1. Session 3 PRODUCTION AND INTAKE OF BREASTMILK

2. Breast Anatomy - Structure 3/1

3. Prolactin Reflex Secretion continues AFTER feed to produce NEXT feed To increase milk productions 3/2

4. Oxytocin Reflex For milk ejection 3/3

5. Helping and Hindering the Oxytocin Reflex For milk ejection 3/4

6. Inhibitor in Breastmilk 3/5

7. Attachment at Breast 3/6

8. Mechanism of ‘Suckling Cycle’ 3/7

9. What Differences Do You See? Picture 1 Picture 2 GOOD ATTACHMENT POOR ATTACHMENT 3/8

10. What Differences Do You See? Picture 1 Picture 2 ATTACHMENT, OUTSIDE APPEARENCE 3/9

11. Consequences of Poor Attachment u Pain and damage to nipples Sore nipples Fissures u Breastmilk not removed effectively Engorgement Baby unsatisfied, wants to feed more Apparent poor milk supply Baby frustrated, refuses to suckle Breasts make less milk Baby fails to gain weight 3/10

12. Use of feeding bottle Inexperienced mother Functional difficulty Lack of skilled support before breastfeeding established for later supplements first baby bottle fed previous baby low birth weight and sick baby nipple poorly protractile large / flat nipple engorgement late start less traditional help and community support doctors, midwives, nurses not trained to help Causes of Poor Attachment 3/11

13. Feeding Reflexes in the Baby Rooting reflex When something touches lips, baby opens mouth puts tongue down and forward Sucking reflex When something touches palate baby sucks Skill Mother learns to position baby Baby learns to take breast Swallowing reflex When mouth fills with milk, baby swallows Gag reflex When something touches anterior part of the tongue, baby pushes it out. 3/12