BREAST MILK and BREASTFEEDING - Nursing Services
Breast milk is nature's miraculous gift to the babies. It is a good and excellent start for the life. Breastfeeding is one of the most beautiful experiences that mothers will experience throughout their lives.
All mothers want to feed and grow their babies in a healthy way. Naturally, babies are fed in in balance and adequately the womb via the placenta While, after the delivery feeding of babies in balance and adequately is provided by breast milk Breast milk is an excellent source of nutrition that meets all the needs of the baby solitarily in the first 6 months and provides the establishment of emotional bond between the mother and their babies. It contains nutrients that provide the healthy growth and development of the babies completely and balanced. In addition, it contains many substances that protect the baby from infections (intestinal infections, ear infections, pneumonia, etc.). Therefore, it is very important to feed the babies only with breast milk for the first 6 months and to maintain breastfeeding up to 2 years together with nutrition with supplemental foods after 6 months. Feeding with breast milk provide the babies to be healthy adults in later years in addition to provide them healthy growth and development. In short, the way of being healthy adults is closely related to nutrition in infancy. In today’s conditions, any food equivalent to breast milk still has not been produced.
Most of the baby formulas are tried to resemble the breast milk, but none of these foods has nutritional properties that breast milk carries. The baby formulas we use today are food that should be thought in case of the lack of breast milk.
Benefits of breastfeeding for mothers and babies;
- Breast milk contains all of the nutrients (protein, fat, carbohydrates and minerals) at sufficient quantity that provide healthy growth and development of your baby.
- It is easy to digest. It is always ready for babies; it is hygienic, easy to prepare and low cost.
- Breast milk protects your baby against many bacterial and viral diseases such as otitis, intestinal infection and lung infection.
- Allergic diseases such as asthma and eczema are less common in breast-fed babies.
- Furthermore, Sudden Infant Death Syndrome (SIDS) is also detected less frequently in breast-fed babies.
- Childhood obesity. advanced age heart diseases, diabetes and cancer are less common in breast-fed babies.
- It has been shown that cognitive functions, IQ and visual functions of breast-fed babies at school age are higher.
- Jaw and dental health of breast-fed babies are affected in a positive way with the sucking reflex.
- Breastfeeding ensures the establishment of an emotional bond between mothers and babies. Breastfed babies are crying less.
- Breastfeeding mothers recover more quickly after delivery. Postpartum hemorrhages are less. The reinstatement of the uterus occurs easier.
- Breastfeeding mothers lose weight easily because they burn calories more.
- Breastfeeding prevents to become pregnant again by delaying the onset of menstruations. (However, it is not a method used for birth control)
- Breastfeeding protects mothers against the risk of ovarian and breast cancer.
- It ensures their bone density to be better. It prevents bone fractures.
- The mother should certainly wash her hands and pay attention to the hygiene.
- The mother should be in a comfortable and calm environment before beginning to breastfeeding. Breastfeeding may not be successful in crowded and noisy environments or in conditions where mother feels nervous.
- The mother should seat in a comfortable place, because breastfeeding is a long lasting process; her armpit and back should be supported with pillows if necessary.
- The face and body of the baby should be facing to the mother, his/her body should form a straight line, the mother should keep her baby close to herself. The more the mother and the baby are close to each other, the easier for the baby to catch the breast
- The mother should place the head of the baby to her elbow and she should support the baby’s body with her arms. The mother will be providing control of the head of her baby by placing the baby’s head to her elbow and it will be easy for the baby to catch the nipple especially by bringing the baby’s mouth and the mother’s nipple face to face in an appropriate manner.
- The mother should grasp her breast in C-Letter shape and should make the breast convenient to enter the baby’s mouth by supporting over with her thumb.
- Then, the mother should wait for the baby to open his/her mouth large open by rubbing her nipple to her/his lips; and she should place her breast into the baby/s mouth at the time that the baby opens his/her mouth large open. The baby must be provided to grasp the nipple of the breast with the black part around it as far as it enters.
- His/her mouth should be large open,
- His/her lips extrovert,
- His/her jaws should be in a shape touching to the breast,
- Black part surrounding the nipple (areola) should be seen less in the lower lip compared to the upper.
