Breastfeeding

Chapters:

Watch video only

Introduction0:00–0:52

Breast milk is pretty amazing; it has all of the nutrients that a baby needs in the first six months of life. The benefits for the baby are impressive - they include lower rates of allergies, ear and lung infections, obesity, and sudden infant death, as well as healthier weight gain, and other long-term outcomes.
That’s compared to infants given cow-milk formula. Moms can benefit from breastfeeding, too.
It reduces uterine bleeding, burns calories, and decreases the risk of breast, ovarian, and uterine cancer, as well as osteoporosis, arthritis, type II diabetes, and heart disease.
Finally, breastfeeding is free and offers mothers and babies a valuable opportunity to bond from the very first skin-to-skin contact—which should start minutes after birth.To understand breastfeeding, let’s start with the breasts themselves.

Breast Tissue0:52–0:52

Breast Tissue0:52–1:41

Breast tissue develops during puberty, and is made up of adipose or fat tissue, as well as glandular tissue that makes the milk, and lactiferous ducts which serve as passageways which guide the milk to the nipple.
Zooming in on the glandular tissue, there is the alveolus, which is a modified sweat gland made up of alveolar cells which actually make the breast milk.
Wrapping around the alveolus are special myoepithelial cells that squeeze down and push the milk out of the alveolus, down the lactiferous ducts, and out one of the pores on the nipple, at which point it enters the baby’s mouth.
When the breasts are full of milk they can get heavy, and there are suspensory ligaments called Cooper’s ligaments which help to hold them up against the chest wall.

Pregnancy Changes1:41–2:30

During pregnancy the placenta releases human placental lactogen and progesterone, and the anterior pituitary gland releases prolactin, and all three of these hormones stimulate the growth of more glandular tissue and prepare the alveolar cells to produce milk.
However, even though the breasts are capable of making milk by mid-pregnancy, the high levels of progesterone associated with pregnancy prevent milk letdown.
So during pregnancy, the breasts don’t release milk, except for some occasional leakages from the nipples. Overall, the breasts enlarge, the area around the nipple, called the areola, begins to darken, and the areolar glands, also called Montgomery glands, which look like bumps on the areola, start to produce lipoid fluid which moisturizes the nipple.

Colostrum2:30–3:07

Once the baby’s delivered, though, the placenta, or afterbirth is also delivered, so placental progesterone disappears, and milk begins to flow.
Initially, though, the breasts don’t actually make milk, they make colostrum, which is a yellowish fluid that’s rich in immune cells and antibodies, but low in fat.
Colostrum coats the baby’s gastrointestinal tract and has a laxative effect, which helps the baby pass the first stool which is called meconium.
Within a few days after delivery, the breasts start producing milk which, relative to colostrum, has a much higher fat content.

Breastmilk Composition3:07–4:08

In fact, the amount of fat in the milk also varies during a feeding session. When milk is sitting in the breast, fat globules stick to the alveolar walls, rather than moving into the lactiferous ducts.
So when a baby begins feeding and drinks the milk that was in the lactiferous ducts first, that milk has a relatively low fat content.
The process of feeding, though, increases the milk flow, and those fat globules get swept into the lactiferous ducts, causing the fat content of the milk to steadily increase as the feeding session continues.
Breast milk also contains lactose, vitamins, micronutrients, and various proteins, like casein and maternal antibodies. Most importantly it contains secretory IgA, which supplements the baby’s gastrointestinal immune system.
The amount of vitamin D in the breastmilk is typically insufficient for bone health, and this is because of the modern, mostly indoor life of newborns, so often supplemental vitamin D is needed.

Milk Letdown4:08–5:22

Now, milk letdown is a conditioned reflex, and it usually starts with a baby latching and sucking on the breast. A good latch is one in which the baby’s mouth is wide open, covering the areola with the lips flanged out, the nipple up against the roof of the mouth, and the baby’s tongue up against the bottom of the areola.
Mechanoreceptors in the nipple sense this stimulation and send a signal via intercostal nerves to the dorsal root ganglion, then via the spinal cord to the hypothalamus.
When the hypothalamus gets that signal two things happen: first, the hypothalamus blocks prolactin inhibiting neurons from releasing dopamine; which allows lactotrophic cells in the anterior pituitary to make prolactin.
Second, the hypothalamus stimulates a group of hypothalamic paraventricular cells to produce oxytocin, which is then sent down the pituitary stalk to the posterior pituitary, where it’s secreted.
Now, prolactin stimulates alveolar cell milk production, and oxytocin stimulates the myoepithelial cells to contract which pushes that milk into the ducts, a process called milk let-down.

