Session 5.
How breastfeeding
works
5/1
© UNICEF/UN0202182
Session 5. Objectives:
How breastfeeding works
After completing this session, participants
will be able to describe:
• the parts of the breast involved in lactation and
their function;
• the physiology of the lactation hormones;
• the physiology of breast-milk production and
flow;
• the difference between good and poor attachment
of a baby at the breast;
• the FOUR KEY POINTS OF ATTACHMENT;
• the suckling action of the baby when well attached
or poorly attached. 5/2
Anatomy of the breast
Oxytocin makes
Muscle cells them contract
Prolactin makes
Milk-secreting cells
them secrete milk
Ducts
Large ducts
Nipple
Areola
Montgomery’s glands
Supporting Alveoli 5/3
tissue and fat © Felicity Savage
Prolactin
5/4
© Felicity Savage
Oxytocin reflex
5/5
© Felicity Savage
Helping and hindering the oxytocin reflex
These help the These hinder
reflex the reflex
• Thinks lovingly
of baby
• Sounds of baby
• Sight of baby • Worry
• Touches baby • Stress
• Confidence • Pain
• Doubt
5/6
© WHO/Yoshi Shimizu
Signs and sensations of oxytocin reflex:
• a squeezing or tingling • milk flowing from her
sensation in her breasts breast in fine streams,
just before she feeds her if her baby comes off
baby, or during a feed; the breast during a
• milk flowing from her feed;
breasts when she thinks • pain from uterine
of her baby or hears the contractions,
baby crying; sometimes with a rush
• milk dripping from her of blood, during feeds
other breast, when her in the first week;
baby is suckling. • slow deep sucks and
swallowing by the
baby, which show that
breast milk is flowing
into their mouth. 5/7
Inhibitor in breast milk (FIL)
If breast remains
full of milk,
secretion stops.
5/8
© Felicity Savage
Attachment to the breast
© Felicity Savage
5/9
Notice the arrow
5/10
© Felicity Savage
Good and poor attachment
• What do you observe?
1 2
5/11
© Felicity Savage
Attachment: External appearance
• What do you observe?
1 2
5/12
© Felicity Savage
Good attachment
• More areola is visible above the baby’s mouth
than below
• The baby’s mouth is wide open
• The lower lip is turned out
• The chin is touching the breast (or nearly so)
5/13
Poor attachment
• Less areola is visible above the baby’s mouth
than below (you might see equal amounts of
areola above and below the mouth)
• The mouth is not wide open
• The lower lip is pointing forward or turned in
• The chin is away from the breast
5/14
Results of poor attachment
• Painful nipples
• Damaged nipples
• Engorgement
• Baby unsatisfied and
cries a lot
• Baby feeds frequently
and for a long time
• Decreased milk
production © Felicity Savage
• Baby fails to gain weight
5/15
Reflexes in the baby
Rooting reflex
When something touches
the lips, the baby opens
the mouth and puts the
Skill tongue down and forward Sucking reflex
The mother When something
learns to touches the palate,
position the the baby sucks
baby
The baby Swallowing
learns to reflex
take the
When the
breast
mouth fills
with milk, the
baby 5/16
© Felicity Savage
swallows