- The nipple should be seen healthy at the end of breastfeeding.
- The proper catch of the baby will ensure him/her to get enough milk, as well as prevent damaging of the mother’s nipples. Therefore, informing the mothers before breastfeeding and checking whether appropriate position is given to the baby during breastfeeding or not are very important.
- Correct and incorrect positions of breast holding are seen in the figures below.
Benefits for mothers;
Breast Milk Formation
Breast tissue consists of nipple, black parts surrounding the nipple called areola vesicles that produce the milk, milk ducts that provide milk to move towards the nipple and supportive tissue. Breast milk is produced by special cells found in the milk vesicles. Produced milk is moved towards the nipple through the ducts and is accumulated in sinuses (lactiferous
sinus). These sinuses are located right beneath the dark colored part called the areola surrounding the nipple. This dark colored part is very important in breastfeeding the babies. The baby must take all of this black part (areola) into the mouth with the nipple in order to get enough milk and to prevent any damage to the mother’s nipple. If the baby cannot be able to hold the breast property, he/she cannot get enough milk and gain sufficient weight as well as
breastfeeding cannot be done at a sufficient level as pain and wounds are formed in the mother's nipple.
Hormonal Control of Milk Production
Some nerve impulses occur from the nipple when the baby starts sucking the mother’s breast. These impulses enable the release of hormones providing milk production and producing milk to move towards the nipple throughout the milk ducts, from a specific region of the brain. The hormone prolactin, which produces milk is released after each feeding: provides milk production for the next breastfeeding by increasing to the maximum level within 30 minutes. The baby to start breastfeeding in the first 30-60-minute after
delivery and breastfeeding the baby very frequently in the first hours / days provide more secretion of prolactin and more production of milk Therefore, to start breastfeeding the baby as soon as possible after birth and breastfeeding the baby at very frequent intervals in the first hours / days will increase the amount of breast milk. During this period,
sometimes mothers breastfeed less due to the concern of not having enough breast milk or sometimes feed their babies with baby formula clue to the fear that their baby stays hungry.
That condition creates a vicious circle by leading to further delay of the increase of breast milk. Sometimes, it also leads to a complete cessation of milk Briefly, the earlier and the more often that the mothers breastfeed their babies, the more they have breast milk. Apart from that, the hormone Prolactin is secreted more especially in breast-feeding at night. Likewise, not to breastfeed the babies at night and to leave breastfeeding at night with the ideas such as “Let’s give some baby formula and let the baby to spend a comfortable night by sleeping” will result for the reduction of breast milk.
Another hormone that controls milk production is Oxytocin. Oxytocin enables the produced milk to be transferred to the milk vesicles beneath the areola along the milk ducts.
The milk vesicles beneath the areola are continuously discharged as the baby sucks the breast, while oxytocin hormone, which is secreted with the suction of breast by
the baby, provides the milk vesicles to be full again and again. So, the baby gets enough milk The transfer of breast milk towards the milk vesicles through Oxytocin hormone is called “Milk Down Reflex”. Sometimes, mothers feel this 2-3 week after the delivery in the form of tingling, numbness, burning may be felt in the breasts. Milk flow from the other breast during breastfeeding or continuation of milk flow from the breast at the end of breastfeeding can be observed. Also, the mother can feel sense of thirst and abdominal pain with contractions in the uterus. But, it is also normal that sometimes the mother does not feel anything in the flow down of milk. Oxytocin hormone is a hormone secreted before starting breast-feeding and during breast-feeding. Especially mothers thinking their babies before breastfeeding hearing their sound, smelling their odor, touching them lead to the release this hormone. Mothers recognize milk drops coming from their breast. But if the matter has a pain, is in an uneasy atmosphere and feeling anxious; this hormone is inhibited and milk flow may come to the stopping point Giving support to mothers about breastfeeding during this period will help to increase the milk flow again.
Reflexes of Newborn Baby
Reflexes are the movements of the living creatures made as unconscious in certain cases. Newborn babies are also born with certain reflexes. These reflexes are movements made as instinctive that help the babies to be fed by breastfeeding and provide their survival. These are seeking for milk sucking and swallowing.