Milk Production5:22–8:00

Interestingly, sometimes when a baby cries, the sound triggers a signal in mom’s brain and is sent to the hypothalamus to initiate the letdown reflex as well.
After delivery, mothers are able to produce more and more milk, and in the first week, the baby’s stomach starts to stretch out and goes from the size of a blueberry to a walnut.
While the baby’s stomach is small and the mother is making colostrum, it’s normal to see a dip in the baby’s weight, but typically no more than 7% of the birth weight, but by the second week of life, though, that weight’s usually completely regained.
These early weeks are critical to both the mother and the baby. During the first few weeks newborns feed about every 1-2 hours, and at maximum every 3 hours for about 8-12 feeds a day.
The first few months of breastfeeding after delivery are largely driven by prolactin. After those first few months, it becomes more mechanically-based where mom’s body produces the amount it needs to replace what was taken by the infant, meaning that it’s more supply-and-demand.
The most critical thing to establishing a stable long-term supply of breast milk is allowing the baby to frequently empty the breasts because that stimulates the glandular tissue to make even more milk.
After a good feeding, the breast typically feels soft and “empty” and the baby looks calm and relaxed. The reverse of this is also true, as an infant grows older and stops breastfeeding, the glandular structures involute or shrivel and the breasts stop producing milk.
For producing milk, a healthy, balanced diet is all that is needed to make high-quality breast milk, and although food can flavor milk there are no particular foods that should be avoided while breastfeeding.
A top concern for most mothers is being able to produce enough milk for a baby, and stress, some medications like decongestants, and dehydration can affect milk supply In general, the biggest impediment to establishing a good milk supply is the introduction of formula and not being able to regularly breastfeed, two issues that go hand-in-hand.
Fortunately, societal pressures are growing to make breastfeeding in public spaces more acceptable and manual or mechanical breast pumps make it easy to express milk and store it for later.
A breast pump can also help a mother increase her milk supply by helping to fully empty her breasts if there is some extra milkIn the early weeks, it’s normal for first-time moms to have some nipple sensitivity and discomfort.
Though it should not usually be severe and typically diminishes after the first few days. Occasionally, there can be nipple cracking, which are treated with topical creams or ointments.

Breast Latch8:00–9:04

Also, moms might experience breast tenderness from a blocked milk duct which typically improves with warmth and continued breastfeeding to keep the milk flowing steadily.
A shallow latch can also cause nipple soreness, cracking, and bleeding. This is because a shallow latch allows the sensitive nipple skin to press against the hard roof of the baby’s mouth.
A good latch places the nipple further back inside the baby’s mouth, where it is soft and flexible. This is achieved by making sure the bottom of the areola is in the baby’s mouth.
Since a good latch can make a huge difference when it comes to breastfeeding success, it’s important to try out different positions for both mom and baby to find one that helps the baby latch on well.
For contraindications to breastfeeding, maternal use of certain medications and illicit drugs like cocaine, heroin, and cannabis preclude breastfeeding altogether because they can harm a developing baby.
Alcohol is also thought to blunt the letdown reflex and affect the baby’s development because it gets into the breast milk, so alcohol should be minimized while breastfeeding.

Contraindications9:04–10:28

Breastfeeding should take place at least two hours after an alcoholic drink. Maternal smoking increases the risk of sudden infant death syndrome and infant respiratory allergy.
Even high-doses of caffeine can get into the breastmilk and alter the baby’s physiology. In addition, maternal infections like HIV are also a contraindication to breastfeeding in high-income settings, but might be appropriate in low-income settings where other factors such as the cost of formula and access to clean water are a serious challenge.
Remember, breastfeeding isn’t always easy: it can be exhausting, frustrating, and can be both emotionally difficult and physically uncomfortable.
And not every mother will choose to breastfeed for a variety of reasons. Ultimately, the most important thing for a baby is to bond with a happy, healthy mom.
So if breastfeeding is causing undue stress and anxiety, supplementing with a balanced formula can be a healthy alternative.
Alright, as a quick recap, breast milk is perfectly designed food for infants, and breastfeeding has benefits for both baby and mom.
During pregnancy, human placental lactogen, progesterone, and prolactin get the breasts ready for milk production and after birth, when progesterone goes away, prolactin and oxytocin, combined with the sucking reflex, establish and continue the production of milk.

Review10:28–10:55

is perfectly designed food for infants and breastfeeding has benefits for both baby and mom during pregnancy human placental lactogen progesterone and prolactin get the breast ready for milk production And after birth when progesterone goes away prolactin and Oxytocin combined with the sking reflex establish and continue the production