness that prevents a mother from caring
for her infant, for example sepsis.
e) Herpes simplex virus type 1 (HSV-1): direct contact
between lesions on the mother's breasts and the
infant's mouth should be avoided until all active
lesions have resolved.
f) Mother is using an illicit street drug, such as PCP
(phencyclidine) or cocaine1 (Exception: Narcotic-
dependent mothers who are enrolled in a
supervised methadone program and have a
negative screening for HIV infection and other illicit
drugs can breastfeed)
5.4. principles involved
● Anatomy and Physiology
- Understanding the structures and the way lactation
occurs.
- Understanding how to place the nipple into the
baby’s mouth to prevent any pain to the mother.
● Safety and Security
- Making sure to hold the baby correctly so that injury
will not occur in the mom or the baby.
● Microbiology
- Washing the breast to protect the baby.
- Knowing how to properly store breast milk.
- Keeping collecting pumps and hands clean.
● Physics
- Hold the baby correctly to assist so that swallowing
will not be difficult.
● Pharmacology
- Understanding how different drugs may affect breast
milk
● Psychology
- Stress and anger may make breast milk go bad.
● Sociology
- Breastfeeding can help in forming a bond between
the mother and the child
● Body Mechanics
- Making sure all positions are executed in a nice
manner in order to prevent straining of the muscles
or pain.
5.5. guidelines
● Breastfeeding should be done typically in a 1 ½ - 3
hour range. The baby’s stomach is small, and
feeding the baby often will help to ensure adequate
nutrients.
● Babies should begin breastfeeding as soon as
possible (typically within the first hour of life) and
continue for at least the first 6 months of life
exclusively.
● After the 6th month of life the baby should slowly get
introduced to more solid foods. Complementary
breastfeeding can continue to a year if the mother
and baby need.
● Because the baby is not able to speak you must
understand feeding cues. For example: hands
moving to the mouth, root or sucking motions, or
becoming very active. This is because the baby is at
a stage called “demand feeding”.
● Always make sure to stay or sit in a comfortable
position, in order to prevent straining in the back or
arms a pillow can be used to support the baby.
● When nursing your baby switch the breast you are
going to feed with in order to maintain balance and
prevent aching.
● Make sure baby is aligned nicely to prevent injuries
to the baby.
● Support the baby’s head with one hand, and guide
the nursing breast into its mouth, and the breast of
the nipple should point towards his nose
● Lightly brush the nipple over the babies lips until its
mouth opens. Then, guide its head onto the breast.
● Make sure most of areola is in mouth. The nose and
cheeks of the baby should touch the breast touch
breast, with its chin making a slight indent in breast.
● If pain is felt, or if latching was incorrect break the
baby’s suction by placing and swiping a finger into
the baby’s mouth and try again.
● If the baby falls asleep in the beginning of the
feeding, you may need to stimulate the baby to
 continue. (Examples of these are change positions,
rub the baby, changing the diaper, etc.)
● After finishing with the first breast, burp the baby then
proceed onto the next breast.
● Understand the baby’s cues when they are done
breastfeeding. (This could been seen by sleeping or
turning away.)
5.6. maternal breastfeeding reflexes
● Let-down reflex (milk ejection reflex)
i. Upon sucking the breast, your baby triggers tiny
nerves in the nipple.
ii. These nerves releases hormones into the
bloodstream.
iii. One of these hormones (prolactin) acts on the milk-
making tissues.
iv. The other hormone (oxytocin) causes the breast to
push out or ‘let down’ the milk.
v. The let-down reflex makes the milk in your breasts
available to your baby.
vi. Cells around the alveoli contract and squeeze out the
milk, pushing it down the ducts towards the nipple.
vii. Oxytocin also makes the milk ducts widen, making it
easier for the milk to flow down them.
viii. The let-down may happen if you see or hear your
baby or even just think about him.
ix. The let-down can also be triggered by touching your
breast and nipple area with your fingers or by using
a breast pump.
x. Breastfeeding is a powerful process. With support
and encouragement, mothers cope with many
different stresses and still breastfeed successfully.
xi. You may be aware of the let-down as:
■ a tingling feeling, which can be quite strong
■ a feeling of sudden fullness
■ milk dripping from the other breast
■ a change in the baby’s sucking pattern from a
quick suck-suck to a rhythmic suck-swallow
pattern as the milk begins to flow.
5.7. technique used during pregnancy to prepare nipples
for nursing
● Do proper breast care
Always wash your hands before breastfeeding or
touching your breast in general. Avoid washing your
nipples with soap, as it removes healthy natural oils
and create dry and irritated skin. Instead, simply
clean your breasts regularly with warm water.
● Test yourself
Many nipples will stiffen and protrude when
stimulated. You can check to see if your nipples are
truly flat or inverted. If you’re able to coax your
nipples out, then chances are your baby will be able
to too.
Here’s how to check:
a. Place your thumb and forefinger on the edges
of your areola, which is the dark area around
your nipple.
b. Squeeze gently.
c. Repeat on your other breast.
d. If your nipple is truly flat or inverted, it will flatten
or retract into your breast instead of pushing
out.
● Hand express
Sometimes, if the mother’s breast is very engorged
with milk, it may feel hard and their nipples may
flatten. Hand-expressing a bit of milk can soften their
breast so that the baby can latch on more easily.
Here’s how to do it:
a. Cup your breast with one hand, with your other
hand make a “C” shape with your thumb and
forefinger near the areola, but not on it.
b. Squeeze gently and release the pressure.
c. Repeat and try to get a rhythm going without
sliding your fingers over the skin.
d. Drops of liquid should appear just before your
milk begins to flow.
e. Express just enough to soften your breast.
● Pull back
Pulling back on your breast tissue may help when
breastfeeding with flat nipples or inverted nipples.
Even if the nipple doesn’t protrude completely, pulling
back on the breast tissue can help your baby get a
better latch. You do this by holding the breast tissue
behind the areola and gently pulling back towards your
chest.
● Stimulate the nipple
You may be able to coax your nipple out by gently
stimulating the nipple yourself. Try gently rolling your
nipple between your thumb and finger or touching your
nipple with a cold, damp cloth. You can also try the
Hoffman technique.
Here’s how to perform the Hoffman technique:
a. Place your index and thumb on either side of your
nipple.
b. Press your fingers firmly into the breast tissue.
c. Gently stretch the areola in each direction.
d. Repeat five times each morning if you’re able to
without pain.
e. You can also perform the exercise with both
hands, using both of your thumbs.
● Use a breast pump
You can use the suction from a breast pump
to help draw out a flat or inverted nipple if
other methods to stimulate your nipples don’t
work. This can be especially helpful if you
have deeply inverted nipples. There are
different types of breast pumps available,
including manual and electric breast pumps.
5.8 positions in breastfeeding and burping Positions for Burping
Positions in Breastfeeding 1. Sit upright and hold your baby against your chest-your
baby's chin should rest on your shoulder as you support
1. Side-lying hold- lying the baby with one hand. With the other hand, gently pat
down with your bodies your baby's back. Sitting in a rocking chair and gently
parallel. Make sure rocking with your baby while you do this may also help.
you're comfortable
enough. For example,
you could rest your head on a pillow, rather than your
arm.