In seeking reflex; the babies generally turn their heads towards the direction that anything touches to their cheeks, edges of the lips or jaw. open their mouth and try to find the breast by extending their tongue forward and downward. Mothers observe when they take the baby to their arms that they open their mouth at the beginning of breastfeeding when nipples touch the baby/s lips, turn their head towards the breast and extend their tongue forward. So, the baby is ready for breastfeeding. Seeking reflex is important at the beginning of breastfeeding and in particular during the holding of the breast by the baby.
While in sucking reflex; the babies start sucking as a reflex when anything touches their palates. This reflex is active from week 28 of the pregnancy. Sometimes, families see in the ultrasound examinations during pregnancy that babies suck their fingers in the womb. This reflex is present even the babies are born premature, and many babies do this instinctively. Swallowing reflex occurs when the baby’s mouth full of milk after suction starts. Babies continue their feeding by sucking, swallowing and breathing in a coordinated manner at the same time. Babies can usually achieve this from the week 32-35 of the pregnancy.
When the breastfeeding process starts, these reflexes, which are naturally had by the baby, to be healthy is very important in terms of the initiation and continuation of breastfeeding.
These reflexes, which are needed for breastfeeding, will be weak in babies that are born premature or sick due to any reason. This condition will affect breastfeeding. Apart from
that, if the baby is being full, that can sometimes prevent the occurrence of these reflexes and the baby may prefer to sleep because he/she is full. In this case, mothers are often concerned but the baby will definitely make these reflexes again when he/she is hungry again. Apart from that, the nose of the baby can sometimes become blocked. In this case. performing sucking swallowing and breathing procedures at the same time in a coordinated manner will be difficult for maintaining breastfeeding. It will be useful to open the nose of the baby with salty water called physiological serum and moisten the room that the baby sleeps for maintaining breastfeeding. Because, performing suction procedure is difficult for the baby with a blocked nose.
Correct Breastfeeding Techniques and Positions Holding of the Breast by Your Baby
Although breastfeeding is a natural process. Most of the mothers are faced with many problems in giving position to their babies, latching the nipple and breastfeeding during this period. Therefore, informing mothers about breastfeeding during pregnancy is very important in the realization of successful breastfeeding. If the mother encounters some problems during breastfeeding in the first hours and days, her breastfeeding desire reduces and continuation of breastfeeding becomes difficult. In short, a few support which will be given the mothers prior to and during breastfeeding will solve all problems. The mother must be shown and taught how to position the baby and how to latch the nipple. The baby to hold the breast in an effective and accurate way will ensure him/her to get enough milk and the nipples of
the mother will not be damaged.
It is very important for the baby to follow the following steps
briefly in latching the breast.
When the baby catches the breast correctly;
Sometimes, it becomes quite difficult for the baby to catch the breast due to some factors of the mother or the baby. In this case, the mothers should be explained and shown that the baby can also hold the breast in other positions. The mother should choose the most comfortable position for her from these.
Positions of the baby for holding the mother’s breast;
I. Cradle Hold: This position is the most frequently used position. it is the classical breastfeeding position. Many mothers are feeding their babies by holding them in this way. Mothers place their babies to their breast in the way we described above.
2 Football Hold: Breastfeeding of the babies’ football position may be used usually in babies that have catching problems, born early and small, twins; if the mother’s breasts are big or there is pain in the abdomen of the mother due to Caesarean section.
In this position, the mother sits in a comfortable position. A pillow is placed on the side of the mother in order to support her elbow and the baby’s legs. The baby is laid on the pillow next to his/her mother in a form that his/her head is in the palm of the mother and his/her legs extends under the arms of the mother. Thus, the mother controls the baby’s head better and observes whether the baby catches the breast well or not
3. Cross-cradle Hold: Cross-cradle hold is used if the baby has catching problems or was born early and small. The mother can observe the baby holding the breast better in this position. The mother takes her baby in her lap while sitting in a comfortable position. She embraces her baby with the arm on the opposite side of her breastfeeding breast. She holds her baby close to her body and ensures him/her to hold the breast in C-shape by using her hand on the side of her breastfeeding breast.
4. Side-lying Hold: Breastfeeding by lying in bed may be preferred in cases where the mother has pain after Caesarean section or too tired. The head and back of the mother are supported by a pillow. The mother lies by turning to her side. The baby’s face will be turned to his/her mother’s breast. The mother grasps her arm behind her baby/s shoulder and brings him/her closer to her body. The mother ensures her baby’s breastfeeding by supporting her breast with her other hand.
The babies are active and awake within the first minutes after birth, and they are ready for breastfeeding. Therefore, the baby must be breastfed by his/her mother as soon as possible (30
min-l hour) after birth. To start breastfeeding by bringing the mother and the baby together as soon as possible after birth is the first step for successful breastfeeding. Then, the babies must be breastfed at any time that they show signs of hunger (seeking, licking crying) without distinguishing day or night. Many babies want to be breastfed at least 8 to l2 times in 24 hours. So, it is very important to breastfeed the babies once in every 2-3 hours by bringing to the breast of the mother for increasing the breast milk as well as for the baby getting enough milk. However, it will be observed that the babies want to be breastfeed a lot more often in the first hours / days after birth. It is normal that they want to be breastfeed too often because breast milk does not increase in the first 48-72 hours after birth and the capacity of the baby stomach is less in the first days. Making the baby full by giving additional food by the mother with the fear of remaining her baby hungry will further delay the increase of breast milk Giving additional food again because of not increased breast milk creates a vicious cycle. Therefore, breastfeeding the babies in the early days at any time that they want with patience is very important in terms of the continuity of breastfeeding and increase of breast milk.
The time that the babies remain on the breast during breastfeeding is quite different. Usually the babies leave the breast of his/her mother as satisfied when they are full. Average breastfeeding time is l5-20 minutes. But it is observed that the babies want to stay on the breast much longer in the early days, when breast milk is not fully increased yet. During this period, it is appropriate to breastfeed around 30 minutes with each breast to particularly avoid damage in the nipples of the
mother and pass to the other breast if the baby still wants to be breastfed afterwards. Sometimes breastfeeding duration may be shorter or longer than usual. it must be checked whether the meter is breastfeeding her baby correctly or not, if breastfeeding duration is shorter than 4 minutes or longer than 30 minutes at one breast and the baby wants to be breastfed at shorter intervals than H .5 hours (except the first 2-3 days). Generally, the expected thing is the baby sucking the breast until satisfaction and leave the breast by himself-herself after the end of breastfeeding.
ls Breast Milk Enough or Not
Many mothers are caught up in concern of their babies are not getting enough milk in the breastfeeding process. Many mothers want to feed their babies with baby formula or to see how much milk is given with her eyes by milking in order their baby not to stay hungry with this concern. In addition, the mothers often think they do not provide enough milk to their babies, who naturally want to be breastfed and cry very frequent during the first days. with the pressure exerted by the elders of the families in the direction of that the baby is hungry. But, the baby receiving enough milk in the real sense is actually prevented as a result of these faults. The decision of whether the babies are getting enough milk or not can be given by looking at the baby’s body weight the number of daily urination and defecation, the status of the mother’s breast. Usually, the babies lose weight up to l 0% of their body weight in the first 5 days after birth. So. it is normal that a baby born in 3000 g weighs 2700 g on the 5th day. They start to gain weight again alter this loss, and they reach to birth weight on the 10th day. Their weight shows steady increase after the 10th day. If the body weight of a baby shows an increase of 140-210 g per week or 600 g per month (20-30 g daily) and over, then breast milk is thought to be sufficient The number of urination and defecation can also give idea whether breast milk is enough or not it is normal that the breastfed babies urinate l-2 times and defecate l-2 times per day in the first 2-3 days because the first colostrum is in a little amount but with dense content. Starting from the 1st week with the increase of breast milk in the coming days, urination of 3-5 times and defecation of 5-6 times per day may also indicate that the baby get enough milk by considering daily changes. In addition, difference in the swelling of the mother’s breasts before and after breastfeeding pain in the nipples and breasts with non-pathological swelling alter breastfeeding can give an idea about the milk that the baby gets. If the baby does not gain enough weight, breastfeeding techniques should be checked, and factors of the mother and the baby in breastfeeding should be investigated. As a result, to start breastfeeding your baby as soon as possible (30-60 minutes) after birth. to feed only with breast milk in the first 6 months and to continue breastfeeding together with additional foods after 6 months up to l -2 years are the best for your baby.