2. Cradle hold (same arm)- holding

your baby across your lap, 2. Hold your baby sitting up, in your lap or across your
supporting her with the same arm as knee. Support your baby's chest and head with one
your breast. hand by cradling your baby's chin in the palm of your
hand. Rest the heel of your hand on your baby's chest,
but be careful to grip your baby's chin, not the throat.
3. Cradle hold Use the other hand to pat your baby's back.
(opposite arm)-
holding your baby
across your lap, using
the opposite arm to
the breast she is
feeding from to
support

4. Rugby ball hold- holding
your baby underarm. You
can lay your baby on a
pillow and gently support
her neck in this position.
3. Lay your baby on your lap on his or her belly.
Support your baby's head and make sure it's higher
than his or her chest. Gently pat your baby's back.

5. Twins hold- using a

cushion under your
babies as you gently
support them with your
hands on their upper
backs.

6. Koala hold- supporting 6. list common problems in breastfeeding

your baby while she's
straddled across your knees
● Breast Engorgement
in an upright position.
○ This is due to exaggerated normal
venous and lymphatic engorgement of
the breast which precedes lactation.
● Clogged Duct
7.Laid-back breastfeeding ○ This is due to an occlusion that has
(biological nurturing)- occured in the ducts where milk passes
semi-reclined, with your through. The clogged duct prevents milk
baby lying across your from passing through or the secretion for
stomach or shoulder. milk is slower.
Read more about how to ● Cracked Nipple
do laid-back ○ This is due to the loss of epithelium with
breastfeeding. the formation of raw area on the nipple;
Fissure is either at the rip or at the base
of the nipple.
8. Laid-back breastfeeding ● Sore Nipples
after a caesarean-Semi- ○ Any persistent pain in the nipples that
reclined, with your baby can last throughout the breastfeeding
lying vertically on you across process or in between feedings.
your shoulder, to protect ● Mastitis
your caesarean wound. ○ This is due to a breast infection that can
be a result from clogged ducts,
engorgement, or cracked nipples.
● Poor Milk Production
○ This is due to hormonal imbalances and
short or infrequent feedings.