Breast care must be elaborated for a healthy breastfeeding. In recent years, it is known that to keep the breast clean and dry is sufficient for breast care. Natural oils in the nipple and breast milk are protective for the nipple. To leave the nipple and areola to dry after applying a few drops of breast milk after the baby finished breastfeeding is sufficient for breast care. Moreover, ensuring breast care can be continued by using natural protective breast creams (by applying to the nipple and areola as a thin layer). Daily shower is sufficient for nipple cleaning. To clean the nipple with alcohol, carbonated water or soap is definitely not recommended because it will cause the drying of the skin and the formation of the cracks. To leave the nipple to dry after each breastfeeding, to use cotton underwear to support the breast and to use breast shields to prevent irritation would be right approaches.
PROBLEMS ENCOUNTERED DURING BREASTFEEDING IN THE FIRST DAYS
Pain in The Nipples
It is normal for the mother to feel pain in her nipples during breastfeeding in the early days. These complaints will disappear in a few days. The most common cause of pain in the nipples is caused by not positioning the baby to the breast well. And improper latching of the breast by the mother. Sometimes the pain can be so severe that the mothers even think about quitting breastfeeding it should be explained to the mothers that this situation is temporary and can be overcame with appropriate breastfeeding techniques.
-The mother should locate the baby to her breast well and try to breastfeed with correct technique.
-The baby should be waited to leave the breast spontaneously at the end of breastfeeding or the mother should remove her breast by inserting her finger in to her baby’s mouth.
-In addition, breast care should be elaborated.
Cracks and Wounds in The Nipples
Wounds and cracks occur in the breasts of many mothers during breastfeeding. Cracks in the nipples are conditions that mothers suffer from and affects breastfeeding process
negatively. The most important causes of the cracks in the breast are caused by improper latching of the baby to the breast and not performing breast care properly.
-The baby should be placed to breast well and tried to be breastfed in accordance with breastfeeding technique. Feeling pain during breastfeeding is an indicator that the baby has held the breast wrong. If the mother is feeling pain while her baby is breastfed. her breast should be removed from the mouth of her baby properly and her baby should be latched to the breast again with correct technique.
-The baby should not be allowed to stay on a breast for more than 30 minutes during breastfeeding. Because, this will lead to further increase of the cracks. The baby should be transferred to the other breast after 30 minutes.
-The baby should be waited to leave the breast spontaneously at the end of breastfeeding or the mother should remove her breast by inserting her finger in to her baby’s mouth.
-The breast should be kept dry between breast feedings and breast care should be elaborated.
- Shields protecting the nipples should be used for the nipples instead of pads in necessary cases.
Inverted or Flat Nipple
It is a normal situation to experience difficult in breastfeeding in the early days due to nipple problems. During this period, many mothers may think that they cannot feed their babies clue to nipple problems. In fact, the size of the mother’s nipple is not important for breastfeeding. Collapsed, flat or short nipple does not affect the suction of the baby. Because, babies are not only sucking the nipple during breastfeeding, but also get most of the areola, dark surrounding part, into their mouth. The important thing is to place and breastfeed the baby in accordance with the breastfeeding technique. Besides, the nipples will protrude with the suction of the baby in the time.
-Breastfeeding should be started at the time that the baby is active.
-The mother should be supported at the time when her baby has difficulties in grasping the breast and gaining the confidence of the mother should be provided.
-The mother should be assisted during breastfeeding: the baby should be provided to grasp the breast in different positions.
-The baby should be provided to get not the nipple. But also almost all of the areola tissue into his/her mouth during latching the breast
-The areola surrounding the nipple should be made massage by pulling out gently via holding with two fingers before beginning breastfeeding and the nipple should be ensured to protrude forward in the way that the baby can latch easier.
-The nipple to protrude forward should be ensured by using various apparatuses that protrudes nipples and milking pumps before breastfeeding and the latching of the breast should be facilitated for the baby.
Swelling in the Breasts
Excessive swelling in the breasts occurs within 48-72 hours after birth as a result of excessive secretion of milk. Although the mothers perceive this situation as a disorder, in fact it is an indication of milk production. The mothers feel this as pain in their breasts, increased temperature and tension towards under the armpit Sometimes excessive hardening of the breasts grates the mothers and affects the breastfeeding process negatively. The nipples may flatten as a result of over-filling of the breast and the latching of the breast by the baby becomes more difficult. If the baby is not emptying the mother’s breast sufficiently, the milk accumulation gradually increases in the breast of the mother. Consequently, undesired problems such as breast milk fever or mastitis occur. Therefore, help should be received from breastfeeding specialists if the swelling in the breast is not reduced within 48 hours.
-The baby should be placed to breast correctly and breastfeed in accordance with correct technique.
-The baby should be breastfed often and emptying of the breast should be provided.
-If the breasts are still full after the baby is breastfed, the breasts should be emptied by milking several times during the day with the help of a milk pump.
-An amount of milk should be milked by the hands or with the help of a pump if the nipples are flattened clue to very high tension as a result of excessive filling of the breast, and the latching of the baby to the breast becomes difficult Thus, the nipples should be softened and the baby should be provided to latch the breast.
-The mother to have a hot shower, applying hot to the breasts and to make massage towards the nipples before breastfeeding will facilitate emptying of the breast.
-It will be also beneficial to perform cold application between breast feedings in order to reduce pain and edema.
Breast Milk Fever
If the excessive milk in the mother’s breast is not emptied at a sufficient amount in the early days. the mother’s fever will increase as a result of the milk mixed to the mother's blood. This situation, called breast milk fever, usually continues for 24 hours. Emptying the milk accumulated in the breast will prevent breast milk fever.
-The mother should breastfeed her baby more often, and her breast milk should be emptied by milking if feeling of fullness is continuing after breastfeeding.
-The fever of the mother will usually spontaneously relieve by emptying of the milk.
-A physician should be consulted if the fever of the mother lasts more than 48 hours.
Milk Duct Blockage
The milk in the breast is carried to the nipple via fine channels. Pain, stiffness and redness together with lumps reveal in those regions as a result of the blockage of these ducts. Duct blockage is caused by the failure of emptying milk from the breast sufficiently. Not to breastfeed the baby often, to keep the duration of breastfeeding short, not to place the baby to the breast well. not fully emptying the breast after breastfeeding to wear underwear that apply pressure would cause milk duct blockage.
-The mother should use appropriate underwear.
-The baby should be placed to the breast correctly and tried to be breastfed with correct technique.
-The breast with duct blockage should be breastfed at frequent intervals and massage should be applied during breastfeeding. The breasts should not be strained during the massage.
-Hot application should be performed in order to facilitate the milk flow.
-The baby latching the breast in different positions (in the way that the baby’s chin is on the side of the blocked duct) will provide the opening of the blocked duct.
Mastitis (breast inflammation)
Mastitis is the inflammation of the breast tissue. Pain, swelling, redness occurs in the breast tissue, and the mother's fever increases. The affected breast is red, hard and hot when touched. Mastitis usually occurs within the first 2-3 weeks. Milk accumulation occurs because of the milk not emptied in an adequate amount due to inadequate breastfeeding of the baby. long breastfeeding intervals, not placing the baby to the breast appropriately or the mother wearing underwear
that applies pressure. Breast inflammation is formed as a result of microorganisms entering into the accumulated milk through the cracks in the nipple of the mother.
-There is no harm of breastfeeding from the breast with mastitis for the baby.
-The baby should be placed to the breast and breastfed frequently (once in every 2-3 hours). In necessary cases, the baby should be breastfed in different positions and emptying of the milk should be provided.
-Breastfeeding should be started with the unaffected breast first Thus, the milk flow is guaranteed to be better from the breast with mastitis by activating the Oxytocin reflex.
-The excess milk in the breast should be emptied after breastfeeding if available.
-Massage and hot must be applied to the breasts before breastfeeding in order to reduce the edema in the breasts, and facilitate the milk flow. The breasts should not be strained during the massage.
-Analgesics and antibiotics should be used upon the advice of a physician.
-To provide resting of the mother and breast care must be taken care of in the period that the mother is with mastitis.
Breast abscess may occur if mastitis (breast inflammation) treatment is not performed properly. Abscess is a quite painful situation and forms swelling, redness and a fluid-filled mass in that region. An abscess developed in the breast should be discharged by performing a surgical procedure or needle aspiration. Meanwhile, antibiotic treatment must certainly be continued.
MILKING AND STORAGE OF BREAST MILK
The mother may need to milk her breast milk after birth in certain cases.
If the baby was born premature. with low birth weight the mother and the baby will stay separate for any reason, or the baby is needed to be fed inpatient in the neonatal unit, the mother should milk her breast milk. Other than that, breast milk should be milked due to problems encountered
during breastfeeding in the early days (excessive filling of the breasts, problems encountered in the nipples, milk duct blockage, flat nipple, mastitis, etc.). In addition, milking the breast milk may be considered if the baby is not able to latch the breast and refusing the breast or the mother is returning her job in the early period. Milking procedure of breast milk manually or with the help of the milk pump is sufficient to be performed at intervals of 3 hours during the day. and 4-5 hours at night
The mother should sit in a comfortable place that can support her back and arms in order to facilitate the milking procedure before starting milking the breast milk The mother drinking
a hot drink to take pictures, clothes, toys and etc. that will remind her baby before, will facilitate the milk flow by providing relaxation of the mother.
Massage should be done to the breast first in order to ensure the movement of the milk accumulated in the breast towards the nipple. The breasts are stroked gently with circular
movements using palms after washing hands. The massage is terminated towards the nipple starting from different points such as under the shoulder, the armpit and the lower part
of the nipple.
To have a shower or put a pre-heated towel on the breast to make massage to the breast. to lean forward increases the milk flow during the milking procedure.
-Hands should be washed before beginning the milking procedure.
-The thumb is kept on top and the index finger at the bottom during milking the breast.
-The target region is the area behind the brown region around the nipple (the sinuses behind areola will be felt).
-Thumbs and index fingers are gently pressed inwards, towards the chest wall. Utmost care is taken not to press more. Otherwise, milk ducts may be blocked.
-The milk is pushed towards the nipple by pressing the areola with fingers. The nipple should never be pressed.
-The relaxation of the breast is provided by emptying by rotating the hand around the breast during the milking procedure.
-Pain should not be felt during milking procedure. If pain is felt, the applied technique is faulty.
-Milking should be repeated in a rhythmic way.
-The manual emptying time of the breasts should be 20-30 minutes.
Milking with Pump
Milking pumps with different features may be used in the milking process of the breast milk with a pump. The pump that will be eligible to mother should be selected from electrical, battery-operated, single or double products. Milking kit is placed hermetically to the nipple. Initially start with low pressure. then increase gradually. Milking a breast for averagely 10-15 minutes is sufficient All parts of the pump should be washed and sterilized after milking is finished.
BREAST MILK STORAGE CONDITIONS
-The amount of milk to be consumed by the baby at one time should be placed in containers (usually 60- l 20 cc). Breast milk milked at different time intervals should not be mixed.
-Date and time should be written on milked breast milk.
-The milk with the oldest date should always be used first.
-The milk should be stored in the refrigerator until use.
-Milked breast milk can be stored for4 hours in the cool part of the room, 72 hours (3 days) in the shelf of the refrigerator and 6 months in the deep freeze (-18° C).
MELTING AND HEATING FROZEN BREAST MILK
The milk stored in the deep freeze is provided to melt by putting in the bottom part of the refrigerator first. After melting the amount of milk that will be given to the baby should be placed into a bottle and heated in boiled and warmed water (water bath method). The heated milk should
be given to the baby after controlling the temperature of it Breast milk must never be heated on the stove or in the microwave oven. Melted / heated milk must never be frozen again and the remaining portion of the milk should not be used again. Melted breast milk may remain for 24 hours. The melted milk must never be frozen and used again after 24 hours.